Placental Abruption

Placental abruption occurs when the placenta separates from the wall of the uterus before delivery, which can cause significant bleeding and reduce oxygen and nutrient supply to the baby. It is a serious obstetric emergency.

• Vaginal bleeding, which may be accompanied by significant abdominal or back pain, distinguishing it from the typically painless bleeding of placenta praevia
• A firm, tender, or rigid abdomen
• Frequent or unusually strong uterine contractions
• Reduced or absent fetal movements
• Signs of shock in the mother — rapid heart rate, low blood pressure — with more severe abruption

• Results from separation of the placenta from the uterine wall before delivery, the exact trigger for which is often not identified in an individual case.
• Risk is increased by hypertension or pre-eclampsia, previous placental abruption, abdominal trauma, smoking, and substance use during pregnancy.
• Multiple pregnancy and rapid loss of amniotic fluid can also increase risk.

• Suspected clinically based on vaginal bleeding with abdominal pain, a tender or rigid uterus, and, often, signs of fetal distress.
• Ultrasound may sometimes show evidence of abruption, though a normal ultrasound does not rule it out, and the diagnosis is often made based on the overall clinical picture.
• Continuous monitoring of the baby's heart rate is important, as abruption can compromise the baby's oxygen supply.

Placental abruption is an obstetric emergency requiring immediate hospital assessment, with the level of urgency depending on the severity of bleeding and the condition of both mother and baby.

Severe abruption with maternal shock or significant fetal distress requires emergency delivery, most often by caesarean section, along with resuscitation and, if needed, blood transfusion for the mother.

Milder cases with a stable mother and reassuring signs from the baby may be managed with close monitoring, particularly if the pregnancy is preterm and there is time to consider medicines to support the baby's lung development before delivery.

Close monitoring of both mother and baby is essential throughout, as abruption can worsen suddenly.

• Attend regular antenatal care, including monitoring and treatment of hypertension or pre-eclampsia, which are important risk factors.
• Avoid smoking and substance use during pregnancy.
• Use appropriate protective measures, such as seatbelts, to reduce the risk of abdominal trauma during pregnancy.
• Seek immediate emergency care for vaginal bleeding with abdominal pain, or reduced fetal movements, during pregnancy.