Placental abruption – why is it dangerous?

A premature placental abruption, meaning the detachment of the placenta from the uterine wall before birth, is a complication that usually occurs in the second half of pregnancy. It is classified as an obstetric emergency, as it can have severe consequences and may even lead to the death of the mother or child. That is why a quick diagnosis and medical intervention are extremely important in the case of placental abruption. But what risk factors and symptoms characterize this dangerous condition?

Placental abruption – causes and risk factors

The main causes of premature placental abruption include changes in the uteroplacental circulation and inadequate vascular supply to the base of the placenta. Normally, the placenta detaches only during the third stage of labor. However, if it detaches from the uterine wall earlier, it is referred to as premature placental abruption. Bleeding occurs at the detachment site, and since about 600 ml of blood flow through the placenta per minute, the consequences can be dramatic. The mother may lose a large amount of blood, while the baby may no longer receive sufficient oxygen and nutrients.

The risk of placental abruption is higher in women with high blood pressure. Other risk factors include multiple pregnancies, polyhydramnios (excess amniotic fluid), placenta previa, a short umbilical cord, and uterine malformations. Abdominal trauma, such as from car accidents, can also increase the risk. Studies also show: the older the pregnant woman, the higher the risk of premature placental abruption.

Placental abruption – symptoms and diagnosis

In 70–80% of cases, placental abruption causes vaginal bleeding. However, if the blood collects between the placenta and the uterine wall, the bleeding may not be visible externally. Many women report abdominal pain and cramping. Diagnosis is difficult because symptoms often occur during labor and may not be immediately recognized as dangerous. Placental abruption leads to reduced oxygen supply to the baby, which may show up as abnormal cardiotocography (CTG) readings or, in the worst case, result in the death of the child. Ultrasound has limited use here, as the spilled blood can be mistaken for the placenta.

Complications of placental abruption

The abruption leads to internal or external bleeding. Severe blood loss can cause the mother to go into circulatory shock, develop clotting disorders, or even die. Placental abruption can also have serious consequences for the baby. The larger the detached placental area, the greater the risk of oxygen deficiency. If this condition lasts too long, the baby may die. If the abruption occurs before the 37th week of pregnancy, there is also a risk of complications from premature birth, such as retinopathy of prematurity, necrotizing enterocolitis, or breathing problems.

Placental abruption – treatment

Because of the potentially serious consequences, a quick and accurate diagnosis of placental abruption is essential. Unfortunately, the non-specific symptoms can delay diagnosis and, therefore, treatment. In most cases, the further course of action depends on the condition of the mother and child. A pregnancy with placental abruption is usually ended by cesarean section.

Placental abruption and umbilical cord blood collection

Placental abruption itself is not necessarily an obstacle to collecting umbilical cord blood. However, if the life of the mother or child is in danger, the medical staff may choose to forgo the collection. In general, it is possible to collect a sufficient amount of umbilical cord blood during both natural birth and cesarean section to obtain enough stem cells.