Placental Abruption – Maternal and Fetal Complications
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Placental abruption is a separation of the placenta before delivery of the baby. Some placental abruptions are caused by traumatic events, like a car accident or a severe fall, but most placental abruptions are related to underlying vascular risk issues. Smoking and high blood pressure each raise the risk of placental abruption, and together they raise the risk more than both combined. Mothers younger than 20 or older than 35 are at a higher risk of abruption, with the risk increasing on the far ends of the curve.
Most women with placental abruption will have vaginal bleeding and uterine tenderness. The “classical” symptom is painless vaginal bleeding, although 10 to 20 present of mothers with placental abruption have uterine contractions. Yet, in mothers past 20 weeks gestation, placental abruption causes only a third of all vaginal bleeding incidents. Usually, the most complicated part for a doctor making a diagnosis is deciding whether the bleeding is coming from a placental abruption, where the placenta has partially or fully separated, or whether the bleeding is coming from placenta previa, in which the placenta has spread over the internal cervical os. In situations where placenta previa is possible, the obstetrician and nurses must not use their finger to examine the os, because they could cause a hemorrhage.
Placental abruptions are typically confirmed with an ultrasound that shows a collection of blood behind the placenta. Once the placental abruption is confirmed, the key question is the severity of the abruption. A large medical study in 2016 found that the severity of the abruption was the single biggest factor in predicting whether or not the mother or the baby suffered severe complications. Women with a severe abruption were more than four times as likely to suffer serious maternal complications.
Treatment for placental abruption starts with monitoring the mother and baby closely. The mother’s heart rate, blood pressure, and urination all need to be followed closely to assess blood loss. If the mother shows signs of disseminated intravascular coagulation or shock, then a delivery should be considered. The baby’s heart rate needs to be followed as well, to look for any signs of a lack of oxygen or blood flow. If the baby shows a “nonreassuring” heartbeat pattern or growth restriction, then delivery should be considered. In general, a vaginal birth is preferred, but any preference for that should give way to signs the mother or the baby need an immediate c-section. In the event of delivery, the doctors should administer corticosteroids and tocolytics.
In January 2017, a family in Scranton, Pennsylvania, won a $19.3 million dollar settlement against Scranton Quincy Hospital in a case involving a placental abruption. As mentioned above, the classical symptom of an abruption is vaginal bleeding, with more serious bleeding and abruptions being correlated with worse outcomes for the mother and the child. In that case, the doctor wanted to wait for an ultrasound before performing a c-section. As a result, the c-section was not performed until 84 minutes after the mother was admitted to the hospital. The child was born “‘profoundly hypoxic'” and without a detectable heart rate for 12 minutes, leaving her with brain injury, visual impairment, seizure disorder and renal failure.