The placenta does not get nearly as much love as it deserves. For most of us, it is a passing curiosity. After my oldest was born the midwife asked if I wanted to inspect it. I looked at the weird bloody jellyfish she was holding and said, “Nah, that’s good enough.”
Even the women who choose to plant / make art with / eat their placenta still may not spend a lot of time contemplating its role during the actual pregnancy.
The umbilical cord gets all the credit for keeping the baby connected to her mother inside her uterine home. Yet, the placenta is the one feeding the cord, filtering out toxins, providing oxygen and generally doing most of the work.
When it stops working, things get scary fast.
One of the most terrifying possibilities is that the placenta decides to try to leave the building entirely.
This is called a placental abruption.
What is placental abruption?
Occurring in approximately .5 – 1% of pregnancies, placental abruption is when the placenta starts to pull away from the uterine wall. It can happen with varying degrees of severity, depending on how much of it detaches.
What are the symptoms?
- Bleeding – The most common symptom, though in the case of a partial abruption the blood can become trapped behind the placenta and not be visible externally.
- Back pain
- Uterine tenderness
- Abdominal pain
If you are having any of these symptoms, call your provider. In the case of heavy bleeding, call on your way to the hospital, or call 911.
In my case, I was 29 weeks pregnant and having a lovely day when I went to the bathroom and felt a gush. I looked at the toilet paper and it was bright red. I stood up and looked in the toilet and the water was also bright red. There were several more gushes of blood in the next hour.
Who is at risk?
Placental abruptions can happen with no warning and it is not entirely known why. However, there are some risk factors:
- History of abruption
- Being over age 35
- Preeclampsia or hypertension
- Using cocaine during pregnancy (generally not a good idea)
- Abdominal trauma
- Uterine abnormalities
- Premature rupture of membranes
- Pregnant with twins+
It is difficult to diagnose a placental abruption, though it can sometimes be seen on an ultrasound. In many cases it is only confirmed after delivery, upon inspection of the placenta.
Treatment depends on the severity of the abruption, amount of blood loss, fetal health, and gestation.
- Mild abruption
The most common type of abruption – when only a small part of the placenta detaches.
In this case you will likely be monitored at the hospital, in some cases for a few days to make sure it resolves and does not worsen. Some form of bedrest and ongoing monitoring will likely be prescribed.
- Moderate abruption
You will work with your provider to assess the risk of staying pregnant vs the risk of premature delivery. If possible you will be given steroid shots to mature the baby’s lungs.
If you are close to full term it is likely you will deliver the baby immediately.
- Severe abruption
The placenta detaching all the way, or nearly all the way, is the pregnancy definition of shit hitting the fan. This is a life-threatening complication and delivery becomes a true emergency.
The baby is no longer getting nutrients and oxygen from the placenta and as the blood vessels connecting the placenta to the uterus tear, it can cause major bleeding for the mother.
Outcomes are dependent on severity, gestational age, and resources.
In developed countries maternal death is rare, though occasionally a hysterectomy is required. Blood transfusions are a more common intervention.
The fetal risk is higher. In the case of severe abruption the fetal mortality rate is 15%, when accounting for both stillbirth and deaths due to complications of prematurity.
This is the Scary Shit Series and placental abruption is truly scary shit. Like many of the most terrifying complications, there is not much you can do to prevent it.
Overall it affects .5 – 1% of pregnancies, though most of those will be mild and without major complications.
If you experience bleeding during pregnancy, call your provider. If you are bleeding heavily, get to a hospital.
Silver lining: In my case, a partial abruption may have saved my life. If I had not started bleeding, I would not have gone to the hospital, where I was diagnosed with preeclampsia. The abruption was mild and resolved itself – but the preeclampsia could have been life threatening, had it gone untreated.
Some girls get all the scary shit.