Placental abruption is a cause of antepartum haemorrhage (defined as bleeding > 24 weeks gestation) and defined as premature separation of a normally sited placenta from the uterine wall, resulting in maternal haemorrhage into the intervening space.
Placental abruption occurs in 0.3% to 1% of births.
Vasa praevia: where fetal blood vessels run near the internal cervical os (involves the characteristic triad of vaginal bleeding, rupture of membranes and fetal deterioration)
Uterine rupture: usually occurs in labour with a history of previous caesarean section
Early labour can sometimes present with a small amount of bleeding and intermittent abdominal pain
Malignant lesions (e.g. carcinoma)
Benign lesions (e.g. cervical ectropion): common
Infections (e.g. chlamydia)
Placental abruption is a clinical diagnosis and there are no sensitive or reliable diagnostic tests available.5
Relevant bedside investigations include:
Cardiotocograph (CTG): should be performed in women above 26 weeks gestation to assess fetal wellbeing. Abruption can result in fetal hypoxia and abnormalities of the fetal heart rate pattern. Under 26 weeks handheld doppler or USS should be performed to assess for a fetal heartbeat.
Kleihauer test: required if the woman is resus negative
Relevant imaging investigations include:
Ultrasound: women presenting with antepartum haemorrhage should have an ultrasound scan performed to confirm or exclude placenta praevia if the placental site is not already known. Ultrasound has limited sensitivity in the identification of retroplacental haemorrhage.
Management of anantepartum haemorrhage due to placental abruption includes a rapid ABCDE assessment and resuscitation. Maternal resuscitation should not be delayed to determine fetal viability.
Definitive management depends on the gestation and presence of fetal distress:
Fetal distress: emergency caesarean section
No fetal distress < 36 weeks: observe closely, steroids, no tocolysis, gestational age determines delivery
No fetal distress >36 weeks: deliver vaginally
In cases of in-utero fetal death, induced vaginal delivery or caesarean section may be indicated due to maternal compromise.
In all cases, anti-D should be administered within 72 hours of the onset of bleeding if the woman is rhesus D negative.
Maternal complications of placental abruption include:
Placental abruption is associated with a high perinatal mortality rate and is responsible for 15% of perinatal deaths.
Placental abruption is defined as premature separation of a normally sited placenta from the uterine wall.
The typical clinical presentation is sudden onset constant pain +/- dark red bleeding depending on whether the abruption is concealed (bleeding remains within the uterus and is not visible) or revealed (visible vaginal bleeding).
Risk factors include past placental abruption, pre-eclampsia, advanced age, multiparity, low maternal BMI, assisted reproductive techniques, smoking, cocaine and endometriosis.
Possible clinical findings include shock, abdominal tenderness, uterus feeling ‘woody’ or ‘tense’, fetal distress and vaginal bleeding.
Placental abruption is a clinical diagnosis and there are no sensitive or reliable diagnostic tests available.
Management involves A-to-E assessment. If fetal distress is present, then an immediate caesarean section should be performed. If no fetal distress and <36 weeks observe closely, steroids, no tocolysis, delivery depends on gestation. If >36 weeks (without fetal distress) aim for vaginal delivery.
Maternal complications include PPH, blood clotting problems and organ dysfunction.
Fetal complications include IUGR, hypoxia, premature birth and stillbirth.
Dr Rachel Greenwood
Obstetrics & Gynaecology Registrar
Dr Chris Jefferies
Ananth CV, Keyes KM, Hamilton A, et al. An international contrast of rates of placental abruption: an age-period-cohort analysis. PLoS One. 2015 May 27;10(5):e0125246.
Tikkanen M. Placental abruption: epidemiology, risk factors and consequences. Acta Obstet Gynecol Scand. 2011 Feb;90(2):140-9.
Blausen. Placental abruption concealed vs. revealed. WikiJournal of Medicine. Licence: [CC BY]
Pariente G, Wiznitzer A, Sergienko R, Mazor M, Holcberg G, Sheiner E. Placental abruption: critical analysis of risk factors and perinatal outcomes. Journal of Maternal, Fetal and Neonatal Medicine. 2010;24:698–702.
RCOG. Antepartum Haemorrhage. Green-top Guideline No.63. Nov 2011. Page 8. Available from: [LINK]