Placental Abruption: What It Is, Causes, Symptoms & Treatment

What Is Placental Abruption?

Placental abruption is defined as the separation of the placenta from the inner wall of the uterus before delivery of the baby. The placenta provides a baby with nourishment and oxygen. If it separates from the uterus too early, then the baby does not receive the required nourishment. The mother also suffers from internal bleeding.

The condition is regarded as an obstetric emergency which occurs acutely and may either be partial or complete. In either case, medical assessment must occur immediately.

What Are the Types of Placental Abruption?

Types of placental abruption include:

How Common Is Placental Abruption in India?

Placental abruption complicates 1 out of every 100 pregnancies. Further, obstetric studies indicate a rate between 0.5 and 1% of all deliveries in India.

India has the largest birth rate globally, meaning the number of at-risk pregnancies is very large each year. Many conditions are prevalent among Indian women and pose an increased risk of abruption, hypertension, anaemia, gestational diabetes and so on. Moreover, placental abruption cases are under-reported in India due to a lack of awareness and the unavailability of specialised medical centres for treatment.

What Are the Symptoms of Placental Abruption?

Typical symptoms of placental abruption include:

• Vaginal bleeding

• Abdominal pain

• Uterine tenderness

• Frequent contractions

• Less fetal movement

• Sudden back pain

• Uterine rigidity

Note: With a concealed abruption, there will be no vaginal bleeding; signs will include abdominal pain and uterine rigidity.

What Causes Placental Abruption?

Causes of placental abruption include:

• High Blood Pressure: Hypertension or preeclampsia causes an increase in the blood vessels in the uterus. This is often one of the more common causes of abruption.

• Abdominal Trauma: Falls, accidents or blows to the abdomen can cause sudden placental separation.

• Sudden Loss of Amniotic Fluid: As the fluid exits the uterus suddenly, it can decrease the size of the uterus. This can lead to abrupt placental separation.

• Blood-Clotting Disorders: Any disorder that affects normal clotting processes

• Smoking: Smoking during pregnancy decreases blood supply to the placenta and can, over time, weaken the placental attachments.

• Drug Use: Cocaine and other illicit drugs, in particular, increase the chance of abruption.

• Multiple Pregnancy: Having twins or more places strain on the uterine wall, making separation more likely.

• History of Abruptio Placentae: If you have had this complication in a previous pregnancy, you have a higher risk.

• Uterine Abnormalities: Fibroids can affect placental position and stability.

What Are the Complications of Placental Abruption?

Complications associated with placental abruption are:

• Severe Maternal Haemorrhage: Significant blood loss that causes the mother to go into shock, and the mother may require a blood transfusion in an emergency.

• Disseminated Intravascular Coagulation (DIC): DIC is a serious disorder that can be triggered by a massive haemorrhage, and it affects the normal functioning of clotting in the body.

• Preterm Birth: Abruption often precipitates the birth of the baby before its time, so that the baby may require high dependency or intensive care.

• Fetal Growth Restriction: The failure of the placenta that may have occurred during pregnancy may have prevented the baby from growing at the normal rate.

• Low Birth Weight: Babies born following an abruption may weigh significantly less than average for gestation.

• Damage to the Mother's Organs: This may include effects on the kidneys or liver that can result from acute bleeding.

• Emergency Hysterectomy: In very rare cases, removal of the uterus may be suggested to prevent further blood loss.

When Should I See My Healthcare Provider?

Call your healthcare provider immediately if you experience any of these signs during pregnancy:

• An abrupt onset of vaginal bleeding any time after 20 weeks of pregnancy.

• A sudden onset of very sharp abdominal pain or sharp low back pain without an obvious cause.

• A hard, tense, or tender uterus on palpation.

• The rapid onset of contractions that do not relax before the next contractions and then persist without abatement.

• A noticeable decrease in the baby's movements within 12 hours.

• A recent fall, accident, or trauma to the abdomen during pregnancy.

• You have a history of hypertension, preeclampsia or previous abruption.

Placental abruption is a true medical emergency; get medical attention right away.

How Is Placental Abruption Diagnosed?

Diagnostic Overview Table

How Is Placental Abruption Treated?

Treatment depends on how severe the problem is, the maturity of the pregnancy and the condition of both mother and baby. Typical methods of treatment include:

Placental Abruption in Subsequent Pregnancies

Having had a previous abruption places you at a greater risk for a repeat abruption in subsequent pregnancies. ACOG states the recurrence rate is approximately 10% after the first abruption.

If you have had an abruption previously, make your doctor aware early in your next pregnancy. Attend regular and frequent prenatal appointments. Blood pressure should be checked at every visit, and any hypertension, gestational diabetes, or lifestyle risks should be controlled.

What Is the Prognosis for Placental Abruption?

It is dependent on when the patient is treated. For mild cases detected at an early stage, normal deliveries are safe, and the mother and child can be well cared for.

However, for moderate and severe cases, risks include preterm delivery, low birth weight babies, and complications of neonatal management. In cases where major blood loss and surgery have occurred, the mother may require a prolonged recovery time.

Most patients recover well with medical management. Long-term problems do not generally occur if treatment is sought immediately. Postnatal follow-up is recommended.

How Can I Reduce the Risk of Placental Abruption?

Although placental abruption is not always preventable, it can be significantly decreased by the measures listed below:

• Control High Blood Pressure: Manage hypertension with prescribed medications and have blood pressure checked at every prenatal visit.

• Go to All Prenatal Checkups: Regular prenatal visits ensure the timely diagnosis of high-risk conditions, such as preeclampsia.

• Quit Smoking Right Away: Smoking has the effect of decreasing blood flow to the placenta and significantly decreases your risk of abruption.

• Do Not Drink Alcohol or Take Drugs: Alcohol consumption and cocaine use increase the risk of abruption significantly.

• Wear Seatbelts Properly: Properly wearing a seat belt at all times when you are travelling in a car will decrease the chance of injury to the abdomen from trauma to the abdomen.

• Control Gestational Diabetes: Make sure that your blood sugars stay in their target range, as unstable glucose control will increase your vascular risks.

• Avoid High-Impact Activity: You will need to avoid high-impact activities, which can cause injury to the abdomen during pregnancy.

• Report Any Abdominal Injury: Immediately inform your doctor if you experience an injury to the abdomen.

Does Health Insurance Cover Placental Abruption?

Yes, most comprehensive health insurance plans available in India cover placental abruption. It's generally included as a complication of pregnancy and childbirth under the maternity benefits of the policy.

Typically, the coverage usually includes:

• Emergency Hospitalisation Expenses: In terms of room rent, ICU charges, doctor's fees and nursing expenses during the pregnancy-related emergency.

• Caesarean Section (C-Section): The cost of an emergency C-section is typically covered under most maternity benefit plans.

• Diagnostic Tests: Tests such as an ultrasound scan, CTG monitor, blood tests, etc. Will be covered under hospitalisation benefits.

• Blood Transfusions: These are covered under inpatient treatment with most health plans.

• NICU Charges: In case of pre-term delivery, the charges for the neonatal intensive care unit may be covered depending on individual policy terms.

• Post-Operative Care: Expenses following childbirth will be included in several plans.

As per IRDAI health insurance regulations, any health insurer offering maternity benefits must cover complications associated with pregnancy and childbirth, placental abruption being one of them.

Most maternity riders and add-ons have a waiting period of two to four years. It is always advisable to buy a maternity health insurance plan well in advance before conceiving. In cases where the condition becomes severe, resulting in a longer ICU stay or complicated surgery, there is a chance of it being covered under critical illness insurance, depending on individual policy terms. Always check your policy document before making a claim.

How Much Health Insurance Coverage Is Needed for Placental Abruption Treatment?

The kind of cover needed will depend on the extent of abruption, the type of treatment and the city/hospital where treatment is being provided. Placental abruption is usually an emergency procedure, may require a caesarean, blood transfusion and a long stay in hospital. These are one of the most expensive obstetric procedures, especially in private hospitals located in metro cities. A health coverage of ₹5 to ₹10 lakh is often recommended to take care of emergency delivery, diagnostic tests, and the usual post-operative recovery of mother and child can be very useful.

When there is an emergency with complications such as prolonged ICU stay, neonatal intensive care, damage to an organ or if an emergency hysterectomy is performed, a higher coverage may be appropriate. Women with pre-existing conditions like hypertension or gestational diabetes, or a previous history of placental abruption, carry more risk. Therefore, in such cases, a higher sum insured of ₹10 to ₹15 lakh can be useful.