Placental abruption or detachment of the placenta before delivery

Outside the operation theatre, he held my arms firmly and gave me a gentle hug. With a voice charged with emotion, he said” Doc, thank you for saving my wife and my baby. Thank you." He was full of joy and gratitude. Tears were rolling down his cheeks as he spoke.

Barely an hour ago, his wife, M, 30 was admitted to the labour ward with severe abdominal pain and heavy vaginal bleeding. She was at the 38th week of her second pregnancy. When I examined her, the womb (uterus) was tense, hard and tender. Large clots were oozing out from the neck of the womb (cervix). Her blood pressure was raised at 150/95 mmHg. The baby’s heart rate was low at 110 beats minutes which suggested a lack of oxygen supply to it.

I performed a Caesarean section right away. At the operation, there was a large amount of blood clot behind the placenta, which had peeled off prematurely from its bed. The baby was delivered quickly and cried well after resuscitation.

M had a serious complication of pregnancy called placental abruption or detachment of the placenta before delivery. The placenta is a structure that connects the baby to the mother’s womb via the umbilical cord. It supplies oxygen and nutrients to the growing baby. If it is shed off from the wall of the uterus prematurely, both the mother and the baby can be in danger.

This condition is not common occurring in 1 to 2 percent of all pregnancies. There are various factors that make placental abruption happen more easily. These include:

· Past history of placental abruption

· Previous caesarean section

· Raised blood pressure during pregnancy

· Maternal age over 35 years of age

· Smoking

· Too much amniotic fluid

· Premature rupture of the membranes (water-bag breaks prematurely before labour)

· A blow to the tummy, such as from a fall or car accident

When placental abruption occurs, there will be varying amounts of bleeding from heavy with clots to slight with staining. But the amount can be deceptive. It does not always correspond to the degree of placental detachment. Blood could be trapped in the uterus by the placenta, resulting in little blood loss when the detachment is in fact, severe. Abdominal pain and/ or backache are often present. They can begin suddenly with a tender and tense uterus as in M’s case.

In severe case of placental abruption, a delayed treatment may put the mother and the child in danger. The mother may go into shock from heavy blood loss. She may go into a life-threatening state when her blood is unable to clot. Her major organs such as kidneys and liver may fail. Maternal death happens with all these complications. For the baby, premature birth, fetal distress and stillbirth are known outcomes. Luckily, we managed to intervene early and delivered M and her baby in time. They were both discharged well three days after the Caesarean section.