Placental abruption

My previous query looked at the safety of strength training during pregnancy, specifically whether it causes the placenta to separate from the wall of the womb (also known as placental abruption, or abruptio placentae, because medial conditions always sound way more dramatic when they’re in Latin).

Placental abruption means the placenta has detached (come away) from the wall of the uterus, either partially or totally. The placenta is essentially the baby’s lifeline so its separation can interfere with the unborn baby’s supply of oxygen and nutrients. As totally amazing as doctors are (tongue firmly implanted in cheek), they cannot reattach the placenta.

How common is placental abruption?
– Occurs in one pregnancy every 100 worldwide;
– 50% of these are mild cases, 25% moderate, and 25% severe.

How does placental abruption present?
– Bleeding, most commonly noticed when the woman starts bleeding from the vagina (bleeding can also clot between the placenta and the wall of the uterus (retroplacental clot) in which case vaginal bleeding will be minimal or absent;
– Continuous abdominal and/or lower back pain;
– A tender/hard abdomen/uterus;
– Very frequent uterine contractions;
– Foetal distress – eg. Abnormal heart rhythm.

What causes placental abruption?
– The cause is unknown in most cases;
– Known causes include: abdominal trauma (eg. car accident, assault or fall) and uterine decompression (eg. When there is sudden loss of amniotic fluid from the womb, for instance with the birthing of twin #1, rupture of amniotic membranes).

Who is at increased risk of placental abruption?
– Advanced maternal age;
– Prior pregnancy – increased risk with increased numbers of previous pregnancies;
– Multiple gestation – twins, triplets, quads;
– Previous placental abruption;
– Maternal hypertension;
– Excessive amniotic fluid (polyhydramnious);
– Substance use – cigarettes, smoking, alcohol, drugs (as Whitney said, ‘crack is wack’);
– Medical conditions where the blood takes longer to clot;
– Iatrogenic (as as complication of a procedure like amniocentesis, if it causes bleeding and/or too much amniotic fluid is removed);
– External cephalic version (when the health care professional attempts to turn a breech baby to the head-down position).

What are the complications of placental abruption?
– Fortunately they usually only occur in moderate-severe cases;
– Unfortunately they’re pretty disasterous: foetal brain damage, stillbirth, maternal blood loss and shock, emergency hysterectomy (removal of the uterus), death of mother/baby.

How is placental abruption treated?
– I’m not going to go into great detail, but depending on the severity treatment ranges from observation to bed rest to delivery.

How can placental abruption be prevented?
– It is impossible to prevent, however we can:
– Reduce risk: basically by addressing the risk factors (have good blood pressure control, stop crack – it’s wack, give up the smoking – seriously you should have already done this… And try to prevent trauma… I know, kinda difficult. We don’t usually wake up and think ‘hmmm, today I’ll start with some hot chocolate and toast, oh, and can I get some trauma with that?’. Don’t put yourself in a situation where trauma is likely and/or possible, and wear your seatbelt always and correctly).

OK, a rather scary topic but I don’t see anything in there about (heavy) lifting cause placental abruption. Again, common sense should prevail – get clearance from your doctor, stop exercising if anything feels wrong… Blah blah…

As pour moi, I plan to keep weight training throughout pregnancy unless something comes up that prevents me from doing so… Like maybe I’ll develop a crack addition*.

* Given the overly PC and litigious world we unfortunately live in, I am obliged to say that I in no way intend to develop a crack habit, nor do I encourage others to do so. Ridiculous I know, but it has to be said.

References
vic.gov.au
mayoclinic.com
nlm.nih.gov
rta.nsw.gov.au/roadsafety/seatbelts/index.html

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One Comment

  1. Thanks for your latest updates! I feel much more reassured now 🙂

    Another question about exercising during pregnancy. I have been told to avoid ab workouts during pregnancy as it will “split my abs” *gasps* (well I don’t have washboard abs, it’s more like flabs). What is the rationale behind this? I’m trying to plan when I should stop doing isolated ab workouts such as crunches or leg raises or pilates. Obviously when I can’t see my toes over my stomach or if my stomach is big enough to cause supine hypotension I will stop but just interested to know the rationale.

    Thanks Dr Nat!!

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