The placenta is an organ that develops in the female during pregnancy. It is formed in the uterus by the union of the uterus mucous membrane with the membranes of the fetus. The purpose of the placenta is to provide nutrients for the fetus and dispose of the fetus’ waste products. The placenta is necessary for the survival of the fetus.
Placental abruption (also known as abruptio placentae) is a rare condition but is the most common cause of bleeding during pregnancy, and it is considered a major obstetrical emergency. Placental abruption is one of the leading causes of maternal mortality and morbidity. Placental abruption occurs when the placenta separates from the wall of the uterus prior to the birth of the baby (this separation should not occur prior to delivery).
Placental abruption occurs in less than one percent of pregnancies. It usually occurs in the third trimester of pregnancy, though it can happen any time after the 20th week of pregnancy. Placental abruption can be an emergency because the fetus relies on a healthy, functioning placenta to get food and oxygen needed for its survival.
Placental Abruption Can Develop Slowly or Suddenly
When placental abruption develops slowly, like a slow tearing away of the placenta from the uterus, the mother may have light bleeding or “spotting.” With sudden onset placental abruption, vaginal bleeding can be rapid and heavy. In 3 out of 10 cases, bleeding may not be obvious with placental abruption. In some cases of placental abruption, the hemorrhaging becomes trapped inside behind the placenta and is not an obvious sign. In these cases, the mother usually may experience a sudden onset of abdominal and/or back pain. This can be tricky, as laboring mothers without placental abruptions often experience such pain, too. Another sign of placental abruption is constant uterine contractions, as the blood irritates the uterus and causes it to contract.
Risk Factors for Placental Abruption
The specific cause of placental abruption is generally not known, but there are risk factors known to be associated with this condition. These risk factors include:
- Pregnancy at an older age;
- Multiparity (risk increases with each pregnancy);
- Previous cesarean section;
- Severe abdominal trauma during pregnancy;
- Cocaine or amphetamine use during pregnancy;
- Chronic high blood pressure prior to pregnancy or development of pre-eclampsia during pregnancy, which causes high blood pressure; and
- Smoking during pregnancy.
Placental abruption can put both the mother and fetus at risk. Risks to the fetus include IUGR (intrauterine growth restriction, a condition where the fetus’ growth slow or stops), early delivery, anemia, RDS (respiratory distress syndrome) in up to 50% of infants, and coagulopathy (blood does not clot adequately). Additional risks include fetal-maternal hemorrhage, a condition where the blood from the fetus enters the mother’s circulation. This can lead to stillbirth, neurologic injury in the fetus, or neonatal death. Placental abruption can also lead to postpartum hemorrhage in the mother, which then can cause maternal hypovolemic shock. Postpartum hemorrhage is usually defined as a loss of greater than 500 ml or 1000 ml of blood within the 24 hours following childbirth. Hypovolemic shock is a form a shock caused by lack of fluid volume within the circulatory system. Hypovolemic shock can cause low blood pressure and elevated heart rate. The low blood pressure, in turn, can cause damage to internal organs, especially the kidneys. Another complication of placental abruption is DIC (disseminated intravascular coagulation), a severe, life-threatening blood-clotting disorder.
Signs and Symptoms of Placental Abruption
First and foremost, the mother’s physician must take note of any risk factors for placental abruption. Risk factors that can be modified (for example, smoking and drug use), should be modified. Although 70-80% of placental abruptions present with vaginal bleeding, the other 20-30% do not present with visible bleeding. The mother should be instructed, by the 20th week of pregnancy, to immediately notify her physician of sudden onset bleeding, any spotting, back and/or abdominal pain, or constant contractions.
Treatment of Placental Abruption
Placental abruption is a medical emergency, and successful treatment for both the mother and fetus depend on immediate institution of appropriate treatment. This treatment can include IV fluids to replace lost blood/fluid volume to ward of hypovolemic shock and kidney injury; transfusion of blood products to replace the high blood losses which can occur in this condition; and close monitoring of both the mother for signs and symptoms of shock, and the fetus for signs of fetal distress. This close monitoring will alert healthcare personnel of the possible need for emergency C-section in the case of fetal distress.
Placental Abruption and Medical Error
Failure to educate the mother regarding signs/symptoms to report to the physician, failure to monitor and control blood pressure, failure to educate on the effects of smoking and drug use, failure to hospitalize and closely monitor when warranted, and failure to proceed to C-section if necessary, are all situations where the physician/healthcare has not met the standard of care for the mother and fetus. Not meeting the standard of care is medical negligence. If you have had complications arising from placental abruption or maternal-fetal hemorrhage, please contact The Eisen Law Firm for an evaluation of a possible birth injury claim. To schedule a free consultation to discuss your case with our excellent birth injury attorney, call 216-687-0900 or contact us online.