This occurs when the placenta dislodges itself from the wall of the uterus prematurely, causing the mother to bleed. Usually it happens close to term or during labor. It is dangerous for both the mother and baby as the blood loss is sudden and plenty and at the same time painful. Sometimes there is an internal hemorrhage; the bleeding happens inside but you will look pale and feel faint and shaky. There are no known reasons but this condition has been associated with the following:


• Preeclampsia, chronic hypertension or gestational hypertension


• Intrauterine growth restriction


• Having more than 5 pregnancies


• Had an abruption previously


• Have blood clotting disorders


• Have over-distended uterus


• Have polyhyramnios


• Carrying multiples


• Smoking


• Preterm premature rupture of membranes



Placental abruption may also be a direct result of an abdominal injury, e.g. you fall onto your stomach, or you are involved in a major accident.

As mentioned sometimes because the bleeding is internal, you may not see any blood initially but you will feel weak. The bleeding follows soon enough but there are some obvious changes that need immediate medical attention. So if you experience any of the below signs, don't delay and call your doctor right away:

• You feel weak, faint, pale, sweaty, disoriented or your heart beats real fast


• Cramping with or without back ache


• Abdominal pain, tenderness in the abdomen


• Frequent contractions or a prolonged contraction


• A decrease in fetal movement


• Vaginal bleeding that is dark red


In some cases the problem goes away with time and your pregnancy can continue as normal. In other situations the birth must be induced and cesarean becomes imminent.


Placenta Praevia or low-lying placenta


In such situations, the placenta lies low in your uterus. The placenta may cover the cervix totally (total praevia) or partially (marginal praevia). An ultrasound is able to capture this image; in a large number of cases the placenta will move out of the way before the birth. If the placenta is low-lying but does not cover the uterus, it will shift positions when the uterus changes shape at around week 28. Usually a scan will be arranged between week 30 and 36 to determine the position. Here again the cause is not known but your risk increases if:


• You had it in your previous pregnancy


• You had previous c-section(s) - your risk increases with each operation


• You had other uterine surgeries such as D&C or fibroids removal


• You are carrying twins or more


• Your age


• You have had many babies


If the placenta is found to be lying low after week 36, you may be admitted to the hospital until you deliver or you have the option of staying at home but you will have to make extra visits to the doctor. A vaginal or cesarean delivery will depend on how much the cervix is covered. Most doctors would prefer the 'wait and see approach' so that baby matures up while others would prefer to induce labor early. Either way you have to take things easy. Avoid lifting and carrying heavy items as there is a risk of heavy bleeding.


Placenta Trivia


• The placenta is literally your baby's support system.


• It starts off as the chorion, a membrane that surrounds the amnion and develops into a specially designed organ which interfaces between you and your baby


• Throughout fetal development, this organ will provide support and nourishment to your baby.


• It is attached to the embryo by the umbilical cord.


• Apart from this, the placenta also takes over in the production of some of the key hormones that was initially manufactured by the ovaries.


• At about 10 weeks after fertilization, the placenta is fully formed and functioning.


• Between weeks 12 and 20, this organ weighs more than the baby.


• The placenta also ensures that the mother's blood and the baby's blood don't mix, and makes sure the waste products are carried away.


• It acts as a barrier against general infection by providing antibodies to the baby that it receives from the mother.


• At term it will weigh about 500gms and measure at 3cm in thickness and 20-25 cm across. It stays firmly attached to the uterine wall, usually the upper part.