Premature placental abruption (abruptio placentae) is a very serious complication during pregnancy that acutely endangers the life and health of the unborn child as well as the mother.
What is premature placental abruption?
As a rule, when a premature placental abruption is recognized, a cesarean section is induced as soon as possible, provided that the child is already viable. Statistically, premature placental abruption occurs in less than one percent of all natural pregnancies. Premature placental abruption occurs when the placenta – which supplies the unborn child with nutrients – either partially or completely detaches from the uterus before the child is born. This detachment results in uterine bleeding, i.e. bleeding in the uterus. This, in turn, leads – if left untreated – to shock from blood loss (hemorrhagic shock) in the mother, as well as to an acute undersupply of oxygen to the unborn child (hypoxia), and even death of the child from lack of oxygen.
Causes
The cause of premature placental abruption can be, for example, a very violent bump or blow to the abdomen, such as one suffered in a fall down stairs or in a car accident. Premature rupture of the membranes – i.e. premature rupture of the amniotic sac before the onset of labor – can also cause premature placental abruption. High blood pressure (hypertension) is considered a contributing factor, so pregnant women who suffer from hypertension are at increased risk (including other complications). The likelihood of premature placental abruption increases with the number of previous pregnancies, i.e., the person-specific risk increases – statistically speaking – with each additional child.
Symptoms, complaints, and signs
Premature placental abruption affects women before the birth of one or more children. In a good third of all cases, no complaints occur at all. The detachment can then only be detected with an ultrasound scanner. It is extremely slight. In addition, advanced and severe forms can be distinguished, which show typical symptoms. In the case of advanced detachment, women complain of sensitivity in the abdominal area. The lower abdomen in particular is affected. Pain occurs suddenly, with no apparent external cause. In this form of placental abruption, minor bleeding from the vagina occurs, also known as spotting. It is the intensity of the bleeding that indicates the degree of detachment. A heavy discharge of blood from the vagina refers to a pronounced form. The pain in the abdominal area then turns out to be severe. They are constant and continue to intensify. If a great loss of blood occurs, shock and clotting disorders are typical. Most pregnant women are filled with anxiety. The heart rate increases. Premature placental abruption, in its most pronounced form, also affects the unborn child. It suffers from a lack of oxygen. The heartbeat changes pathologically. In rare cases, it even dies in the womb.
Diagnosis and course of the disease
Premature placental abruption is almost always associated with sudden, severe pain in the abdomen and is often accompanied by heavy bleeding, significant palpitations and severe circulatory problems. The fact that there is a problem is therefore usually noticed immediately, so that in almost all cases of premature placental abruption there is rapid initial treatment in hospital. The confirmed diagnosis is made there either on the basis of an ultrasound examination or else a coagulation test (of the mother’s blood). Premature placental abruption endangers both the life of the unborn child and the life of the mother – while about one percent of affected mothers lose their lives, the probability of losing the child ranges from 10% to 50%, depending on the week of gestation and the weight of the child. Thus, although premature placental abruption is a very rare pregnancy complication, it has the highest mortality rate of all common complications during pregnancy.
When should you go to the doctor?
Detachment of the placenta can occur naturally exclusively in sexually mature girls or women who are pregnant. In principle, when pregnancy is detected, consultation and cooperation with a physician should be carried out. In the process of growth of the fetus, expected and possible developments in the course of the entire pregnancy as well as confinement should be discussed. The expectant mother should inform herself extensively about the upcoming changes and make necessary arrangements for the course of the delivery. Due to the multitude of complications and adversities, a birth should under no circumstances take place without the presence of medical nursing staff. It is generally advisable to have an inpatient birth, since the best possible medical care is available in the event of any disturbances. In particular, if a high-risk pregnancy is assessed, a hospital should be visited no later than the onset of labor. If irregularities or abnormalities occur during the birth, this is monitored by midwives, nurses or doctors who are present. They react immediately so that no life-threatening situations arise for mother and child. In the event of spotting, unusual pain or unanswered questions, consultation with medically trained obstetricians should take place throughout the pregnancy and especially during the birth. The better existing complaints can be described, the faster the cause of the irregularities can often be documented.
Treatment and therapy
As outlined at the outset, if the diagnosis is confirmed and the child is already viable, an immediate cesarean section is almost always performed, during which the child is surgically removed from the uterus. If, on the other hand, the child is not yet viable, i.e., if premature placental abruption occurs before the end of the 34th week of gestation or if fetal development is delayed, an attempt can be made to reduce labor with medication, thereby delaying the necessary cesarean section until the unborn child has reached viability (especially with regard to lung maturity).
Prevention
The options for prevention of premature placental abruption are few. As mentioned above, the main risk factor that can be influenced is the presence of hypertension in the mother. If the problem is known, it can be treated in advance of pregnancy either with medication or conventionally (reduction of body weight, change of diet, targeted physical activities). In addition, the risk of premature placental abruption increases with the number of previous pregnancies, which is why mothers at risk are sometimes advised to refrain from having another pregnancy. Furthermore, during pregnancy – but also for other health reasons – the practice of physically stressful or dangerous activities should be avoided as far as possible, in the context of which there could be trauma to the abdominal region and thus trigger premature placental abruption.
Follow-up
Premature placental abruption in pregnancy is always an intensive care emergency because the lives of the mother and baby are at risk. Severe internal bleeding occurs and often the placenta along with the uterus must be surgically removed. Because of the many possible complications, follow-up care after premature placental abruption is very important. Severe blood loss can greatly weaken the affected woman and lead to anemia. Here, as part of the aftercare, it must be checked whether the body has already recovered from the blood loss or whether further measures are necessary. Especially in the case of a cesarean delivery and possible removal of the entire uterus, follow-up care is important in order to control the resulting wounds postoperatively. Wound healing is examined during follow-up care, as is any pain, the cause of which can be further investigated via ultrasound. Premature placental abruption is a serious emergency, which makes it especially important for those affected to keep their appointments for follow-up care after the event. Further, sometimes life-threatening complications such as renewed internal bleeding or delayed wound healing can usually be avoided by close follow-up, but require the patient’s cooperation.
You can do it yourself
Premature placental abruption is a medical emergency. After a fall or signs of placenta detachment, the first step is to call the emergency services. Then, the affected woman must lie still. The emergency physician must be informed about the situation. After that, treatment in the hospital is necessary. The most important measure is to remain calm and inform the doctor at the hospital as thoroughly as possible about the incident. Since premature placental abruption is often fatal, affected women often need therapeutic support as well. This can be supported by discussions with the partner and other affected persons. Attending a self-help group or registering on an Internet forum for affected parents also offer themselves as supportive measures. In addition, any pain associated with placental abruption must be treated. It is important to take the prescribed painkillers. At best, this should be monitored by the partner or a relative, as the affected women are usually in a shock situation. After completion of the treatment, a discussion should be held once again with the gynecologist and a therapist, in which open questions are clarified.
