The Scary Box - Placental Abruption [TW] Pregnancy Complication

By: Aunt Doula (01/17/2023)

Placental abruption is a rare complication that can occur during pregnancy, typically defined as after 20 weeks gestation and possibly during delivery. A placenta is interwoven with the inner surface of the uterus via a complex network of blood vessels that allow it to process and provide the baby with oxygen and nutrients via the umbilical cord. On rare occasions, the placenta can be dislodged from the uterine wall due to trauma (like a significant car accident, hard falls that strike the belly or other direct strikes to the abdomen) a random event, or during labor it may be dislodged too early before the baby is born. All of these scenarios are rare, and the environment of the uterus is designed to be quite resilient and protective of the baby. If you have a scenario where you encounter a strong strike to the belly, a car accident or have significant bleeding you should always proceed immediately to the hospital or go with emergency personnel who respond – when in doubt, get checked out. The best-case scenario when you are worried and go to the emergency room is that they tell you everything is OK and you get to go home!

There are levels of severity of placental abruption, and some that occur are small and do not threaten the pregnant person or the baby. Minor abruptions can be self-contained by the clotting abilities in the pregnant person's body and after monitoring and restrictions determined by providers, pregnancy continues. Moderate abruptions may require intensive monitoring and possibly blood transfusions or clotting factors being given to the pregnancy person to help stop the bleed. Most presentations before 34 weeks gestation will be provided with steroid shots to promote development of the baby’s lungs in case delivery becomes necessary. Monitoring will continue for as long as necessary in the hospital until doctors are assured there is no further excessive risk of bleeding. Severe bleeds may require emergency delivery of the baby for the safety of both the pregnant person and the baby. Depending on the gestation of the baby, doctors will do their best to halt the bleeding however there is a narrow window to protect the lives of both the pregnant person and the baby. Placental abruption between 20 and 24 weeks when viability cannot be assured is extremely rare and is typically caused by extenuating external circumstances such as trauma. Severe placental abruption after 34 weeks gestation that risks the lives of the baby or pregnancy person usually results in an emergency c-section. In the case of severe bleeds, too much surface of the placenta may have disconnected from the uterine wall and delivery may be required even if bleeding has stopped due to the placenta not being able to function fully if it does not have adequate connection to the uterine wall. This will be determined during ultrasounds to decide if the placenta can continue to support during the remainder of the pregnancy.

*Prior to 20 weeks, bleeding that occurs on the margin of the placenta is often referred to as a subchorionic hematoma and has its own page you can refer to by clicking the blue text. *

Placental abruption that occurs during delivery may be due to a low-laying placenta known as placenta previa. In an ideal situation, the placenta edge is over 20mm from the cervical os (the exit ‘hatch’ of the uterus) and in cases where a previa was missed on ultrasound or no ultrasounds were performed during pregnancy, excessive bleeding will present during labor or delivery and doctors will respond with the assumption of a placental or uterine issue and perform an emergency c-section to protect the lives of the baby and pregnant person, remove the placenta and repair any areas that are bleeding to stop the blood loss. Placental abruption can also occur due to extremely strong contractions caused by induction medications that cause a hyper-sensitizing reaction in the uterus and it contracts too quickly and with excessive strength that otherwise would not occur without that medication. This is a known risk to induction medications such as Misoprostol and high dose Pitocin given too early in the labor process. With care and proper usage, these medications have been regularly administered in great frequency – remember that the goal is not to scare you, it is to educate you. There are risks during every delivery and in addition, risks of induction exist - the more you know, the better you can make decisions about your choices to accept induction medications, use alternatives, or opt out of their usage entirely.

The long and short of placental abruption is that it is a rare complication of pregnancy and sometimes delivery that is not likely to occur for a normal and low-risk pregnancy, however the knowledge of its causes, its potential treatments and what you may experience at different points during the diagnosis is key to remaining calm, levelheaded and in control should it happen during your pregnancy or delivery. Placental abruption has differing levels of severity which impact the treatment and monitoring processes you may encounter. Placental abruption may be an emergency, so things may move very quickly if you are diagnosed with a moderate or severe abruption – staying calm, remembering that this complication has a well-defined path of treatment, and that your doctors are trained for this will help carry you through the fast-paced response from your care team.