Placenta Abruption: What Can Cause This and What Are the Risks?

My niece is 16 weeks pregnant. An ultrasound showed the baby is progressing normally, but the placenta appears to be about 50 percent bruised and pulling away from the uterus. The doctor suggested an abortion because the chances of her carrying the baby to term are slim.


Peg Plumbo CNM

Peg Plumbo has been a certified nurse-midwife (CNM) since 1976. She has assisted at over 1,000 births and currently teaches in the... Read more

You are describing a placental abruption and you are correct that it is a premature separation of the placenta from its uterine attachment site. In some cases, we can identify a cause, but in others there is no apparent cause. Risk factors for abruption include trauma to the abdomen, uterine malformation or excessive scarring from procedures or infections as well as maternal drug use, smoking, maternal hypertension and babies with certain kind of heart defects.

At 16 weeks, if the placenta is half abrupted, the picture looks bleak -- but not beyond hope. If whatever caused the separation has ceased, there is still much time for placental growth. The baby should be followed with frequent ultrasounds for fetal growth. She would be at an increased risk for intrauterine growth restriction and premature labor.

Efforts should be made to discover the cause of this.

If the abruption is "occult" or "concealed" (no obvious external bleeding), the mother can still lose blood behind the placenta and develop abdominal pain, uterine irritability and even rigidity. If the abruption is at the margin of the placenta, "apparent" hemorrhage may occur. She would see bleeding externally. I,f left untreated, both of these types are dangerous for mother and baby.

There is no way to really stop placental hemorrhage once it occurs. The baby must be forfeited if the blood loss is severe. Whether or not this is an indication for abortion would depend upon the extent of the abruption and its effects thus far on the baby. Serial ultrasounds could mark any progression in the separation and monitor baby's reaction. I would seek a second opinion if possible.

I'm sorry that you both have to go through this. I wish you well with these difficult decisions.

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