Placental Abruption During Labor & Delivery

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Placental abruption happens when the placenta separates prematurely from the uterine wall. It usually occurs in the third trimester, but can occur as early as 20 weeks gestation. Placental abruption occurs in about one percent of pregnancies (1).

When this happens, the baby can stop receiving adequate oxygen. Even cases of partial placental abruption (when the placenta is not completely detached) can progress and become severe very quickly, so physicians should carefully monitor the situation and be prepared for an emergency C-section. If a necessary C-section is delayed, the baby may experience birth asphyxia and sustain forms of brain damage such as hypoxic-ischemic encephalopathy (HIE) and cerebral palsy (CP).

There are a number of conditions and risk factors associated with placental abruption. These can include (1, 2):

• Maternal hypertension (preeclampsia or high blood pressure)
• Trauma to the abdomen
• Rupture of membranes (mother’s water breaks)
• Chorioamnionitis
• Pregnancy with multiples
• Previous placental abruption
• Advanced maternal age (over 35)
• Abnormalities in the uterus
• Smoking
• Induction of labor
• Intrauterine growth restriction (IUGR)

Signs and symptoms of placental abruption can include (1, 2):

• Vaginal bleeding (however, 20 percent of women will not experience bleeding)
• Rapid contractions or uterine irritability
• Uterine pain or tenderness
• Abdominal pain
• Fetal heart rate abnormalities
• Back pain

Any amount of vaginal bleeding during pregnancy should be documented and assessed by your medical caregiver as soon as possible. Excessive bleeding requires immediate emergency medical attention.

Any trauma to the abdomen during pregnancy should be assessed immediately!

Caregivers should suspect and act on placental abruption based on the risk factors and symptoms described above.

A patient with a partial placental separation must be closely monitored and the baby should be delivered emergently if the condition becomes non-reassuring (1).

Placental abruption can lead to the following (1, 2):

• Premature birth
• Low birth weight
• Fetal growth restriction
• Maternal blood loss
• Need for blood transfusion
• Blood clotting issues
• Maternal hemorrhage
• Fetus not getting enough oxygen*
• Fetal death

Failure to quickly deliver a baby when a placental abruption occurs can cause the baby to experience severe oxygen deprivation (birth asphyxia), which can cause birth injuries such as:

• Hypoxic-ischemic encephalopathy (HIE): HIE usually involves damage to the basal ganglia, cerebral cortex, or watershed regions of the brain, but it sometimes includes periventricular leukomalacia (PVL)
• Neonatal encephalopathy
• Permanent brain injury
• Seizure disorders
• Cerebral palsy (CP)
• Developmental delays
• Learning disabilities
• Motor disorders
• Microcephaly

Medical professionals should follow standard of care to minimize the chance of placental abruption (especially in women with risk factors), monitor the health of both mothers and babies, and promptly intervene if a placental abruption occurs. Failure to do these things is negligence, and if negligence causes harm, it constitutes medical malpractice.

A birth injury can be defined as any type of harm to a baby that occurs shortly before, during, or after delivery. In cases of placental abruption, babies may sustain birth injuries such as hypoxic-ischemic encephalopathy, cerebral palsy, and other forms of brain damage.

If your child has a birth injury caused by mismanaged placental abruption, they may be eligible for compensation through a birth injury lawsuit. This compensation can cover medical treatments, caretaking expenses, assistive technology (e.g. mobility equipment), and other forms of support they may require throughout their life.