Placental abruption; a rare but grave complication

A woman has had a smooth pregnancy all along; she keenly adhered to clinic visits, an active baby has been performing all manner of somersaults in her belly then shortly before the due date, the doctor does not seem to detect a heartbeat! She did everything right yet she has to deliver a stillborn baby. While there are numerous issue-free births happening in the globe every day, for some women, the childbirth process is not as smooth.

What is placental abruption?

Placental abruption also known as abruptio placentae is a potentially life threatening situation that occurs when the placenta prematurely detaches from the uterus before the baby is born.

Ordinarily, the placenta is implanted in the upper region of the uterus and it detaches after delivery. The placenta is a critical organ that contains vascular networks responsible for providing oxygen and nutrients to the unborn baby. It also aids in clearing out the baby’s waste products.

When the vascular structures are compromised due to sudden stretching of the uterine wall, the less elastic placenta separates from the uterus as the blood vessels tear away.

The premature separation rids the baby of the life sustaining functions of the placenta and contributes to perinatal mortality and bleeding. “It is not a common condition. It is only that when it happens it has devastating results,” says Dr Tom Risa, a gynaecologist and obstetrician.

Why is it a concern?

Placental abruption is a deadly but relatively rare condition. “We do not have any local data that one can refer to,” says Dr Risa.

According to research published in PubMed, placental abruption occurs in about one per cent of pregnancies globally; meaning 1 in every 100 women may face complications of placental abruption.

“Probably among women who have hypertensive disease in pregnancy, you may get something like the 1 in 100 in Kenya, but we don’t have local studies that can definitely show exactly how prevalent it is,” adds Dr Risa.

Who is more at risk?

Physical trauma in the abdominal area caused by a fall or an accident can potentially cause placental abruption.

According to Dr Risa, as much as most cases have been observed in women with hypertensive disease in pregnancy such as preeclampsia, there are increasing incidences in women who have had traditional pregnancy massage.

“That type of massage is a form of trauma that can sometimes cause placental abruption, “he says. Furthermore, women who have had trauma inflicted due to partner abuse need to be handled in a more supportive manner as some may shy away from exposing partner.

Other risk factors may include;

·         Smoking

·         Cocaine use

·         Prior abruption

·        Pregnancy with multiple babies

·         Being older than 35

·         Uterine infection

·         History of caesarean section

What should one look out for?

Its occurrence is often unexpected and intense; requiring prompt medical attention. Some women may notice vaginal bleeding even though the amount of bleeding may vary.

Others may not notice any bleeding at all. The absence of heavy bleeding does not mean that the situation isn’t dire. Blood may get trapped inside the uterus.

Persistent blood loss puts the lives of mother and baby in jeopardy. Other symptoms include tenderness, abrupt stomach and back pain, continuous contractions and decreased foetal movement.

Proper diagnosis is normally conclusive after the baby has been delivered. However, on suspicion of the same—based on physical examination, ultrasound imaging and history--the doctor may recommend the best way forward for the mother and baby.

How bad can it get?

As Dr Risa puts it, placental abruption is normally an acute emergency scenario. Timely medical attention and level of abruption matters. The chances of the survival of mother and baby depend on the degree of abruption. Mild placental abruption between the 24th and 34th weeks may need hospital stay for close monitoring and allowing more time for the baby’s growth. In mild abruption cases after 34 weeks, the doctor may recommend early delivery since the period is near full term. Moderate to severe types of abruption manifesting with revealed or concealed blood loss require immediate delivery. “Babies do survive in minor degrees of placental separation. Where we have near-complete or complete placental abruption, the baby will not have any chance of survival. The mother has a high risk of death due to acute bleeding. In our set up actually, the highest cause of maternal death is bleeding; either postpartum (after delivery) or antepartum,” adds Dr. Risa After delivery, the uterus may fail to contract, increasing the risk of bleeding after delivery. In rare cases, hysterectomy—surgical removal of the uterus—may be done if the bleeding is not arrested. Additionally, disseminated intravascular coagulopathy—blood clots throughout the body—and renal failure can precipitate from placental abruption.

Related Topics

placental abruption