Placental abruption is when the placenta separates early from the uterus, in other words separates before childbirth. It occurs most commonly around 25 weeks of pregnancy. Symptoms may include vaginal bleeding, lower abdominal pain, and dangerously low blood pressure. Complications for the mother can include disseminated intravascular coagulopathy and kidney failure. Complications for the baby can include fetal distress, low birthweight, preterm delivery, and stillbirth.The cause of placental abruption is not entirely clear. Risk factors include smoking, pre-eclampsia, prior abruption (most important and predictive risk factor), trauma during pregnancy, cocaine use, and previous cesarean section. Diagnosis is based on symptoms and supported by ultrasound. It is classified as a complication of pregnancy.For small abruption, bed rest may be recommended, while for more significant abruptions or those that occur near term, delivery may be recommended. If everything is stable, vaginal delivery may be tried, otherwise cesarean section is recommended. In those less than 36 weeks pregnant, corticosteroids may be given to speed development of the babys lungs. Treatment may require blood transfusion or emergency hysterectomy.Placental abruption occurs in about 1 in 200 pregnancies. Along with placenta previa and uterine rupture it is one of the most common causes of vaginal bleeding in the later part of pregnancy. Placental abruption is the reason for about 15% of infant deaths around the time of birth. The condition was described at least as early as 1664. Signs and symptoms
In the early stages of placental abruption, there may be no symptoms. When symptoms develop, they tend to develop suddenly.
The fetal prognosis is worse than the maternal prognosis; approximately 12% of fetuses affected by placental abruption die. 77% of fetuses that die from placental abruption die before birth; the remainder die due to complications of preterm birth.Without any form of medical intervention, as often happens in many parts of the world, placental abruption has a high maternal mortality rate. Mother
A large loss of blood may require a blood transfusion. If the mothers blood loss cannot be controlled, an emergency hysterectomy may become necessary. The uterus may not contract properly after delivery so the mother may need medication to help her uterus contract. The mother may develop a blood clotting disorder, disseminated intravascular coagulation. A severe case of shock may affect other organs, such as the liver, kidney, and pituitary gland. Diffuse cortical necrosis in the kidney is a serious and often fatal complication. Placental abruption may cause bleeding through the uterine muscle and into the mothers abdominal cavity, a condition called Couvelaire uterus. Maternal death. Baby
The baby may be born at a low birthweight. Preterm delivery (prior to 37 weeks gestation). The baby may be deprived of oxygen and thus develop asphyxia. Placental abruption may also result in death of the baby, or stillbirth. The newborn infant may have learning issues at later development stages, often requiring professional pedagogical aid. Epidemiology
Placental abruption occurs in approximately 0.2–1% of all pregnancies.