What Is Placental Abruption? Causes, Symptoms, and Treatment

Placental abruption is a serious pregnancy complication that can threaten the health of both you and your baby.

This condition is relatively rare, affecting approximately just 1% of pregnancies, so it might not seem like a big deal. 1 However, knowing the causes, risk factors, and warning signs of placental abruption can help you minimize your risk of experiencing it.

Placental abruption, also known as abruptio placentae, happens when the placenta either partially or completely detaches from the wall of your uterus.

It’s normal for the placenta to detach after you give birth. The problem is when the separation occurs too early, before your baby is born or while you’re actually in labor. 2 3 4

What is the placenta, exactly?

You probably know the placenta as the jellylike substance that surrounds your baby in the womb. It’s a temporary organ that acts as your baby’s kidney, liver, brain, and lungs while she’s developing, and it provides her with the oxygen and nutrients she needs via the umbilical cord. 5

When it detaches prematurely, this supply line may be disrupted, which leads to potential complications.

When does placental abruption occur?

Separation can happen at any time after 20 weeks of pregnancy, though it usually occurs in the third trimester.  6 7 Again, it can also happen while you’re in labor. 6

If you experience an abruption, it may happen suddenly. However, sometimes, it progresses slowly over time, in which case it’s known as chronic abruption. 8 9

Premature placental abruption can cause your baby to receive less oxygen. You may also be at risk of blood loss. 2 This can lead to further complications for both of you.

Risks for your baby

Based on how severe the abruption is, your baby’s at risk of: 9

• Premature birth (“premature” means before you’re 37 weeks pregnant) 10
• Low birth weight (weighing less than 5 pounds and 8 ounces).11
• Slowed growth in your womb (intrauterine growth restriction).
• Fetal brain injury due to a lack of oxygen
• Stillbirth or death shortly after birth

Risks for you

For you, potential complications include: 9

• Severe bleeding (hemorrhage)
• Blood clotting problems
• Kidney failure
• Death

In some cases, placental abruption can also cause damage to your pituitary gland after childbirth, which is also known as Sheehan syndrome or postpartum pituitary gland necrosis. 9 This can lead to problems with breastfeeding, like an inability to even produce milk. 12

Treatments for placental abruption can (sometimes) be fairly major procedures, including blood transfusions and even the removal of the uterus (a hysterectomy).

All of this may sound scary, but again, placental abruption only occurs in 1% of pregnancies, and even if it does occur in yours, it won’t necessarily be a severe case. 1 Make sure you attend all your prenatal appointments and call your doctor if you have any concerns about your pregnancy to stay on top of things.

The symptoms of placental abruption vary depending on the severity of the separation. The most common signs are dark red vaginal bleeding with a sharp and sudden pain in your abdomen or back.

Watch out for these other symptoms, too: 9 2 6

• Frequent contractions or a single, sustained contraction that doesn’t subside
• A hard or tight abdomen, even between contractions
• Feeling your baby move or kick less than usual
• Sudden increase in heart rate
• Feeling dizzy or lightheaded when you stand up
• Nausea
• Thirst

While bleeding is a common sign, it’s also possible the blood will be trapped behind the placenta, hiding it. 1

Contact your doctor or midwife immediately if you experience any of these symptoms. Heavy bleeding or signs of shock, such as weakness, dizziness, or fast breathing are all signs of a severe problem and warrant an immediate call to 911. 9 13

Placental abruption vs. placenta previa

You may have heard of another complication with the placenta called placenta previa. While an abruption involves separation from your uterus, placenta previa occurs when the placenta hangs too low in front of your cervix, which either partially or completely blocks your baby’s exit from your womb. 2 4

Here’s how your doctor will distinguish between these two placental conditions: 9

The exact cause of placental abruption isn’t known. However, several factors can increase your risk of developing the condition, such as if you’re over 35, smoke, drink, or use recreational drugs. 9 14

Certain health conditions also increase your risk. These include sickle cell anemia, heart disease, blood-clotting disorders, and high blood pressure during pregnancy (whether that’s from pre-existing chronic hypertension, gestational hypertension, or preeclampsia). 1 15 6

Some of the most common risk factors for placental abruption include: 9

• Previous placental abruption: You have an elevated chance of experiencing a placental abruption if you had one in a prior pregnancy, and an even higher chance if you had it in two.
• Injury to your abdomen: Trauma to your abdomen (e.g., from falls, violence, or car accidents) can make you more likely to develop the condition. Always wear a seatbelt!
• Multiple pregnancy: Carrying twins, triplets, or more increases your risk of a separation, particularly after the delivery of your first baby.
• Premature breaking of your water: When the amniotic sac ruptures (also known as your water breaking) before 37 weeks, the risk of abruption increases. 16
• Problems with your uterus: Conditions like uterine fibroids or an abnormally shaped uterus can increase your risk. 17 18 A short umbilical cord can also play a role.
• Excessive amniotic fluid: Having too much amniotic fluid surrounding your baby (polyhydramnios) can increase your risk.

Having one or more of these risk factors doesn’t guarantee that you will experience placental abruption, but it does increase the likelihood. Talk about your risk with your doctor or midwife.

If your doctor suspects you have a placental abruption, they’ll conduct a thorough evaluation, which will include ultrasounds and blood tests, to determine the extent of the separation and the risk to both you and your baby. 9

Here’s what you can expect: 1 9

• Physical exam: During this exam, your doctor will assess your symptoms, bleeding, vitals, and pain. 6 They may check your uterus for tenderness, firmness, and contractions. 9
• Pelvic exam: They may perform this to rule out other causes of vaginal bleeding, such as an infection or cervical problems.
• Fetal heart rate monitoring: Your doctor will listen to your baby’s heartbeat and ask about her movements. They’ll continue to monitor her heart rate to identify any signs of distress.
• Prenatal ultrasound: Your doctor may perform an abdominal ultrasound to visualize the placenta and detect signs of abruption, although it may not always be visible, especially in the early stages of separation.
• Prenatal test: Your doctor will also use ultrasounds in combination with other noninvasive tests to assess your baby’s biophysical profile (fetal movement, breathing, muscle tone, amniotic fluid, and heart rate).
• Blood tests: Blood tests, such as a complete blood count, can help assess the severity of your blood loss and check for signs of blood clotting problems.

If you’re Rh-negative (meaning your blood lacks a certain protein), your doctor may also perform a special kind of blood test known as a Kleihauer-Betke (KB) test to see if any of your baby’s blood has mixed with yours.

If it has, it won’t necessarily pose a threat to you or your baby, but it can lead to an autoimmune reaction that can cause problems in future pregnancies. To prevent this, if you’re Rh-negative, they’ll give you a RhoGAM shot—a carefully calibrated dose of injectable medicine. 9

The treatment for placental abruption depends on several factors, including the severity of the abruption, your baby’s gestational age, and you and your baby’s overall health.

Mild placental abruption

For a mild separation that happens before you’re around 34 weeks pregnant, your doctor may prescribe a few days of bed rest. 14 They’ll also give you medicine to prolong your pregnancy (i.e., prevent preterm labor), which will let your baby continue developing. 19

Abruption near the end of pregnancy (regardless of severity)

If the abruption occurs near the end of your pregnancy (i.e., after that 34-week mark), your doctor may recommend that you just deliver your baby, regardless of the severity of the separation. 19 This is because the risk of complications increases as your pregnancy progresses.

Moderate to severe placental abruption

Your doctor will be more hands-on if you have more severe placental abruption.

You’ll need to stay in the hospital and you might need a blood transfusion, oxygen therapy, and intravenous fluids. Your doctor will also monitor your baby’s heart rate. 14 9

You may need to have your baby immediately if she’s in distress or you’re losing too much blood or becoming anemic. Your doctor may induce labor so you can deliver vaginally. If that’s not possible, they’ll perform a C-section. 14

If you’re at risk of preterm delivery, they’ll give you medications such as corticosteroids to help your baby’s lungs mature. This helps make sure she can breathe and survive on her own once she’s born. 20

If you think you might be at risk of a placental abruption, don’t panic. Try not to think of the worst-case scenario. Just communicate openly with your doctor to mitigate your risk and stay on top of your prenatal visits to minimize your risk.

As always, if something feels off at any point in your pregnancy, don’t hesitate to get checked out, even if you don’t have an appointment scheduled for a while. Your doctor will do everything they can to safeguard you and your baby’s well-being.