Abruptio Placenta

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Abruptio Placenta

Topic Overview

What is abruptio placenta?

Abruptio placenta is a problem with the placenta during pregnancy. The placenta is a round, flat organ that forms during pregnancy to give the baby food and oxygen from the mother. During a normal pregnancy, the placenta stays firmly attached to the inside wall of the uterus until the baby has been born. But with abruptio placenta, the placenta breaks away, or abrupts, from the wall of the uterus too early, before the baby is born. This problem can cause:

  • Premature birth.
  • Low birth weight.
  • Major blood loss in the mother.

Abruptio placenta can be very harmful for both the mother and the baby. In rare cases, it can cause death.

See a picture of abruptio placenta.

Abruptio placenta is also called placenta abruptio or placental abruption. It affects about 9 out of 1,000 pregnancies. It usually occurs in the third trimester, but it can happen at any time after the 20th week of pregnancy.

What causes abruptio placenta, and how can you lower your risk?

Doctors aren't sure what causes abruptio placenta. But there are things that raise a woman’s risk for an abruption. These things are called risk factors. If you avoid them, you can lower your risk.

Common risk factors for abruptio placenta include:

  • High blood pressure (140/90 or higher). This is the most common risk factor linked to abruptio placenta, whether the high blood pressure is chronic (long-term) or is caused by the pregnancy (pre-eclampsia).
  • Having a placental abruption in the past.
  • Smoking during pregnancy.

Less common risk factors for abruptio placenta include:

  • Using cocaine.
  • Having a scar from a past surgery or a uterine fibroid where the placenta has attached to the wall of the uterus.
  • Having an injury to the uterus. This could happen in a car accident.
  • Premature rupture of membranes for 24 hours or more, especially when there is an infection in the uterus.

What are the common symptoms?

If you have abruptio placenta, you may notice one or more warning signs. Call your doctor right away if you are pregnant and have any of these symptoms:

  • Light or moderate vaginal bleeding. Bleeding caused by an abruption depends on where the abruption is and how long it has taken for the blood to pass.
  • A uterus that hurts or is sore. It might also feel hard or rigid.
  • Signs of early labour. These include regular contractions and aches or pains in your lower back or belly.

Call 911 or emergency services right away if you have:

  • Sudden or severe pain in your belly.
  • Severe vaginal bleeding.
  • Any symptoms of shock. These include feeling light-headed or like you are going faint; feeling confused, restless or weak; feeling sick to your stomach or vomiting; and having fast, shallow breathing.

You can't really tell how serious an abruption is by the amount of vaginal bleeding. There might be a serious problem even if there is only a little bleeding. Sometimes the blood can be trapped between the placenta and the wall of the uterus. In rare cases, symptoms of shock will be the only signs that there is a problem.

How is abruptio placenta diagnosed?

Your doctor will ask questions about your symptoms and will check your baby’s heart rate. You may have an ultrasound test. Your doctor might also do a blood test to see if you're anemic from losing blood.

If your doctor thinks that you have a placental abruption, you'll likely have to stay in the hospital for at least a few hours. Your doctor will need to find out how severe the abruption is, if it is getting worse, and if it is affecting your baby.

How is it treated?

The kind of treatment you will have depends on:

  • How severe the abruption is.
  • How it is affecting your baby.
  • How close your due date is.

If you have a mild abruption, it may get better on its own. You may just be closely watched for the rest of your pregnancy. You may not have to stay in the hospital.

A medium to severe abruption means that you will likely have to stay in the hospital so that the baby's health can be watched closely. In most cases, the baby will need to be delivered, sometimes by emergency caesarean section.

Frequently Asked Questions

Learning about abruptio placenta:

Being diagnosed:

Getting treatment:


Not every woman with abruptio placenta has symptoms.

If you have abruptio placenta, you may notice one or more symptoms, including:

  • Vaginal bleeding. Depending on the location and amount of separation, vaginal bleeding varies in amount (scant to heavy) and colour (bright to dark red). Light vaginal bleeding does not necessarily indicate a minor problem. In some cases, a large amount of blood can be pooled between the placenta and the uterine wall, resulting in little or no vaginal bleeding.
  • Uterine tenderness or pain. The uterus may feel hard or rigid.
  • Signs of preterm labour. In some women with abruptio placenta, labour symptoms are the first sign of trouble. Labour symptoms can include:
    • Regular contractions.
    • Pain in the abdomen or back. This pain can be sharp or aching.

In rare cases, when heavy blood loss is retained in the uterus behind the placenta, the only signs of abruptio placenta are symptoms of shock. Early signs of shock (most of which are present at the same time) include:

  • Light-headedness or a feeling that you are about to pass out.
  • Restlessness, confusion, or feelings of fear or anxiety.
  • Shallow, rapid breathing.
  • Moist, cool skin or possibly profuse sweating.
  • Weakness.
  • Thirst, nausea, or vomiting.

High blood pressure (hypertension) is the most common risk factor associated with abruptio placenta. For more information, see the topic Pre-Eclampsia and High Blood Pressure During Pregnancy.

Examinations and Tests

A separation of the placenta from the uterine wall, or abruptio placenta, can be difficult to identify. Diagnosis is based on a physical examination, a medical history, and a process of elimination. Testing may include:

  • Fetal heart monitoring, to assess the fetus's condition and check for contractions of the uterus.
  • An ultrasound test, which can detect about 50% of placental abruptions.1 A negative ultrasound result does not necessarily guarantee that the placenta is intact.
  • A blood test for anemia. A woman with abruptio placenta can become anemic from excessive blood loss.

Treatment Overview

A placenta that has separated from the uterine wall (abruptio placenta) cannot be repaired. Until its severity can be assessed, abruptio placenta is considered a medical emergency. If you have suspected or diagnosed abruptio placenta, 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 abruptio placenta, you will have an Rh immune globulin shot, such as WinRho. This is because your fetus could be Rh-positive. Bleeding from an abruption can mix the Rh-positive blood with yours. The Rh immune globulin prevents your immune system from attacking the Rh-positive blood.

Abruptio placenta is usually treated by an obstetrician or perinatologist.

Mild abruptio placenta

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 labour, the separation is minor, and you are far from your due date, you may be given tocolytic medicine to stop labour. For more information, see the topic Preterm Labour.

Moderate to severe abruptio placenta

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 caesarean (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 centre 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).
  • The Society of Obstetricians and Gynecologists recommends you take 0.4 mg (400 mcg) to 1 mg (1000 mcg) of folic acid two to three months before conception and throughout pregnancy.3 Talk with your health professional about how much folic acid you need.
  • See your health professional regularly throughout your pregnancy.

Home Treatment

Call 911 or other emergency services immediately if you have:

  • Sudden, severe belly pain.
  • Severe vaginal bleeding.
  • Any symptoms of shock (from heavy blood loss). Symptoms of shock include light-headedness, weakness, confusion, restlessness, and shallow, rapid breathing.

During pregnancy, pay attention to symptoms or injuries that can be related to the placenta separating from the uterine wall (abruptio placenta). Call your health professional immediately if you are pregnant and you experience:

  • Light or moderate vaginal bleeding.
  • Sudden, but moderate, belly pain. The uterus may feel hard or rigid.
  • A blow to the abdomen, as from a fall or a physical attack.
  • A motor vehicle accident.
  • Signs of preterm labour, including:
    • Regular contractions.
    • Pain in the abdomen or back. This pain can be sharp or aching.


Although most cases of abruptio placenta cannot be directly prevented, you can avoid or treat factors that are known to greatly increase your risk of placental abruption.

  • Avoid cigarette smoking during pregnancy.
  • Avoid cocaine and methamphetamine use during pregnancy.
  • Keep a regular schedule of prenatal checks throughout your pregnancy.
  • If you have high blood pressure, carefully follow your health professional's treatment recommendations.
  • The Society of Obstetricians and Gynecologists recommends you take 0.4 mg (400 mcg) to 1 mg (1000 mcg) of folic acid two to three months before conception and throughout pregnancy.3 Talk with your health professional about how much folic acid you need.

Even during a healthy pregnancy, abruptio placenta is a possible complication. But you can optimize your fetus's and your ability to handle a medical complication by making healthy lifestyle choices and having regular prenatal checks throughout your pregnancy. For more information, see the topic Pregnancy.

Coping with loss

Should your baby die as a result of abruptio placenta, allow yourself permission and time to grieve your loss. Your partner, children, and other family members may also need time to grieve.

Contacting a support group, reading about the experiences of other women, and talking to your doctor, friends, a counsellor, or a member of the clergy may help you and your family deal with your loss. For more information, see the topic Grief and Grieving.

If you have plans to become pregnant after having had abruptio placenta, talk to your health professional ahead of time about maximizing your chances of a healthy pregnancy in the future.

Other Places To Get Help


Society of Obstetricians and Gynaecologists of Canada (SOGC)
780 Echo Drive
Ottawa, ON  K1S 5R7
Phone: 1-800-561-2416
(613) 730-4192
Fax: (613) 730-4314
Email: helpdesk@sogc.com
Web Address: www.sogc.org

The mission of SOGC is to promote optimal women's health through leadership, collaboration, education, research, and advocacy in the practice of obstetrics and gynaecology.

March of Dimes
1275 Mamaroneck Avenue
White Plains, NY  10605
Phone: (914) 997-4488
Web Address: www.marchofdimes.com

The March of Dimes tries to improve the health of babies by preventing birth defects, premature birth, and early death. March of Dimes supports research, community services, education, and advocacy to save babies' lives. The organization's Web site has information on premature birth, birth defects, birth defects testing, pregnancy, and prenatal care. You can sign up to get a free newsletter and also explore Understanding Your Newborn: An Interactive Program for New Parents.

SHARE: Pregnancy and Infant Loss Support
c/o St. Joseph's Health Center
300 First Capitol Drive
St. Charles, MO  63301-2893
Phone: 1-800-821-6819
(636) 947-6164
Fax: (636) 947-7486
Email: share@nationalshareoffice.com
Web Address: www.nationalshareoffice.com

This organization provides mutual support for bereaved parents and families who have suffered a loss due to miscarriage, stillbirth, or neonatal death. SHARE provides newsletters, pen pals, and information regarding professionals, caregivers, and pastoral care.



  1. Kay HH (2008). Placenta previa and abruption. In RS Gibbs et al., eds., Danforth's Obstetrics and Gynecology, 10th ed., pp. 387–399. Philadelphia: Lippincott Williams and Wilkins.
  2. Miller DA (2002). Abruptio placentae. In DR Mishell Jr et al., eds., Management of Common Problems in Obstetrics and Gynecology, 4th ed., pp. 141–144. Malden, MA: Blackwell.
  3. Wilson DR, et al. (2007). Pre-conceptional vitamin/folic acid supplementation 2007: The use of folic acid in combination with a multivitamin supplement for the prevention of neural tube defects and other congenital anomalies. SOGC Clinical Practice Guideline No. 201 (replaces No. 138). Journal of Obstetrics and Gynaecology Canada, 29(12): 1003–1013. Also available online: http://www.sogc.org/guidelines/documents/guiJOGC201JCPG0712.pdf.

Other Works Consulted

  • Cunningham FG, et al. (2010). Placenta abruption section of Obstetrical hemorrhage. In William's Obstetrics, 23rd ed., pp. 757–795. New York: McGraw-Hill.
  • Joseph KS, et al. (2005). The perinatal effects of delayed childbearing. Obstetrics and Gynecology, 105(6): 1410–1418.
  • Scearce J, Uzelac PS (2007). Third-trimester vaginal bleeding. In AH DeCherney et al., eds., Current Diagnosis and Treatment Obstetrics and Gynecology, 10th ed., pp. 328–341. New York: McGraw-Hill.


By Healthwise Staff
Primary Medical Reviewer Sarah Marshall, MD - Family Medicine
Primary Medical Reviewer Brian D. O'Brien, MD - Internal Medicine
Specialist Medical Reviewer William Gilbert, MD - Maternal and Fetal Medicine
Last Revised August 9, 2011

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