Placental abruption: When a fetal-maternal link is at risk

Pregnant woman in hospital bed with IV, risk of placental abruption

“Oh no… something is wrong.” When these words suddenly enter your mind or spill out of your mouth, there is usually good reason to worry – especially when you’re pregnant.

Severe complications during a pregnancy can arise without warning. In some instances, the problem may not be evident until it is discovered through routine blood tests or imaging. But in other cases, the trouble is immediately apparent. With placental abruptions, it’s often the latter.

Vaginal bleeding, intense abdominal or back pain, and unexpected uterine contractions, tenderness or rigidity are all potential signs of a placental abruption that are clearly evident to an expectant woman. Usually, one or more of these symptoms will prompt a visit to the doctor’s office or hospital. Once a diagnosis has been made, the medical team will determine how to proceed based on the severity of the abruption, the stage of the pregnancy, and the risk to the fetus and woman.

Although many pregnancies with placental abruptions will still conclude with the labour and delivery of healthy babies, some will result in premature births, still births, and birth injuries such as cerebral palsy caused by a lack of oxygen and nutrients getting to the fetus.

When one of these tragic outcomes occur, it’s only natural to ask: “Could something have been done?”

In this blog post I’ll explain how placental abruptions occur, list some risk factors, outline potential treatments, and discuss why some cases of placental abruptions may be candidates for a birth injury lawsuit.

The placenta and abruptions

The placenta is a temporary fetal organ that develops soon after conception. When this flat, oval-shaped organ implants itself in the uterus, it creates a critical link between the fetus and mother.

Maternal and fetal blood are brought into very close contact in the placenta (but not mixed) as a way for the mother’s body to supply oxygen and nutrients to the developing baby and to remove waste. The placenta (also known as afterbirth because it is expelled from the uterus after delivery) is connected to the fetus by the umbilical cord.

Until a newborn baby can breathe on its own, feed, and expel waste through urine and feces, the placenta (with the umbilical cord) is a literal fetal lifeline.

In about one percent of all pregnancies, the placenta separates from the uterine wall lining prior to birth. In most cases this abruption is partial. With proper medical monitoring and treatment, the developing baby can still receive adequate oxygen and nutrients to assist in its growth.

However, if the separation is moderate to severe or a complete abruption, it is a medical emergency. As the fetus and mother may both be at risk, an emergency C-section will be performed. If there was severe bleeding from the abruption the mother may require a blood transfusion or other blood products. In rare cases, if bleeding cannot be stopped, an emergency hysterectomy may be required.

What are Placental Abruption Risk Factors?

Often the cause of a placental abruption remains unknown. However, certain conditions appear to put some pregnancies at higher risk. These include:

· a previous non-trauma related placental abruption

· trauma to the abdomen

· multi-fetus pregnancies

· high blood pressure

· preeclampsia

· blood clotting disorders

· maternal infection

· smoking

· illicit substance abuse, particularly cocaine

· excess amniotic fluid

· premature rupture of the membranes and rapid loss of amniotic fluid

· advanced maternal age (over 40)

· low PAPP-A (pregnancy associated plasma protein-A) in the first trimester

· high AFP (alpha-fetoprotein) in the second trimester

· uterine artery waveform notching

Placental Abruption Prevention and treatment

Placental abruptions are generally unpredictable. However, good prenatal care and monitoring – especially when risk factors are present – can lead to better outcomes. For example, if a woman has experienced a previous non-trauma related placental abruption, her risk of a future abruption during a subsequent pregnancy increases 15- to 20-fold. Ensuring the doctor is aware of such risks can help them decide whether more frequent pre-natal visits or testing are advisable.

If other risk factors can be minimized through maternal education (smoking and drug use), otherwise treated (maternal infections) or managed (high blood pressure), the odds that a pregnancy will experience a placental abruption may decrease.

Many partial abruptions can be identified on ultrasounds, while abnormal fetal growth or development are additional signs that there may be a problem with the placenta or umbilical cord that is limiting nutrient and oxygen delivery to the fetus.

If an abruption does take place, medical practitioners must follow established standards of care to provide the best chances for an outcome that protects the fetus and/or the pregnant woman. This includes timely decision-making about whether it is possible to prolong the pregnancy or how to deliver the baby to minimize injury to it and/or the mother.

When does a placenta abruption cause harm?

Unfortunately, despite a doctor’s best efforts, some placental abruptions will lead to still births, birth injuries, and/or maternal injury. In the aftermath of such injuries or deaths, part of the grieving process often involves loved ones asking: “How could this have happened?”

Frequently, all standards of care were followed, and it is reasonable to conclude that nothing could have been done to prevent the harm. In these cases, even if a child has sustained a severe birth injury, medical providers are not liable for any damages or compensation to the child or its loved ones.

In some cases, however, there may be reason to believe that an error made through medical negligence has breached standards of care and caused harm. For example, if a pregnant woman presented with obvious signs of a placental abruption at a hospital or doctor’s office, she should receive some form of treatment such as additional monitoring. If she was sent home without such intervention and she either miscarried or later delivered a child with a birth injury such as cerebral palsy or birth asphyxia, the medical providers could be liable.

If you or a loved one has experienced a placental abruption that resulted in harm to you or your child, and you believe substandard medical treatment may have played a role, it is usually worthwhile to contact an experienced birth injury lawyer to review the facts and medical records. A birth injury lawsuit for medical malpractice can result in a settlement or court award that could significantly assist you, your child, and your loved ones as you move forward with your lives. This is especially true if your child requires significant medical treatment or life-long care.

When the medical malpractice lawyer team at Gluckstein Personal Injury Lawyers receives a call about a placental abruption injury, we conduct a preliminary investigation to determine if it is something actionable. If we believe we can help you collect damages and compensation after this investigation, we will offer to represent you as you make a civil claim.

But even if what happened to you cannot be remedied in the courts, our commitment to full circle client care means we will do whatever we can to help you find alternative paths to healing, including connecting you with support groups and assisting with complaints to medical regulatory colleges or hospital ombuds.

When something has gone terribly wrong with a pregnancy, you should know you are not alone and that there are many forms of help available to you and your loved ones. To learn how Gluckstein may be able to assist you, contact us for a free consultation.


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