Some vaginal spotting during pregnancy can be disconcerting — but fortunately, in many cases, it's nothing to worry about.

However, if you experience vaginal bleeding accompanied by abdominal pain, it could be a sign of placental abruption — a more serious but treatable condition, especially if it's caught early.

Here's what you need to know about placental abruption, from symptoms to diagnosis and treatment.

What is placental abruption?

Placental abruption (also called abruptio placentae) is the early separation of the placenta (the fetal support system), which provides baby with nutrients and oxygen from you via the umbilical cord) from the uterine wall during pregnancy, rather than after delivery.[1]

How common is placental abruption?

Placental abruption is relatively rare, with slight separation occurring in only about one of 100 pregnancies (that's less than 1 percent).

Two-thirds of abruptions are severe. It almost always occurs in the third trimester, and most commonly at term.[2]

Who is most at risk for placental abruption?

Placental abruption can happen to anyone, but it occurs most frequently in women who:

  • Have had a previous abruption
  • Smoke or use cocaine
  • Have blood pressure, including chronic hypertension and preeclampsia
  • Experience abdominal trauma (a severe blow/fall on the abdomen or car accident)
  • Are older (over 40)
  • Have structural uterine abnormalities, such as fibroids
  • Have premature rupture of the membranes (before week 37 of pregnancy)

If the placenta separation is slight, there is usually less danger to the mother or baby, but prompt evaluation by your doctor is needed.

If the abruption is more severe, however, the risk to the baby is considerably higher. That's because a placenta's complete detachment from the uterine wall means that the baby is no longer getting oxygen or nutrition. In more severe cases, placental abruption can put both mother and baby at risk for hemorrhage.

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What are the signs and symptoms of placental abruption?

The symptoms of abruptio placentae depend on the severity of the detachment, but usually include:

How is placental abruption diagnosed?

A diagnosis is usually made using patient history, physical exam and observation of uterine contractions and fetal response to them. Tests for placental abruption may include, among others:

Treatment for placental abruption

Treatment depends on the severity of the separation:

  • Slight separation: If your placenta has separated from the uterine wall but has not completely detached and your baby's vital signs stay regular, you may be held in the hospital for observation and released if the condition doesn't worsen and bleeding stops. You'll also probably be put on bed rest (more commonly known these days as activity restriction). If the bleeding continues, you may require intravenous fluids. Your practitioner may also administer steroids to speed up your baby's lung maturation in case you need to deliver early.
  • Severe separation: If the abruption is severe or if it continues to progress, the only way to treat it is to deliver the baby — otherwise the fetus may not be getting nutrients and oxygen and the mother may experience significant, though rarely life-threatening, blood loss or postpartum hemorrhaging (in which case a blood transfusion is usually required). The decision as to whether to do a vaginal or cesarean delivery will depend on your condition and that of your baby. If the mother is Rh negative and has been in a car accident or trauma, she may need the medication RhoGAM.

When to call your doctor if you suspect placental abruption

Let your practitioner know immediately if you have abdominal pain accompanied by bleeding, especially in the second half of your pregnancy.[3]

Same goes if you fall on your abdomen or are in a car accident. Placental abruption can be treated to protect both you and your baby — but delayed diagnosis and treatment can be dangerous for both of you.