Placenta Abruptio

Treatment Overview

A placenta that has separated from the uterine wall (placenta abruptio) cannot be repaired. Until its severity can be assessed, placenta abruptio is considered a medical emergency. If you have suspected or diagnosed placenta abruptio, you will need to be observed in the hospital. Some abruptions can get worse quickly and become life-threatening for both you and your fetus.

If your blood type is Rh-negative and you have placenta abruptio, you will have a RhoGAM shot. This is because your fetus could be Rh-positive. Bleeding from an abruptio can mix the Rh-positive blood with yours. The RhoGAM prevents your immune system from attacking the Rh-positive blood.

Placenta abruptio is usually treated by an obstetrician or perinatologist.

Mild placenta abruptio

If placental separation is minor, vaginal bleeding is light, and your fetus is not in distress, you may be observed in the hospital for several hours or several days. For the remainder of your pregnancy, you'll probably be advised to avoid strenuous activities, and you and your fetus will need to be monitored regularly.

If you are in preterm labor, the separation is minor, and you are far from your due date, you may be given tocolytic medication to stop labor. For more information, see the topic Preterm Labor.

Moderate to severe placenta abruptio

If placental separation is moderate to severe, or if it causes a life-threatening condition called disseminated intravascular coagulation (DIC), rapid delivery is almost always necessary. Although vaginal delivery is sometimes possible, the need for rapid delivery increases the likelihood of a cesarean (C-section). In rare cases of heavy bleeding that won't stop, the uterus is surgically removed (hysterectomy).

Depending how much blood you have lost and whether you have disseminated intravascular coagulation, you may need a transfusion of blood or blood-clotting products, such as platelets.

How well your baby does after a placental abruption depends on how prematurely he or she is delivered and how well the placenta was able to circulate blood oxygen and nutrients to the fetus before delivery.

Following delivery, it may be necessary to remain close to a health center able to care for premature infants. A sick or premature newborn can receive the best treatment possible in a neonatal intensive care unit, or NICU. Care in the NICU can last days or weeks, depending on the baby's level of maturity, the extent of the baby's problems, and the amount of care needed. For more information, see the topic Premature Infant.

Treatment for premature infants can be provided by a neonatologist, a doctor who specializes in the care of newborns.

Future pregnancy

After having one placental abruption, you have an increased risk of developing another during a future pregnancy. After two or more, you have a 1-in-4 risk of having another.² Although there are no specific treatment guidelines for preventing another placental abruption, you and your health professional can take some steps to reduce your risk.

• Avoid high-risk factors such as drug use, cigarette smoking, or untreated high blood pressure (140/90 mm Hg or higher).
• Take prenatal vitamins with adequate folate [400 mcg (0.4 mg)], since low folate has a possible link to placental problems and abruption.^{6, 5}
• See your health professional regularly throughout your pregnancy.

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Author:	Monica Rhodes	Last Updated: February 26, 2008
Medical Review:	Sarah Marshall, MD - Family Medicine William Gilbert, MD - Perinatology
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