What is Placental Abruption?
A Pregnancy Complication That Endangers Mothers and Babies
An expectant mother’s placenta plays an enormous role in her baby’s well-being. The placenta is an organ that grows in the mother’s uterus during pregnancy and attaches itself to the uterine wall. The placenta is what provides the baby all of his or her oxygen and nutrients during pregnancy and labor. The baby’s umbilical cord is connected to the placenta and is how nutrients and oxygen are transmitted to the baby. Placentas also carry away the fetus’s waste products.
Any complications with the placenta, including abruption, endanger both mother and baby.
When placental abruption occurs, the mother can suffer excessive bleeding, shock, and organ failure. Placental abruption can also deprive the baby of oxygen because of reduced blood flow. As a result, the baby can suffer fetal distress and hypoxic-ischemic encephalopathy (HIE). If a placental abruption is not immediately addressed and treated, both mother and baby could die or suffer long-term damage.
It’s critical that medical providers understand the causes of placental abruption, identify women who are at risk, and know how to treat and respond to this medical emergency.
What Happens When Placental Abruption Occurs?
The placenta normally separates from the uterus after the baby is born. In fact, its removal is called the third stage of labor. The baby no longer needs the oxygen and nutrients the placenta provided in utero at that point.
Placental abruption occurs when the placenta prematurely separates from the uterus for some reason. Since the uterus is a muscle, it is more “elastic” than the placenta. Sometimes when the uterus stretches or moves for some reason (like trauma or prolonged excessively hard or long contractions), the placenta does not move.
The uterine movement strains the vascular structures between the uterus and placenta. They may begin to tear away from the uterine lining, jeopardizing the placenta’s essential functions.
If abruption occurs, there may be bleeding between the placenta and uterus. The resulting accumulation of blood also causes them to further separate. For some mothers, the blood remains trapped in the uterus instead of being expelled through the vagina.
This separation also puts the baby at risk as the placenta’s ability to provide oxygen weakens. A baby receiving less oxygen may show signs of fetal distress as their heart attempts to compensate. This, then, can lead to hypoxic-ischemic encephalopathy (HIE) as the flow of oxygenated blood to the brain decreases. Babies in fetal distress typically must be delivered quickly, sometimes by emergency C-section.
Are There Different Types and Classifications of Placental Abruption?
A pregnant woman may exhibit symptoms of abruption, but there are several types:
- Partial: The placenta is not completely detached from the wall of the uterus.
- Complete or total: The placenta is completely detached.
- Revealed: The mother will have moderate to severe vaginal bleeding.
- Concealed: There is little to no visible vaginal bleeding. Typically, this is because the blood is trapped in the uterus.
Also, doctors and other medical providers may classify a placental abruption as follows:
- Class 0: Asymptomatic. The abruption may not be evident until after the placenta is delivered.
- Class 1: Mild. The mother may exhibit little to no vaginal bleeding with very slight uterine tenderness. However, the mother’s vital signs are normal, and there are no signs of fetal distress.
- Class 2: Moderate. The mother may have only moderate vaginal bleeding with significant uterine tenderness. The mother’s heart rate and blood pressure may change, and signs of fetal distress appear.
- Class 3: Severe. Vaginal bleeding may be heavy, causing the mother to go into shock. Her uterus may be rigid. The fetus may die unless removed quickly.
The health of both mother and baby depends on their doctors, nurses, and other medical professionals. The first step is for the mother’s obstetrician or family doctor to recognize she’s at risk.
Are There Any Identifiable Risk Factors?
There are signs that a pregnant woman might be at risk for placental abruption. Such risks fall into one of three groups:
1. Medical History: Information in a mother’s medical history can signal she’s at risk for placental abruption:
- Previous placental abruption
- Uterine fibroid tumors
- Prior surgery on the uterus
- Being an older mother (over age 35-40)
- Blood clotting disorders
- Heart disease
- Chronic high blood pressure
2. Current Pregnancy: Complications and events that occur during a woman’s pregnancy can call for increased monitoring:
- Preeclampsia, eclampsia, HELLP (Hemolysis, Elevated Liver enzymes and Low Platelets), and hypertension-related conditions
- Substance abuse, including alcohol, cocaine, and smoking
- Infections of the uterus, placenta, or amniotic fluid
- Early rupturing of membranes
3. Unexpected Trauma: Finally, placental abruption can be brought on by trauma that results from:
- Falls
- Vehicle accidents
- Violence including blows to the abdomen
Placental Abruption Risk Factors
Medical History
- Previous placental abruption
- Uterine fibroid tumors
- Prior uterus surgery
- Being an older mother(over 35-40)
- Blood clotting disorders
- Heart disease
- Chronic HBP
Current Pregnancy
- Preeclampsia, eclampsia, HELLP, and hypertension-related conditions
- Substance abuse: alcohol, cocaine, and smoking
- Infections of the uterus, placenta, or amniotic fluid
- Early rupturing of membranes (PROM)
Unexpected Trauma
- Falls
- Vehicle accidents
- Violence including blows to the abdomen
Doctors and other healthcare providers should watch closely for signs of complications like abruption, whether a woman is at-risk or not.
What Signs and Symptoms Indicate Placental Abruption Is Occurring?
Doctors must closely monitor women with high-risk pregnancies. Some abruptions are unexpected, but signs and symptoms should be noted and treated. If the following symptoms appear, a woman might need more testing, closer observation, bed rest, or admission to the hospital:
- Vaginal bleeding during pregnancy: This is one of the most common signs of abruption. However, bleeding can indicate a mild abruption, or another condition could cause it. Also, not all women with abruptions have significant vaginal bleeding.
- Pain: Women may experience abdominal or back pain or both.
- Uterine changes: The mother may experience tenderness, pain, rigidity, or contractions.
It’s particularly critical to monitor women in the last trimester of pregnancy. Most placental abruption cases occur just a few weeks before a woman’s due date.
Expectant mothers should notify their doctors when they feel something is wrong. However, it’s even more crucial for medical providers to react quickly and appropriately with treatments ranging from bed rest to an emergency C-section. Doing so protects both mother and baby.
How Do Doctors Diagnose and Manage Placental Abruption?
First, obstetricians and other doctors can get a good medical history from the mother. This can provide clues to any conditions that make placental abruption more likely.
- Ultrasounds can show the doctor where the placenta is placed – top, side, front, or back of the uterus.
- Blood tests can give doctors a good baseline to start. Subsequent blood tests can be evaluated against the baseline to watch for troubling changes.
One test – the Kleihauer-Betke test – can detect fetal blood cells in the mother’s blood. Their presence does not mean placental abruption has occurred but proves that the fetus’s blood has mingled with the mother’s blood. This can be significant when the mother is Rh-negative.
Treatment and management of an abruption depend on the severity of the situation.
- Mild abruption with no signs of maternal or fetal distress: The doctor might monitor the mother and baby closely, especially if the pregnancy is less than 37 weeks.
- Moderate or severe abruption: Immediate action is needed. Vaginal birth may happen quickly and is actually less risky for the mother. However, an emergency C-section is usually performed at signs of fetal distress. If the birth is delayed, the baby could suffer brain damage like hypoxic-ischemic encephalopathy (HIE) and develop cerebral palsy or cognitive disabilities.
Failing to identify and treat placental abruption puts baby and mom at risk. Such inaction may also be considered medical negligence or medical malpractice.
What Complications Can Mother and Baby Face?
When a placental abruption occurs, the following may happen:
For the mother:
- Severe bleeding
- Blood clotting disorders
- Increased risk of cardiac events
- Premature delivery
- Transfusion-associated complications
- Cesarean section
- Hysterectomy
- Maternal death
For the baby:
- Hypoxic-ischemic encephalopathy (HIE), which is a birth-related brain injury
- Death
Where Can Medical Providers Go Wrong?
Doctors, nurses, midwives, and hospitals have a duty of care to their patients. For a pregnant woman, this means:
- monitoring mom and baby for complications,
- diagnosing those complications, and
- providing swift, effective treatment.
Medical negligence can occur, including the following medical errors:
- Failing to identify that an expectant mother is high-risk for placental abruption.
- Understanding the risk but failing to monitor both mother and baby closely.
- Missing signs of placental abruption.
- Failing to identify signs of maternal and fetal distress.
- Not treating a mother with placental abruption.
- Failing to protect the baby from brain damage, hypoxic-ischemic encephalopathy, and death.
When medical malpractice or medical negligence causes injury or harm, the families of injured babies may be entitled to compensation from negligent medical professionals and hospitals.
Is Your Child’s Birth Injury the Result of Medical Malpractice?
The parents of children who suffered birth injuries after a placental abruption often want answers. They want to know:
- Were signs of fetal distress not recognized by the doctors and nurses?
- Were there signs of a placental abruption that were not quickly responded to that caused a brain injury to my child?
- How could my child’s birth injury have been prevented?
Our dedicated birth injury lawyers want to help you find those answers.
We diligently investigate the facts, including a detailed examination of the fetal heart rate monitoring strips and labor and delivery records. If this review shows the medical providers did not diagnose or respond to fetal distress, we hold responsible parties accountable by pursuing medical malpractice claims against them. The compensation our clients receive helps them pay for their child’s current and future medical treatment, assistive technology and equipment, attendant care, and the other expenses associated with caring for a child with brain injuries, seizure disorders, and cerebral palsy.
Sometimes families are afraid to talk to lawyers about their child’s case because they worry there is a fee. There is never a fee unless and until we make money recovery for our clients.
Why Should You Talk with the Knowledgeable Attorneys at Miller Weisbrod?
The only way to find out if you have a birth injury case is to talk to an attorney who understands birth injury.
At Miller Weisbrod, a team of committed professionals uses our detailed case review process to assess your potential claim. They start by learning more about you and your child. Then we gather medical records to determine what happened before, during, and after your delivery. We call in skilled medical experts who review your records and let us know if they think medical errors could have caused your child’s injuries.
If we feel medical malpractice was present, we meet with you to discuss how you can receive compensation from the medical professionals who made the errors.
At no point in our legal intake process will we ask you to pay anything. The medical review of your case and the consultation are free. We only receive payment when you do.