In the case of premature placenta detachment (also called premature placenta detachment or abruptio placentae), the placenta detaches from the uterine wall before birth. This leads to symptoms such as severe pain in the lower abdomen, dark red spotting, a hard stomach and even shock. Premature placenta detachment is often life-threatening for both mother and child. Read more about symptoms, consequences, causes and treatment here!
ICD codes for placenta detachment: O45
Quick overview
- Symptoms: Sudden severe pain in the lower abdomen, dark red spotting, hard and tender abdomen, feeling unwell, thirst, drop in blood pressure, circulatory shock. In rare cases, premature placenta detachment is symptom-free.
- Course: Depending on how much of the placenta detaches, the consequences for mother and child are different. A complete detachment is life-threatening for both.
- Description: In the case of premature placental detachment, the placenta detaches partially or completely from the uterine wall. Detachment of the placenta during childbirth is normal.
- Causes: So far unclear. Risk factors include bumps and falls on the stomach, old age of the mother, sudden changes in pressure (e.g. after membrane rupture).
- Treatment: Depending on the degree of detachment, the doctor will administer medication or perform a cesarean section. In mild cases, close monitoring of the pregnant woman and bed rest are sufficient.
- Diagnosis: Physical examination (e.g. abdominal palpation), ultrasound, blood test.
- Prevention: avoidance of risk factors such as smoking, alcohol consumption, drug use; in the case of medical risk factors (e.g. gestational ddiabete) close checks by the gynecologist; Leading a healthy lifestyle (enough sleep, healthy diet).
How to recognize a premature placenta detachment?
The symptoms of a premature placenta detachment depend on how much of the placenta has detached and how much blood the pregnant woman has lost. The detachment itself is painless.
One of the most common symptoms is cramping pains in the abdomen. These are triggered by the uterus trying to expel the placenta from the body by contracting (the uterus contracts).
The symptoms usually only appear after the placenta has already detached!
Other symptoms appear depending on where the placenta detaches. The placenta detaches either from its center or in the peripheral area.
If it first detaches at the edge, there is often visible, usually dark red bleeding from the vagina (marginal sinus bleeding) in addition to the severe abdominal pain. This is because the uterus bleeds where the placenta separated. Blood drains through the woman’s cervix and vagina (external hemorrhage).
About 30 percent of bleeding that occurs during pregnancy is caused by premature placental detachment.
If the pregnant woman loses too much blood, this can lead to circulatory shock. This is noticeable at the beginning through restlessness, fear and a feeling of weakness; later there is a drop in blood pressure and an increase in heart rate up to unconsciousness.
This bleeding does not always have to come from the vagina. For example, if the placenta begins to detach in the middle, there may be little or no blood going through the vagina at first. In this case, most of the blood collects inside the uterine wall without draining (internal haemorrhage) and initially goes unnoticed. Those affected often have severe pain. Most of the time, the stomach feels hard as a board. Labor is also possible. This condition is usually life-threatening because the pregnant woman bleeds inwards – into the wall of the uterus.
In some cases, a bruise (retroplacental hematoma) then forms behind the placenta (between the placenta and the uterus). The larger the bruise, the greater the risk that the blood clotting of the pregnant woman will be out of balance. The body uses more coagulation substances such as blood platelets (thrombocytes), which it normally needs to stop bleeding.
The body cannot replicate these clotting substances fast enough. Doctors then speak of consumption coagulopathy or disseminated intravascular coagulation (DIC). As a result, pregnant women tend to bleed even more (increased tendency to bleed).
However, premature placenta detachment is not always associated with symptoms. If the placenta detaches only partially and slightly, it often goes unnoticed. The doctor often only finds this out during an ultrasound as part of the preventive medical check-up.
Regular check-ups are important for the health of mother and child!
What is a placenta detachment?
The placenta is a tissue on the wall of the uterus that forms during pregnancy and supplies the unborn child with oxygen and nutrients. Normally, about 10 to 15 minutes after the mother gives birth, the placenta detaches itself from the uterine wall as an afterbirth and is expelled from the body through the birth canal.
Sometimes, however, the placenta detaches during pregnancy, i.e. before the child is born. In this case one speaks of a premature placenta detachment (Latin: Abruptio placentae). It is possible for the placenta to detach completely or only partially (sometimes only 10 to 20 percent) from the uterine wall.
Premature placenta detachment is one of the serious complications of pregnancy. Depending on how much of the placenta detaches, the condition can be life-threatening for both mother and child.
What are the warning signs of placenta detachment?
The following warning signs indicate, among other things, a more extensive premature detachment of the placenta:
- Sufferers suddenly have severe pain in the lower abdomen.
- You have dark red spotting.
- Your abdomen is hard and extremely sensitive to pressure.
- You feel unwell and dizzy. You are scared and feel weak.
- They are increasingly thirsty and nauseous.
- You have signs of shock: your heart rate is very high; her blood pressure drops dangerously. In some cases, people lose consciousness.
If you recognize one or more of these symptoms, consult a gynecologist immediately!
What are the consequences of a placenta detachment?
Depending on how much of the placenta detaches from the uterine wall, the consequences for mother and child are different. If the placenta is only partially and only slightly detached, it is possible that the pregnant woman hardly notices anything and the detachment stops by itself. The child is then supplied with sufficient blood, depending on how much of the placenta is still adhering to the wall of the uterus. With strict bed rest and under medical observation, the baby can usually continue to develop in the womb.
On the other hand, if more than a third of the placenta detaches and there is heavy bleeding, this is life-threatening for both the mother and the unborn child. Especially in the case of a complete premature placenta detachment, it is important that medical treatment takes place quickly. If the placenta no longer supplies the unborn child with sufficient oxygen and nutrients, there is an acute risk that the child will be undersupplied and die. An emergency caesarean section is then usually the only chance that the baby will survive.
Premature placenta detachment can also be dangerous for the mother-to-be. If too much of the placenta detaches, heavy bleeding can occur. If doctors don’t stop this in time, the mother bleeds to death internally and circulatory failure occurs.
It is therefore important that pregnant women with a premature placenta detachment are treated immediately. This is crucial for the course. Mortality from placental detachment is around 1% for mothers and between 10% and 67% for children, depending on their weight and week of pregnancy.
How common is premature placenta detachment?
Detachment of the placenta is rare, occurring in about 0.4 to 1.5 percent of all pregnant women. This means that a maximum of one in 100 babies will have a premature placenta detachment. The probability of a complete placental detachment is 0.002 percent, which corresponds to one in 500 cases.
Detachment usually takes place after the 20th week of pregnancy. Statistically, the risk of a premature placenta detachment is highest between the 24th and 26th week of pregnancy.
What are the causes of a placenta detachment?
So far, it has not been clearly clarified which causes trigger a premature placenta detachment.
However, doctors suspect some risk factors that promote and possibly cause premature placenta detachment. These include, for example:
- When the placenta is misaligned during pregnancy (e.g. placenta previa) and preterm labor occurs.
- If the pregnant woman falls on her stomach or buttocks or if the stomach is injured, for example as a result of an accident or blunt force (e.g. kicks, hits).
- If the umbilical cord is too short or the umbilical cord wraps itself around the child (umbilical cord entanglement) and this causes a strong pull on the placenta.
- If the mother has constricted vessels that reduce the adhesion of the placenta to the uterine wall (e.g. in preeclampsia, in smokers).
- If the pressure inside the uterus changes suddenly (e.g. after the membranes have ruptured or in the case of twin births).
- If the mother has gestational diabetes or is malnourished.
- If the pregnant woman consumes alcohol or drugs or if she smokes.
- If the mother already had a placenta abruption in a previous pregnancy (risk between five and ten percent).
- If the mother is elderly (35 years or older).
How is a placenta detachment treated?
In the case of any premature placental abruption, it is important that the pregnant woman is immediately admitted to an obstetrics clinic and admitted to the hospital. Doctors there regularly and intensively monitor the state of health of the mother and the unborn child.
Depending on how much of the placenta has detached and the condition of the mother and child, the doctor treats a placenta differently.
If the placenta has only detached slightly and mother and child are not in acute danger, before the 35th week of pregnancy the doctor prescribes medication (eg corticosteroids) to support the lung maturation of the unborn child.
This is to prepare the child for an impending premature birth and to reduce the risk of respiratory distress syndrome (dysfunction of the lungs) in the newborn. Under close supervision, the doctor tries to maintain the pregnancy for as long as possible.
If the placenta detaches after the 35th week of pregnancy, the doctor usually performs a caesarean section immediately. By this time, the child’s lungs are usually largely mature. Continuing the pregnancy would then be associated with greater risks than delivering the child.
If the placenta detaches completely and there is heavy bleeding (or if the mother’s life is in acute danger), the doctors also perform an emergency caesarean section. If the child has already died in the womb (intrauterine death), the doctor usually induces the birth with medication and the mother delivers the child without a cesarean section.
In milder cases (e.g. marginal sinus bleeding) it is often only necessary for the pregnant woman to rest and move little until the bleeding has stopped. Doctors usually advise pregnant women to rest in bed. It is also advisable to avoid sexual intercourse during this time.
How does the doctor make a diagnosis?
If the placenta detaches prematurely, the life of both mother and child is at risk. If symptoms occur, it is therefore important to call an emergency doctor or an ambulance immediately. In the hospital, the doctor (gynaecologist) carries out a detailed physical examination (e.g. palpation of the abdomen and uterus, pulse and blood pressure measurement) and asks about any symptoms that occur.
The symptoms usually give the doctor clues as to whether the placenta is premature. In addition, the doctor constantly checks the child’s vital parameters such as pulse, blood pressure and respiration as well as the heartbeat using a CTG (cardiotocography). To do this, the doctor places a belt with measuring sensors over the mother’s abdominal wall, with which he uses a device (cardiotocograph or contraction recorder) to record the child’s heart sounds.
Premature placenta detachment is usually indicated by a change in the child’s cardiac activity. This is also referred to as “fetal distress”. The child’s pulse changes depending on how much of the placenta has detached:
- Partial placenta detachment: The child’s heart rate is consistently fast.
- Extensive placenta detachment: The baby’s heart rate is permanently low.
- Complete placental detachment: The child’s pulse may be absent.
If there is a suspicion that the placenta has separated prematurely, the doctor will also carry out an ultrasound examination (Doppler sonography). He checks whether the placenta is in the right position and whether the child is moving. The doctor can also detect a possible bruise (hematoma) behind the placenta, which may trigger placenta detachment, using ultrasound.
In women who have already had a placenta detachment, ultrasound Doppler checks are useful in the case of a subsequent pregnancy from the 20th week of pregnancy.
In addition, the doctor examines the mother’s blood. The coagulation values, such as the number of blood platelets (thrombocytes), play an important role here and usually increase sharply in the event of premature placenta detachment. In addition, the doctor checks the hemoglobin level (red blood pigment) in the blood in order to be able to assess whether there may be heavy bleeding.
How can you prevent placenta detachment?
To prevent complications during pregnancy, doctors recommend expectant mothers to avoid risk factors such as smoking, alcohol consumption and drug use.
If another medical risk factor is known, such as preeclampsia (high blood pressure, edema and protein in the urine) or gestational diabetes, medical checks should be more frequent during pregnancy.
Basically, a healthy lifestyle with enough sleep, plenty of exercise in the fresh air and a balanced diet promotes a healthy pregnancy.
