Placental Abruption: Can It Happen Again?

I am beside myself with grief since the loss of my baby a few months ago due to placental abruption. I almost lost my life as well. I saw a specialist who told me that on my ultrasound he could see a tear. This was a few days before the abruption. What are the chances that I could have a recurrence of placental abruption with a subsequent pregnancy?

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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

I am so sorry about the loss of your baby. Unfortunately, not many cases of placental abruption can be diagnosed prior to the hemorrhage and, in most cases, we only guess at what may have precipitated the placental separation.

The incidence of this condition is about 1 in 125 to 150 pregnancies but there are many different degrees of abruption. Unfortunately, the baby is lost in about 20 percent of such cases.

This condition seems to be increasing in frequency in the United States but the severity is decreasing at some sites. As parity -- the number of children born to one mother -- decreases, and as emergency transport methods improve, the death rate for mother and baby is declining.

Sadly, even if the baby lives, many have lifelong disabilities due to the diminished blood flow during the crisis.

Incidence increases with parity and age and is more common in African-American women. By far, the most commonly associated condition is either pregnancy induced hypertension or chronic hypertension.

When the abruption occurs early in gestation, the most common reason for the occurrence is associated with preterm premature rupture of the amniotic membranes. Sudden decompression may also cause premature placental separation such as occurs when one twin is delivered and the other one is still in the uterus.

External trauma that might occur with abuse or accidents may cause this condition. In addition, cigarette smoking and/or the use of cocaine and alcohol has been linked as well. Uterine fibroids may also predispose one to abruption.

Risk of placental abruption the second time is higher than with the first pregnancy. Whether or not this recurs depends upon the causation and on the presence of the predisposing factors. Some studies have shown recurrence rates to be one in eight, while some have reported a ten fold increase in rate.

There has been some research into the possibility of blood indicators for abruption. Tests for Ca-125 and thrombomodulin are experimental but may prove useful as markers for abruption before fatal hemorrhage. Serial ultrasound is another diagnostic tool but this has not been proven effective at diagnosing all cases and allowing intervention early enough.

Seek out a care provider who is willing to give you expert care both physically and emotionally. I hope you are able to fondly remember your pregnancy and your baby and are able to get to the point where another pregnancy would be possible.

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