← Diagnosis and Management Guides
Placental Abruption
Key considerations: Massive abruption with fetal demise, DIC, Hypovolemic shock
Cannot miss
- Massive abruption with fetal demise
- DIC
- Hypovolemic shock
Likely diagnoses
- Placental abruption
- Placenta previa
- Vasa previa
- Cervical dilation/labor
Red flags
- Painful vaginal bleeding in 3rd trimester
- Uterine tetany/tenderness
- Fetal distress
- Hemodynamic instability
- DIC labs
Workup
- history: Painful vaginal bleeding, trauma, hypertension, cocaine use, prior abruption; exam: Uterine tenderness, tetanic contractions, vaginal bleeding, fetal heart tones; labs: CBC, coags (fibrinogen <200 = DIC risk), type and crossmatch, Kleihauer-Betke if Rh negative; imaging: Ultrasound may show retroplacental clot (sensitivity only ~50%); Absence of US findings does NOT rule out abruption; bedside: Continuous fetal monitoring, maternal vitals
Management
- immediate: Large bore IVs, aggressive fluid resuscitation; Emergent cesarean if fetal distress or maternal instability; Crossmatch and prepare blood products; general: Mild abruption at term: delivery; Mild abruption preterm: hospitalize, steroids if <34wk, close monitoring; RhoGAM if Rh negative
Disposition
- admit: All patients with confirmed or suspected abruption; discharge: Never acutely; consults: OB/GYN, MFM, anesthesia, neonatology
Clinical pearls
- Abruption is a clinical diagnosis — US has only ~50% sensitivity, so negative US does NOT rule it out
- Cocaine use is a major risk factor — always ask
- Fibrinogen <200 in the setting of abruption strongly predicts massive transfusion need
Source and review
- ACOG Antepartum Hemorrhage PB 2017. Last reviewed: 2024-11-01