Spotting, back pain, and cramps are all typical third-trimester symptoms — but they're also all potential signs of placental abruption, when the placenta separates from the wall of the uterus. It only happens in about 1% of pregnancies, but if you have a severe abruption, your baby won't receive oxygen or nutrients and may need to be delivered immediately.

Here's how to know if this might be happening to you and what to expect next.

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Key Takeaways
  • Placental abruption is rare but potentially serious. It happens when the placenta separates from the uterus before delivery.
  • Bleeding plus abdominal pain can be an important warning sign. Risk is higher with factors such as previous placental abruption, high blood pressure, or preeclampsia, smoking, abdominal trauma, and premature rupture of membranes.
  • Prompt medical evaluation and treatment are important. Mild cases may be monitored closely, but if you have a severe or worsening case, your baby may need to be delivered right away.

What is placental abruption?

Placental abruption (also called abruptio placentae) is the early separation of the placenta (the fetal support system) from the uterus. The placenta provides your baby with nutrients and oxygen via the umbilical cord during pregnancy.[1]

How common is placental abruption?

Placental abruption is relatively rare, with slight separation occurring in only about one of 100 pregnancies.

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

Looking for a little extra reassurance? Download the What to Expect app to track your symptoms and connect with other expectant mamas in our supportive Community forums.

Who is most at risk for placental abruption?

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

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

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

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:

What is the 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 kept 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 your baby — otherwise the baby may not be getting enough nutrients and oxygen, and you 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 delivery or cesarean delivery will depend on your condition and that of your baby. If you are Rh negative and have been in a car accident or experienced trauma, you may need the medication RhoGAM.

What to Expect Community mom qwerty56799 describes her partial abruption at 16 weeks: "I was put on strict bedrest for a week, monitored again a week later, and the abruption had completely healed. I was then on pelvic rest and weight restrictions to not lift more than 20 pounds for the remainder of the pregnancy." Her baby was born at 38w4d, completely healthy.

"They determined I had a partial abruption, so I was given steroid shots to help his lungs mature faster (just in case) and was put on bedrest (at home) until the end of my pregnancy (about 6 weeks)," says Community mom 6 littlezzz. "I was told if the bleeding continued, I’d need a c-section. Thankfully, it didn’t continue, but I did have to stay on strict bedrest until he was due (I was induced at 40 weeks). Everything turned out fine in the end, thankfully! Delivery went well and he was perfectly healthy. No NICU stay."

Should you call your practitioner if you suspect placental abruption?

Let your practitioner know immediately if you have abdominal pain along with 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.