Placental Abruption

Placental abruption is also known as a premature separation of the placenta. All placentas normally detach from the uterus shortly after delivery of the baby. If any portion of the placenta detaches prior to birth of the baby, this is called a placental abruption.

A placental abruption may be partial or complete.

• A complete abruption is a disastrous event. The fetus will die within 15-20 minutes. The mother will die soon afterward, from either blood loss or the coagulation disorder which often occurs. Women with complete placental abruptions are generally desperately ill with severe abdominal pain, shock, hemorrhage, a rigid and unrelaxing uterus.

• Partial placental abruptions may range from insignificant to the striking abnormalities seen in complete abruptions.

Clinically, an abruption presents after 20 weeks gestation with abdominal cramping, uterine tenderness, contractions, and usually some vaginal bleeding. Mild abruptions may resolve with bedrest and observation,  but the moderate to severe abruptions generally result in rapid labor and delivery of the baby. If fetal distress is present (and it sometime is), rapid cesarean section may be needed.

Because so many coagulation factors are consumed with the internal hemorrhage, coagulopathy is common. This means that even after delivery, the patient may continue to bleed because she can no longer effectively clot. In a hospital setting, this can be treated with infusions of platelets, fresh frozen plasma and cryoprecipitate. In an operational setting where these products are unavailable, fresh whole blood transfusion will give good results.

Patients not in a hospital setting who are thought to have at least some degree of placental abruption should be transferred to a definitive care setting. While transporting her, have her lie on her left side, with IV fluid support.