Placental abruption

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  • Premature separation of placenta from uterus
  • Usually occurs spontaneously but also associated with trauma (even minor trauma)
  • Usually occurs at >15 weeks gestation
  • Must be considered in patients who presenting with painful vaginal bleeding near term
  • Abruption may be complete, partial, or concealed
    • Amount of external bleeding may not correlate with severity

Risk Factors

  • Hypertension
  • Trauma
  • Smoking
  • Advanced maternal age [1]
  • Multiparity
  • Preeclampsia
  • Prior placental abruption
  • Thrombophilia
  • Cocaine abuse
  • History of C-section or other uterine symptoms

Clinical Features

Differential Diagnosis

Abdominal Pain in Pregnancy

The same abdominal pathologies as non-pregnant patients, plus:

<20 Weeks

>20 Weeks

Any time

  • Hemorrhagic ovarian cyst
  • Fibroid degeneration or torsion
  • Ovarian torsion
  • Constipation


  • Type & Cross
  • CBC
  • Platelets
  • PT/INR
  • PTT
  • Fibrinogen
  • D-dimer
  • Fibrin Degraded Products
  • Pelvic US
    • Specific, not Sensitive (as low as 24% sensitive)
    • Cannot be used alone to rule-out placental abruption if negative
    • Can rule-out placenta previa
  • If available, obtain fetal heart monitoring
  • Consider FAST exam if trauma


  • Fluid resuscitation
  • Transfuse blood products (as needed)
  • Emergent OB/GYN consult
    • If unavailable consider C-section in ED
  • Consider minimum 6 hours observation even if abruption not identified, if mechanism is concerning




  • Neurodevelopmental abnormalities
  • Death: 67 to 75% rate of fetal mortality

See Also


  1. Rosen's


Ross Donaldson