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Some complications can appear further along in pregnancy, with symptoms showing themselves around the third trimester. Placental abruption is such a complication. Simply put, a placental abruption is where the placenta separates from the uterus, causing distress for the foetus and a range of problems for the mother.
What is the placenta?
The placenta is a very important organ during pregnancy as it connects the developing foetus to the wall of the uterus. Aside from this, the placenta does the important job of transferring nutrients and oxygen from the mother to the developing baby as well as removing waste products and carbon dioxide via the mother's blood supply.
What goes wrong?
No one really knows what causes a placental abruption but sadly it occurs in one in 200 pregnancies, often occurring on or after the 20th week of pregnancy up until birth. A placental abruption happens when the placental lining comes away from the wall of the uterus causing bleeding. In turn the blood may gather and push the placenta further away from the uterus. With the placenta not in place the baby can be deprived of the important oxygen and nutrients that it needs. A placental abruption is the most common cause of bleeding in late pregnancy, although it can often happen without presenting obvious signs of bleeding.
How do I know if I'm having a placental abruption?
Symptoms of a placental abruption can be varied and although many cases are initially diagnosed due to vaginal bleeding during late pregnancy, often there is no obvious bleeding to pick up on. Other symptoms can include extremely high blood pressure, pain in or around the uterus or tenderness and swelling in the abdomen. Some women have experienced continuous contractions without any breaks where the uterus becomes enlarged. Another symptom is a change in the mother's appearance such as a sudden paleness to the skin on the face and hands.
What does it mean for my baby and myself?
Having a placental abruption during late pregnancy will have different effects on both mother and baby. Depending on how severe the case is, it can be quite dangerous for both. In simple cases, a placental abruption can mean a lack of essential nutrients and oxygen being transferred to the growing foetus, which may affect the baby's growth and development. In most cases an abruption can cause the foetus distress which may continue until delivery.
Once placental abruption occurs a baby may be born prematurely and need to spend time in the intensive care unit once born, often due to problems with breathing and feeding. There might also be rather low levels of oxygen in the blood after birth, which will need to be monitored. In more extreme cases, where the placental abruption is quite severe, the baby could suffer brain damage or may even die before or soon after delivery.
For the mother, the effects can also be complicated and need to be monitored. The loss of blood may see the need for a blood transfusion after delivery and the mother may have problems with blood clotting. For many, a large amount of pain may be experienced and there is a worry about the mother going into shock, which can then affect other important organs such as the liver and kidneys.
After delivery, the uterus may not contract properly, which will mean taking additional medication to encourage the placenta to contract and detach properly.
What might happen once I've been diagnosed?
A placental abruption is usually suspected when a mother has sudden pain or discomfort in the abdomen. It is often accompanied by vaginal bleeding. If you are affected by pain during late pregnancy it is always a good idea to check in with your doctor.
If a placental abruption is suspected you should be put under observation immediately. The fundus, which is the top part of the uterus, will be monitored closely as a rising fundus can show signs that bleeding is occurring even if no vaginal bleeding can be seen. You should be offered a routine ultrasound, which could rule out other problems such as a placenta praevia. This is where the placenta attaches to the uterine wall either close to, or covering the cervix. Placenta praevia is also a complication that can cause vaginal bleeding.
Treatment can depend on the amount of blood lost and how distressed the foetus may have become. If your pregnancy is less than 36 weeks along you may simply be monitored in hospital and asked to take it easy. However, in severe cases planning an immediate delivery may be the only option. In a small amount of cases a hysterectomy may be needed.
Can I avoid a placental abruption?
Sadly, there are no definite causes of a placental abruption, so it is hard to pinpoint what you can do to avoid such a complication. It is thought you are more susceptible if you have experienced an abruption before or have smoked or used drugs during your pregnancy. As with any pregnancy, staying healthy, taking it easy and keeping your blood pressure stable helps to minimise the chances of complications.