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Placental abruption: Management

Yinka Oyelese, MD
Cande V Ananth, PhD, MPH
Section Editor
Charles J Lockwood, MD, MHCM
Deputy Editor
Vanessa A Barss, MD, FACOG


This topic will discuss the management of pregnancies complicated by placental abruption. The clinical features, diagnosis, and potential consequences of abruption are reviewed separately. (See "Placental abruption: Clinical features and diagnosis".)


Pregnant women with symptoms of abruption should be evaluated promptly on a labor and delivery unit to establish the diagnosis, assess maternal and fetal status, and initiate appropriate management. Patients who have an apparently small abruption and are initially stable may deteriorate rapidly if placental separation progresses. They may also deteriorate from sequelae of potential comorbidities, such as preeclampsia, cocaine use, or trauma.

The following actions are reasonable initial interventions:

Initiate continuous fetal heart rate monitoring, since the fetus is at risk of becoming hypoxemic and developing acidosis.

Secure intravenous access. Place one wide-bore intravenous line; two if the patient presents with signs of moderate or severe abruption, such as moderate to heavy bleeding, hypotension, tachysystole, uterine hypertonicity and tenderness, coagulopathy, or an abnormal fetal heart rate. Administer crystalloid, preferably Lactated Ringer's, to maintain urine output above 30 mL/hour.


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Literature review current through: Sep 2016. | This topic last updated: Mar 2, 2016.
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