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Placental Abruption

Placental abruption (abruptio placentae) is a pregnancy complication that happens when the placenta separates from your uterus before delivery. The placenta is a temporary organ that connects a growing fetus to your uterus during pregnancy. It attaches to the wall of your uterus, usually on the top or side, and acts as a lifeline that gives nutrients and oxygen to the fetus through the umbilical cord. The placenta also removes waste from the fetus’s blood.

In placental abruption, the placenta may completely or partially detach. This can decrease the amount of oxygen and nutrients the fetus gets. It can also cause heavy bleeding. Your healthcare provider will need to monitor you closely and determine if an early delivery is necessary. 

Your healthcare provider will classify the abruption based on how much the placenta detaches from your uterus:

  • A partial placental abruption occurs when the placenta doesn’t completely detach from the uterine wall.
  • A complete or total placental abruption occurs when the placenta completely detaches from the uterine wall. There’s usually more vaginal bleeding with a complete abruption.

They’ll further classify it by how much you’re bleeding:

  • Revealed placental abruptions have moderate to severe vaginal bleeding that you can see.
  • Concealed placental abruptions have little or no visible vaginal bleeding. Blood is trapped between the placenta and uterine wall.

Each person can have different symptoms of placental abruption. But the most common symptom is vaginal bleeding with cramping during the third trimester of pregnancy. Other symptoms include:

  • Abdominal pain.
  • Uterine contractions that are longer and more intense than typical labor contractions.
  • Uterine tenderness.
  • Backache or back pain.
  • Feeling the fetus move less.

Vaginal bleeding can vary and isn’t an indication of how severe the abruption is. In some instances, there could be no visible bleeding because the blood is trapped between the placenta and the uterine wall. Pain can range from mild cramping to strong contractions that come on suddenly.

These symptoms can resemble other pregnancy conditions. Always contact your pregnancy care provider if you experience vaginal bleeding and cramping.

What are the first signs of a placental abruption?

The most common symptom of a placental abruption is vaginal bleeding, although you won’t always bleed. You may also have sudden, ongoing pain in your abdomen (belly) or back.

What does placental abruption feel like?

You may experience sudden or sharp pain, cramping or tenderness in your lower pelvic region or back during a placental abruption. You could also feel the fetus move less. Discuss these symptoms with your pregnancy care provider immediately.

Do you always bleed during a placental abruption?

Most of the time, you’ll see some blood during a placental abruption. But if the abruption is concealed, the blood will be trapped behind the placenta. In that case, there will be no bleeding. In other cases, the abruption develops slowly, which can cause occasional, light bleeding.

Talk to your healthcare provider about any vaginal bleeding you experience during your pregnancy.

The cause of placental abruption is often unknown. Healthcare providers only know what increases your risk for an abruption. For example, abdominal trauma, such as from a fall or accident, can increase your risk for placental abruption.

Can pushing on your belly cause placental abruption?

Pushing on your belly, like when your provider presses on your belly at your prenatal appointments, doesn’t cause a placental abruption. But a blow to your belly (such as in a car accident or falling down the steps) can cause the placenta to detach.

Can a bumpy ride in a car cause placental abruption?

No, a bumpy ride in a vehicle, bus or airplane isn’t one of the causes of a placental abruption. But your provider will ask that you avoid any activities that have a high risk of falling or abdominal trauma. This could include things like riding horses or rollercoasters.

What are the risk factors for placental abruption?

The following factors increase your risk of placental abruption:

  • Trauma or injury to your uterus (like a car accident, fall or blow to the stomach).
  • Previous placental abruption.
  • Multiple gestations (pregnant with more than one fetus).
  • High blood pressure (hypertension), gestational diabetes or preeclampsia.
  • If you smoke or use recreational drugs.
  • Being older than 40.
  • Uterine fibroids.
  • Thrombophilia (a blood clotting disorder).
  • Premature rupture of membranes (your water breaks before the fetus is full term) or losing too much amniotic fluid.
  • Chorioamnionitis (an infection in your amniotic fluid).

Placental abruption can be life-threatening to the fetus and, sometimes, to you. Complications from a placental abruption include:

For the fetus:

  • Premature birth.
  • Low birth weight.
  • Growth problems (intrauterine growth restriction).
  • Brain injury from lack of oxygen.
  • Stillbirth.

For the mother:

  • Anemia.
  • Blood clotting issues.
  • Blood transfusion.
  • Hemorrhage.
  • Kidney failure.

Your healthcare provider will diagnose placental abruption with an exam and other tests. You may be admitted to the hospital depending on the severity of the abruption or you may be able to rest at home. Your healthcare provider will:

  • Ask how much bleeding has occurred.
  • Ask where you feel pain and how intense the pain is.
  • Ask when symptoms started.
  • Monitor your blood pressure.
  • Monitor your contractions.
  • Monitor the fetal heart rate and movement.
  • Use ultrasound to locate the bleeding and to check the fetus.
  • Recommend urine or blood tests.

There are typically three grades, or classes, of placental abruption a healthcare provider will diagnose:

  • Grade 1: Small amount of bleeding, some uterine contractions and no signs of stress to you or the fetus. This is usually a mild or partial placental abruption, meaning only part of the placenta is detached.
  • Grade 2: Mild to moderate amount of bleeding, some uterine contractions and possible signs of fetal distress.
  • Grade 3: Moderate to severe bleeding or concealed bleeding, uterine contractions that don’t relax, abdominal pain, low blood pressure and potential fetal death.

Once the placenta has separated from the uterus, it can’t be reconnected or repaired. A healthcare provider will recommend treatment based on:

  • The severity of the abruption.
  • How long the pregnancy is/gestational age of the fetus.
  • Signs of distress from the fetus.
  • Amount of blood you’ve lost.

Generally, the severity of the abruption and gestational age of the fetus are the two most important factors in determining treatment.

If the fetus isn’t close to term:

  • If it’s too soon for the fetus to be born and your abruption is mild, your healthcare provider will monitor you closely. You may go home to rest, or you may stay in the hospital. Your provider may give you corticosteroids to help the fetus’s lungs mature. They’ll continue to monitor you.
  • If the abruption is severe and the health of you or the fetus is at risk, immediate delivery may be necessary even if the fetus isn’t close to term (37 weeks of pregnancy).

If the fetus is near term:

  • If the abruption is mild and the fetal heart rate is normal, your provider may allow your pregnancy to continue to term. They may give you corticosteroids to mature the fetus’s lungs and monitor you closely for changes.
  • If the abruption is severe, delivery may need to happen immediately. If you or the fetus is in danger at any time, the baby will be delivered (typically via emergency C-section).

If at any point any of the following occur, you may need to give birth (no matter what the age of the fetus):

  • The abruption gets severe/worsens.
  • You’re bleeding heavily or develop severe anemia.
  • The fetus is in distress and showing signs it lacks oxygen.

How do you treat a mild placental abruption?

Even if the abruption is mild, your healthcare provider will consider the gestational age of the fetus in their treatment plan. For example, if you’re at term, they may still recommend inducing labor. If you’re still months away from your due date, your provider may consider a different approach, even for a mild abruption. Generally, the pregnancy can continue to term unless the abruption or bleeding worsens, or the fetus shows signs of being in trouble.

How do you treat a severe placental abruption?

A severe abruption is usually a medical emergency because both the fetus and mother are at risk for life-threatening complications. Delivery typically occurs immediately.

What can I expect if I have a placental abruption?

This can vary depending on the severity of your symptoms and how far along you are in your pregnancy. You can expect for your healthcare provider to monitor you closely and often. Watch for any changes in symptoms and discuss them with your provider immediately.

Can a baby survive a placental abruption?

The two factors that affect survival rate are gestational age at birth and the severity of the abruption. Early detection, close monitoring and quick treatment can help reduce complications. If a severe abruption occurs, there’s about a 15% chance it’ll end in fetal death.

Can I have another placental abruption?

You have about a 15% chance of having another abruption in a future pregnancy after you have one. With two prior abruptions, this chance increases to about 25%. Tell your healthcare provider if you’ve had a previous placental abruption.

Can I prevent a placental abruption?

You can’t typically prevent a placental abruption. But you can reduce your risk by:

  • Not smoking or using recreational drugs. Talk to your provider before taking any medication during pregnancy.
  • Keeping your blood pressure at a healthy level.
  • Managing chronic health conditions.
  • Taking health and safety precautions like wearing a seat belt.
  • Reporting any abdominal trauma or vaginal bleeding to your healthcare provider.

When do I call my healthcare provider if I suspect a placental abruption?

Call your healthcare provider immediately if you’re bleeding, cramping or experiencing pelvic pain during your pregnancy, especially in the third trimester.

What are questions I should ask my healthcare provider?

Your healthcare provider should be able to answer your questions and prepare you for placental abruption treatment. Here are some questions you might ask:

  • Is my baby’s life in danger?
  • What could happen to me if I have an abruption?
  • What are my treatment options?
  • Can I give birth now?
  • How will I know if my abruption is worsening?
  • What are potential complications?
  • Do I need additional tests?
  • Will this happen again in future pregnancies?
  • American Pregnancy Association. Placental Abruption (https://americanpregnancy.org/healthy-pregnancy/pregnancy-complications/placental-abruption/). Accessed 3/17/2024.
  • Ananth CV, Lavery JA, Vintzileos AM, et al. Severe placental abruption: clinical definition and associations with maternal complications (https://pubmed.ncbi.nlm.nih.gov/26393335/). Am J Obstet Gynecol. 2016;214(2):272.e1-272.e9. Accessed 3/17/2024.
  • Brandt JS, Ananth CV. Placental abruption at near-term and term gestations: pathophysiology, epidemiology, diagnosis, and management (https://pubmed.ncbi.nlm.nih.gov/37164498/). Am J Obstet Gynecol. 2023;228(5S):S1313-S1329. Accessed 3/17/2024.
  • Hull, Andrew D. et al: Placenta previa and accrete, vasa previa, subchorionic hemorrhage, and abruptio placentae In: Robert Resnik MD and Robert M. Silver MD. Creasy and Resnik’s Maternal-Fetal Medicine: Principles and Practice. 8th ed. Elsevier;2019: 786-97. Accessed 3/17/2024.
  • March of Dimes®. Placental abruption (https://www.marchofdimes.org/find-support/topics/pregnancy/placental-abruption). Last updated 9/2021. Accessed 3/17/2024.
  • Merck Manuals, Consumer Version. Placental Abruption (https://www.merckmanuals.com/home/women-s-health-issues/complications-of-pregnancy/placental-abruption). Last reviewed 10/2022. Accessed 3/17/2024.
  • Schmidt P, Skelly CL, Raines DA. Placental Abruption (https://www.ncbi.nlm.nih.gov/books/NBK482335/). 2022 Dec 19. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan. Accessed 3/17/2024.
  • The American College of Obstetricians and Gynecologists. Bleeding During Pregnancy (https://www.acog.org/womens-health/faqs/bleeding-during-pregnancy). Last reviewed 8/2022. Accessed 3/17/2024.

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