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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: Nov 2017. | This topic last updated: Oct 03, 2017.
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  1. Zuckerwise LC, Pettker CM, Illuzzi J, et al. Use of a novel visual aid to improve estimation of obstetric blood loss. Obstet Gynecol 2014; 123:982.
  2. POE MF. Clot observation test for clinical diagnosis of clotting defects. Anesthesiology 1959; 20:825.
  3. WEINER AE, REID DE, ROBY CC. Incoagulable blood in severe premature separation of the placenta: a method of management. Am J Obstet Gynecol 1953; 66:475.
  4. Lee RI, White PD. A clinical study of the coagulation time of blood. Am J Med Sci 1913; 145:494.
  5. Ananth CV, Lavery JA, Vintzileos AM, et al. Severe placental abruption: clinical definition and associations with maternal complications. Am J Obstet Gynecol 2016; 214:272.e1.
  6. Neilson JP. Interventions for treating placental abruption. Cochrane Database Syst Rev 2003; :CD003247.
  7. Kayani SI, Walkinshaw SA, Preston C. Pregnancy outcome in severe placental abruption. BJOG 2003; 110:679.
  8. Oyelese Y, Ananth CV. Placental abruption. Obstet Gynecol 2006; 108:1005.
  9. Bond AL, Edersheim TG, Curry L, et al. Expectant management of abruptio placentae before 35 weeks gestation. Am J Perinatol 1989; 6:121.
  10. Combs CA, Nyberg DA, Mack LA, et al. Expectant management after sonographic diagnosis of placental abruption. Am J Perinatol 1992; 9:170.
  11. Sholl JS. Abruptio placentae: clinical management in nonacute cases. Am J Obstet Gynecol 1987; 156:40.
  12. Fitzgibbon J, Morrison JJ, Smith TJ, O'Brien M. Modulation of human uterine smooth muscle cell collagen contractility by thrombin, Y-27632, TNF alpha and indomethacin. Reprod Biol Endocrinol 2009; 7:2.
  13. Lockwood CJ, Kayisli UA, Stocco C, et al. Abruption-induced preterm delivery is associated with thrombin-mediated functional progesterone withdrawal in decidual cells. Am J Pathol 2012; 181:2138.
  14. Saller DN Jr, Nagey DA, Pupkin MJ, Crenshaw MC Jr. Tocolysis in the management of third trimester bleeding. J Perinatol 1990; 10:125.
  15. Towers CV, Pircon RA, Heppard M. Is tocolysis safe in the management of third-trimester bleeding? Am J Obstet Gynecol 1999; 180:1572.
  16. Ananth CV, Berkowitz GS, Savitz DA, Lapinski RH. Placental abruption and adverse perinatal outcomes. JAMA 1999; 282:1646.
  17. Ananth CV, Cnattingius S. Influence of maternal smoking on placental abruption in successive pregnancies: a population-based prospective cohort study in Sweden. Am J Epidemiol 2007; 166:289.
  18. Ananth CV, Savitz DA, Williams MA. Placental abruption and its association with hypertension and prolonged rupture of membranes: a methodologic review and meta-analysis. Obstet Gynecol 1996; 88:309.
  19. Kåregård M, Gennser G. Incidence and recurrence rate of abruptio placentae in Sweden. Obstet Gynecol 1986; 67:523.
  20. Rasmussen S, Irgens LM, Dalaker K. The effect on the likelihood of further pregnancy of placental abruption and the rate of its recurrence. Br J Obstet Gynaecol 1997; 104:1292.
  21. Rasmussen S, Irgens LM, Dalaker K. Outcome of pregnancies subsequent to placental abruption: a risk assessment. Acta Obstet Gynecol Scand 2000; 79:496.
  22. Rasmussen S, Irgens LM. Occurrence of placental abruption in relatives. BJOG 2009; 116:693.
  23. Ruiter L, Ravelli AC, de Graaf IM, et al. Incidence and recurrence rate of placental abruption: a longitudinal linked national cohort study in the Netherlands. Am J Obstet Gynecol 2015; 213:573.e1.
  24. Toivonen S, Heinonen S, Anttila M, et al. Obstetric prognosis after placental abruption. Fetal Diagn Ther 2004; 19:336.
  25. Tikkanen M, Nuutila M, Hiilesmaa V, et al. Prepregnancy risk factors for placental abruption. Acta Obstet Gynecol Scand 2006; 85:40.
  26. Rasmussen S, Irgens LM, Albrechtsen S, Dalaker K. Women with a history of placental abruption: when in a subsequent pregnancy should special surveillance for a recurrent placental abruption be initiated? Acta Obstet Gynecol Scand 2001; 80:708.
  27. Clark SL. Placentae Previa and Abruptio Placentae. In: Maternal Fetal Medicine, 4th ed, Creasy RK, Resnik R (Eds), WB Saunders Company, Philadelphia 1999. p.623.
  28. Pritchard JA, Mason R, Corley M, Pritchard S. Genesis of severe placental abruption. Am J Obstet Gynecol 1970; 108:22.
  29. Rasmussen S, Irgens LM, Dalaker K. A history of placental dysfunction and risk of placental abruption. Paediatr Perinat Epidemiol 1999; 13:9.
  30. Ananth CV, Vintzileos AM. Maternal-fetal conditions necessitating a medical intervention resulting in preterm birth. Am J Obstet Gynecol 2006; 195:1557.
  31. Ananth CV, Peltier MR, Chavez MR, et al. Recurrence of ischemic placental disease. Obstet Gynecol 2007; 110:128.
  32. Ananth CV, Vintzileos AM. Epidemiology of preterm birth and its clinical subtypes. J Matern Fetal Neonatal Med 2006; 19:773.
  33. Ananth CV, Vintzileos AM. Medically indicated preterm birth: recognizing the importance of the problem. Clin Perinatol 2008; 35:53.
  34. Ananth CV, Savitz DA, Luther ER. Maternal cigarette smoking as a risk factor for placental abruption, placenta previa, and uterine bleeding in pregnancy. Am J Epidemiol 1996; 144:881.
  35. Ananth CV, Smulian JC, Vintzileos AM. Incidence of placental abruption in relation to cigarette smoking and hypertensive disorders during pregnancy: a meta-analysis of observational studies. Obstet Gynecol 1999; 93:622.
  36. Melamed N, Hadar E, Peled Y, et al. Risk for recurrence of preeclampsia and outcome of subsequent pregnancy in women with preeclampsia in their first pregnancy. J Matern Fetal Neonatal Med 2012; 25:2248.