What is placental abruption?

Placental abruption happens when the placenta partially or completely separates from the wall of the uterus (womb). While it can happen at any stage from 20 weeks into pregnancy, almost 1 in every 2 cases of placental abruption happen after week 37 of pregnancy.

While placental abruption is rare, it is a medical emergency, because your baby depends on the placenta for their survival.

What are the symptoms of placental abruption?

Common symptoms of placental abruption are:

• vaginal bleeding
• abdominal (tummy) or back pain

The amount of bleeding doesn’t necessarily reflect how bad the abruption is. In some cases, bleeding (which can be severe) occurs behind the placenta and does not come out of your vagina. However, in most cases, there will be some type of vaginal bleeding.

With placental abruption, pain tends to be constant, rather than coming in waves like contractions. It is usually severe, however in some cases there is only mild pain or none at all.

If you experience bleeding during your pregnancy, contact your midwife or doctor immediately. If the bleeding or pain are severe, call an ambulance on triple zero (000), or go to your nearest hospital emergency department.

CHECK YOUR SYMPTOMS — Use the Symptom Checker and find out if you need to seek medical help.

What are the causes of placental abruption?

The cause of placental abruption is usually unknown.

In a minority of cases, a serious injury to the abdomen, such as a fall or car accident, is the cause of placental abruption.

Factors that may increase your chance of placental abruption include:

• placental abruption in a past pregnancy
• your waters breaking before 37 weeks of pregnancy
• having twins or other multiple pregnancy
• smoking or using drugs such as cocaine or amphetamines
• high blood pressure or pre-eclampsia
• an infection in your uterus
• age over 35 years old

When should I see my doctor?

If you have any vaginal bleeding during your pregnancy, it’s important to see your doctor or midwife as soon as possible.

Vaginal bleeding during the last trimester of pregnancy is often due to a problem with your placenta.

It’s important to keep your routine antennal appointments throughout your pregnancy. This helps your health team find and address any problems early, so you and your baby have the best chance of a safe, uncomplicated birth.

If you experience bleeding during your pregnancy, contact your midwife or doctor straight away. If the bleeding or pain are severe, call triple zero (000) and ask for an ambulance.

FIND A HEALTH SERVICE — The Service Finder can help you find doctors, pharmacies, hospitals and other health services.

How is placental abruption diagnosed?

There is no test that can be used to definitively diagnose placental abruption. Your doctor may suspect placental abruption based on your symptoms, a physical examination and some special tests.

The physical examination will usually include, with your consent, an internal examination with a speculum to check for the source of the bleeding.

Ultrasound isn’t usually used to diagnose placental abruption, but it may be used to rule out other causes of pain and bleeding such as placenta praevia.

Your doctor or midwife may also recommend fetal heart monitoring with a cardiotocograph (CTG) to check for contractions and assess your baby’s general wellbeing. You may also have blood tests to check your haemoglobin levels and blood group, in case you need a blood transfusion.

How is placental abruption treated?

Placental abruption is a medical emergency that requires urgent assessment and treatment.

If your placenta has completely separated, there is nothing your doctor can do to reattach it. It is a medical emergency that is life-threatening to your baby if it is not treated immediately. In most cases, you will need an emergency caesarean to birth your baby safely. Complete placental abruption can also cause severe bleeding that may be life-threatening for you without urgent medical treatment.

In cases where the placenta has only partially separated from your uterus and you have mild symptoms only, your doctor may recommend close monitoring in hospital. This is especially true if you are less than 37 weeks pregnant. In these cases, the bleeding may resolve on its own. If it worsens, you will be in the safest place for urgent treatment.

Your doctor will discuss with you the safest course of action depending on your situation.

What are the complications of placental abruption?

Placental abruption is rare, but the serious complications can be life-threatening.

Your baby depends on the placenta for survival. If the placenta separates too early, there is a chance of stillbirth.

Treatment for placental abruption often requires premature birth, which is associated with its own potential risks.

If you have severe blood loss following placental abruption, you may need a blood transfusion or other treatments recommended by your medical team.

What can I expect recovering from a birth with placental abruption?

If you needed to give birth urgently because of a placental abruption, you or your baby may need to recover for longer than expected in hospital.

Whether you had a recovery or caesarean birth, recovery can be more difficult if your birth didn’t go as planned.

If you experience unexpected problems during pregnancy and birth, you may feel disappointed, sad or distressed. It’s important to speak with your medical team about how you are feeling so they can help you and your family through your recovery.

Learn more about the emotional impact of birth trauma.

If you need to talk to someone about your mental health call Beyond Blue on 1300 22 4636.

Resources and support

Speak with your medical team so they can help you and your family through your recovery.

You can get help and information from:

• Westmead Hospital's Women's and Newborn Health has a fact sheet about placental abruption.
• The Australian Birth Trauma Association offers advice, resources and a peer support service.
• The Centre of Perinatal Excellence (COPE) gives information and a list of support services.

You can also call:

• Pregnancy, Birth and Baby to speak to a maternal child health nurse on 1800 882 436 or video call. Available from 7 am to midnight (AET), 7 days a week (including public holidays).
• Perinatal Anxiety & Depression Australia (PANDA) on 1300 726 306 to speak with a counsellor.

Other languages

NSW Health offer a Having a baby book in English and other languages.