Vaginal bleeding is the most common symptom of abruptio placentae and is seen in 80% of the cases. The severity of bleeding varies from patient to patient and may not correspond to the extent of placental abruption. Abdominal/back pain, and tenderness in the uterus are also very common, and are seen in 70% of the patients presenting with placental abruption. About 60% of the cases present with fetal distress. Frequency of uterine contractions increases in some patients. Some patients may have to go for premature labor to alleviate fetal or maternal distress. Pain, both abdominal and back, often have a sudden onset. In some cases, bleeding may be limited to the uterine cavity without any external signs. This is more serious as the amount of bleeding is often underestimated.

• Hemophilia A

  Almost 90 years ago De Lee reported a case of fetal coagulation disorder with abruptio placentae and described it as "temporary hemophilia." [ncbi.nlm.nih.gov]

  DeLee, who in 1892 described the condition as abruptio placentae because of the rupture of vascular elements, later attended a patient with uncontrollable uterine hemorrhage in association with placental abruption and postulated a hemophilia-like condition [glowm.com]

• Anemia

  Iron deficiency anemia was assessed in early pregnancy and defined as hemoglobin level RESULTS: Eleven percent of abruptio placentae cases and 3.3% of controls were diagnosed with iron deficiency anemia. [ncbi.nlm.nih.gov]

  As in several African studies [8,9], anemia is the major maternal complication of HRP. In our series, anemia was present in 83% of cases, 35% of cases of severe. However, 3 cases of maternal death were noted in our series; 2.26%. [heraldopenaccess.us]

  Both deaths were due to severe anemia and irreversible shock. Discussion Abruptio placenta is an important pregnancy complication associated with high fetal and maternal morbidity. [tjogonline.com]

  Abstract OBJECTIVE: To determine the frequency of anemia and need for blood transfusion among 100 patients of placental abruption. DESIGN: Prospective and Observational case Study. [bibliomed.org]

• Severe Pain

  Severe pain in the lower abdomen or back. Hard, tender abdomen. Shock (rapid heartbeat, rapid breathing and dizziness). Fetal distress; heartbeat of the unborn child may be inaudible. [nmihi.com]

  Your uterus feels tender and firm, and your abdominal pain feels more severe. If more than half the placenta detaches, you may experience very heavy bleeding. You may also experience uterine contractions. [highmarkblueshield.com]

  Call 911 or emergency services right away if you have: Sudden or severe pain in your belly. Severe vaginal bleeding, such as a gush of blood or passing a clot. Any symptoms of shock. [healthy.kaiserpermanente.org]

• Weight Gain

  This appeared related to weight gain, women who made more visits had higher weight gains at each gestational age than women who made fewer visits. (Supported by U.S.P.H.S. contract N01-NS-3-2311). [nature.com]

  RESULTS: History of delivering a stillborn infant (OR 10.0; 95%CI 4.0-25.2), pregnancy complicated by preeclampsia/eclampsia (OR 3.7; 95%CI 2.2-6.3); and a low rate of pregnancy weight gain ( CONCLUSION: At present, the constellation of abruptio placentae [ncbi.nlm.nih.gov]

  gain NEC 646.1 face presentation 652.4 failure, fetal head to enter pelvic brim 652.5 false labor (pains) 644.1 fatigue 646.8 fatty metamorphosis of liver 646.7 female genital mutilation 648.9 fetal fibroid (tumor) (uterus) 654.1 footling presentation [icd9data.com]

• Collapse

  Depending on the degree of detachment and the amount of blood loss, the mother may be collapsed and the fetus hypoxic or already dead. [patient.co.uk]

  Without prompt and effective intervention, abruptio placentae can lead to maternal death from hemorrhage, shock, and circulatory collapse. [medical-dictionary.thefreedictionary.com]

  At admission hypertension was diagnosed at 28% and collapse at 13% of patients. The mean gestational age was 36 weeks of amenorrhea with extremes of 22 and 40 weeds of amenorrhea. More than 82% of patients had a pregnancy between 34 and 40 weeks. [heraldopenaccess.us]

• Abdominal Pain

  The diagnosis is essentially made on the clinical picture that includes vaginal bleeding (usually dark blood), abdominal pain, and uterine contractions. [ncbi.nlm.nih.gov]

  Symptoms Like Allison, most women experiencing placental abruption will complain of severe abdominal pain and vaginal bleeding. The abdominal pain is unlike contractions because it is usually constant, whereas contractions come and go. [study.com]

  Women may have abdominal pain and tenderness and vaginal bleeding and may go into shock. When the placenta detaches too soon, the fetus may not grow as much as expected or may even die. [merckmanuals.com]

• Nausea

  […] symptoms Clinical Features Painful vaginal bleeding (may be absent if retro-placental) Characteristically dark and the amount is often insignificant Up to 20% have no vaginal bleeding or pain Severe uterine/pelvic pain Uterine contractions Hypotension Nausea [wikem.org]

  She states that she began feeling poorly yesterday with a stomach-ache, nausea, and vomiting. [step2.medbullets.com]

  Some discomforts, like nausea, back pain, and fatigue, are common during pregnancy. Sometimes it is hard to know what is normal. Call your health care provider if something is bothering or worrying you. [icdlist.com]

  Symptoms may include: Vaginal bleeding Abdominal pain Uterine contractions that do not relax Blood in amniotic fluid Nausea Thirst Faint feeling Decreased fetal movements The symptoms of placental abruption may resemble other medical conditions. [chop.edu]

• Severe Abdominal Pain

  A 25-year-old woman, grayida 4, para 2012, presented with acute onset of severe abdominal pain; frequent, low-amplitude contractions; and a nonreassuring fetal heart tracing. [ncbi.nlm.nih.gov]

  Symptoms Like Allison, most women experiencing placental abruption will complain of severe abdominal pain and vaginal bleeding. The abdominal pain is unlike contractions because it is usually constant, whereas contractions come and go. [study.com]

  Diagnosis Symptoms Acute constant severe abdominal pain which may be localised or diffuse. Dark vaginal bleeding results from escape of blood from the retroplacental haematoma. Cessation of foetal movement is common. [gfmer.ch]

  You have severe abdominal pain or contractions. You are leaking fluid from your vagina, or a large amount of fluid comes out of your vagina. You have new and sudden chest pain or trouble breathing. [drugs.com]

• Acute Abdomen

  Other causes of acute abdomen. Investigations Ultrasound: detects normally sited placenta with retroplacental haematoma that may dissect the placental margin. Tests for DIC (see later). Treatment At home The same as in placenta praevia. [gfmer.ch]

• Hypertension

  These perinatal outcome variables were compared between the hypertensive and normotensive patient groups. RESULTS: Black women with abruptio placentae were significantly more likely to be hypertensive (p = 0.0078). [ncbi.nlm.nih.gov]

  A similar result was reported in Kano, Northern Nigeria.[19] The association of abruptio placenta with hypertension was demonstrated in this study. More than half of patients with abruptio placenta had hypertensive disorder in index pregnancy. [tjogonline.com]

• Tachycardia

  Petechiae around BP cuff site, maternal tachycardia and diaphoresis. FIBRINOGEN LEVELS (ELEVATED in PREGNANCY) DROP IN MIN TO THE POINT AT WHICH BLOOD WILL NO LONGER COAGULATE. Large amounts of thromboplastin = DIC resulting in hypofibrinogenemia. [quizlet.com]

  Tachycardia. (B) Abdominal examination: Uterus is large for date and increasing gradually in size due to retained blood. Uterus is very tender and hard (board-like). Foetal parts are difficult to be felt. [gfmer.ch]

  tachycardia (>160 bpm) Uterine tenderness Foul odor of amniotic fluid[4] Exclusions: Maternal upper respiratory infection. [en.wikipedia.org]

  Grade III or Class 3 The patient presents with severe to no vaginal bleeding; severe uterine pain; hypotension; pale, cool, and clammy skin; tachycardia; and a narrow pulse pressure. Fetal death is likely. [emsworld.com]

• Hypotension

  Physical Exam Grade Uterine Irritability Maternal Hemodynamics Maternal Fibrinogen Fetal Heart Rate Mild Mild Normal Normal Normal Moderate Moderate Postural hypotension, tachycardic Low decreased variability, late decelerations Severe Tetany Hypotension [sharinginhealth.ca]

  MANAGEMENT PREVENTION 1 .Prevention of known factors  Early detection and effective therapy  Needle puncture  Avoidance of trauma  To avoid supine hypotension  routine administration of folic acid 24. [slideshare.net]

  […] other uterine symptoms Clinical Features Painful vaginal bleeding (may be absent if retro-placental) Characteristically dark and the amount is often insignificant Up to 20% have no vaginal bleeding or pain Severe uterine/pelvic pain Uterine contractions Hypotension [wikem.org]

  Hypotension BP 1: Inspect skin color, temperature, and capillary refill 2: Count and weigh pads hourly. Record pad saturation amount using a specific amount of time (50mL of dark red blood on pad in 20 min.) 1 g = 1mL of blood. [quizlet.com]

  Precautions Adverse effects include flushing, blurry vision, headaches, and nausea; more serious adverse effects, seen only at toxic levels, include pulmonary edema, respiratory depression, cardiac arrest, maternal tetany, profound hypotension to reverse [www1.cgmh.org.tw]

• Narrow Pulse Pressure

  Grade III or Class 3 The patient presents with severe to no vaginal bleeding; severe uterine pain; hypotension; pale, cool, and clammy skin; tachycardia; and a narrow pulse pressure. Fetal death is likely. [emsworld.com]

• Back Pain

  Patients with placental abruption often present with heavy bleeding, abdominal pain, back pain, uterine contractions, and fetal distress. Many complain of sudden belly and back pain. They may also have discomfort or tenderness in the belly. [symptoma.com]

  Signs & symptoms  Vaginal bleeding: 78%  Uterine tenderness: 66%  Back pain: 60%  Fetal distress: 22%  Hypertonus: 17%  Fetal demise: 15% 26 August 2016 Abruptio placentae - Dr.Rupa 16 17. [slideshare.net]

  Placental Abruption Placenta Previa Pain Abdominal pain, low back pain Painless unless in labour Uterus Tender, irritable Nontender, soft (unless contracting) Presentation Not associated with abnormal presentation Breech or high presenting part Fetus [sharinginhealth.ca]

  […] vaginal bleeding (may be absent if retro-placental) Characteristically dark and the amount is often insignificant Up to 20% have no vaginal bleeding or pain Severe uterine/pelvic pain Uterine contractions Hypotension Nausea and vomiting Back pain Premature [wikem.org]

  Signs and symptoms of placental abruption include: Vaginal bleeding Abdominal pain Back pain Uterine tenderness Uterine contractions, often coming one right after another Firmness in the uterus or abdomen Abdominal pain and back pain often begin suddenly [mayoclinic.org]

• Third Trimester Bleeding

  Analyzing 130 cases of abruptio placentae among 26,743 deliveries (1:206), the authors conclude that effective management depends primarily on early recognition of the high-risk patient, immediate hospitalization of all women with third trimester bleeding [jamanetwork.com]

  […] umbilical cord Cocaine Previous third trimester bleeding Alcohol use Types Central : placenta separates centrally - blood trapped between placenta and uterine wall - concealed bleeding - concealed type Complete : total separation - massive vaginal bleeding [examnnotes.com]

  Clinically it most often presents with bleeding, uterine contractions, and fetal distress. It is a significant cause of third trimester bleeding and is associated with both fetal and maternal morbidity and mortality. [www1.cgmh.org.tw]

  It is a potentially fatal complication of pregnancy and is a significant cause of third-trimester bleeding/antepartum hemorrhage. The estimated incidence is ~1% of all pregnancies. [radiopaedia.org]

  Towers CV, Pircon RA, Heppard M (1999) Is tocolysis safe in the management of third-trimester bleeding? Am J Obstet Gynecol 180:1572–1578 CrossRef PubMed Google Scholar 61. [link.springer.com]

• Placental Disorder

  Primary placental disorders such as preeclampsia and intrauterine growth restriction (IUGR) predispose to abnormal trophoblastic invasion and abruption. [visualdx.com]

  "Cesarean section and placental disorders in subsequent pregnancies--a meta-analysis". Journal of Perinatal Medicine. 42 (5): 571–83. doi:10.1515/jpm-2013-0199. PMID 24566357. [en.wikipedia.org]

• Reduced Fetal Movement

  Be aware of other symptoms, such as abdominal cramping or severe pain, backache, and reduced fetal movement. If you notice any of these symptoms or any kind of vaginal bleeding during your pregnancy, contact your health care provider right away. [highmarkblueshield.com]

• Second Trimester Bleeding

  Spotting (during first and second trimester) Bleeding that is sudden, profuse and PAINLESS (during end of second trimester, or during third trimester) Note: Bleeding may occur until onset of cervical dilatation causing the placenta to loosened from the [slideshare.net]

• Grieving

  Coping with loss Should your baby die as a result of placenta abruptio, allow yourself permission and time to grieve your loss. Your partner, children, and other family members may also need time to grieve. [cardiosmart.org]

  Gestational sac in tube in UTZ Visualization of pelvic organs through culdoscopy Presence of bloody fluid Administration of RHOGAM to Rh negative mothers Vaginal spotting or bleeding may be present Provide emotional support for the grieving process Rigid [slideshare.net]

• Dizziness

  A 30 year old white woman presented at term with vaginal bleeding, dizziness and blurred vision due to bilateral serous retinal detachments. [ncbi.nlm.nih.gov]

  The patient may feel dizzy, faint, nauseated, or very thirsty. [en.wikipedia.org]

  You feel faint, dizzy, or too weak to stand up. Further information Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. Medical Disclaimer [drugs.com]

  Shock (rapid heartbeat, rapid breathing and dizziness). Fetal distress; heartbeat of the unborn child may be inaudible. [nmihi.com]

• Agitation

  […] associated clotting disorder; – Shock, out of proportion to the severity of the external bleeding (intra-uterine bleeding): rapid or weak or undetectable pulse, very low or undetectable blood pressure; tachypnoea, pallor, sensation of cold, damp skin, agitation [medicalguidelines.msf.org]

  Maternal hypovolemia caused by extensive hemorrhage is manifested clinically by the cardinal signs of shock: a low or rapidly falling blood pressure, a rapid and weak pulse, generalized pallor with cold and clammy extremities, tachypnea, and agitation [glowm.com]

• Vaginal Bleeding

  The diagnosis is essentially made on the clinical picture that includes vaginal bleeding (usually dark blood), abdominal pain, and uterine contractions. [ncbi.nlm.nih.gov]

  Signs and Symptoms Signs of placental abruption may include vaginal bleeding, tenderness or pain in the abdomen and frequent contractions. All vaginal bleeding in the second or third trimester should merit a call to a healthcare practitioner. [verywell.com]

  During Pregnancy and Vaginal Bleeding. [emedicine.com]

  One of the most common symptoms is vaginal bleeding with pain during the third trimester of pregnancy. [outsourcestrategies.com]

• Uterine Tenderness

  This is unlike abruptio placentae, where the patient experiences abdominal pain and uterine tenderness. [emsworld.com]

  Other related symptoms include – Abdominal pain Vaginal bleeding Uterine tenderness Uterine contractions, often coming one right after another Tender uterus Firmness in the uterus or abdomen Backache It is important to note that some of the above listed [outsourcestrategies.com]

  Six (85.7%) patients had severe vaginal bleeding, abdominal pain and uterine tenderness. [pjms.com.pk]

  Grade 2 : uterine tenderness; tetany, with or without uterine bleeding; fetal distress; mother is not in shock. Approximately 20% to 50% of the total surface area of the placenta is detached. [medical-dictionary.thefreedictionary.com]

  25% Fetal death - 15% Physical Placental abruption is mainly a clinical diagnosis based on findings of vaginal bleeding, abdominal pain, uterine tenderness, uterine contractions, and fetal distress. [emedicine.com]

• Pelvic Pain

  […] vaginal bleeding (may be absent if retro-placental) Characteristically dark and the amount is often insignificant Up to 20% have no vaginal bleeding or pain Severe uterine/pelvic pain Uterine contractions Hypotension Nausea and vomiting Back pain Premature [wikem.org]

  This morning, she began feeling painful contractions and noted vaginal bleeding after she fell off her bike while riding to work. She is experiencing lower abdominal and pelvic pain between contractions as well. [step2.medbullets.com]

  Call your healthcare provider immediately if are bleeding, cramping or experience pelvic pain during your pregnancy, especially in the third trimester. [my.clevelandclinic.org]

• Uterine Hemorrhage

  In this situation, there often is fear of uterine hemorrhage secondary to atony; however, this usually is not the rule. [glowm.com]

Clinical diagnosis is the most common diagnostic feature for abruptio placentae. Sensitive and reliable confirmatory diagnostic tests are very rare for this condition. Class 0 abruptio placentae is usually diagnosed retrospectively based on the presence of blood clot or a depression in placenta. Physical examination is very important in identifying the origin of hemorrhage in patients who present with bleeding. Prompt stabilization of the patient is also equally important. Severe abruption can be identified by the presence of tense and tender uterus. Imaging techniques like ultrasound may not be effective in diagnosis as it is difficult to distinguish the blood clot from placenta. But his method is often used to rule out other causes of bleeding in the third trimester. Retroplacental clot, concealed hemorrhage, and expanding hemorrhage are all indicators of abruption. Clots may be hyperechoic to isoechoic initially, but this may change to hypoechoic within a week. Cardiotocograph is used to check for abnormalities in the fetal heart rate due to hypoxia.

Platelet count is often reduced in abruption and is often used to confirm the same. Coagulopathy is also common and is indicative of abruption. Coagulopathy is indicated by moderately reduced levels of fibrinogen. Sever abruption often result in fibrinogen level lesser than 200 mg/dL. Coagulation status of the patient is checked before cesarean section. Even with heavy bleeding, blood pressure of the patient may remain normal. This is because a healthy individual is able to tolerate significant loss of blood before presenting signs of decompensation. Other procedures may be recommended on the basis of gestational age, and fetal status. This includes fetal heart monitoring and type of delivery.

Reattachment of the placenta to the uterine wall is not possible, and hence, treatment modality depends on the circumstance. Mother has to be resuscitated and stabilized before deciding on delivery, and is independent of gestation period. The criteria include – 1. Assess airway and breathing, 2. Evaluate circulation, and 3. Assess fetal status.

Treatment also depends on the quantity of blood lost and fetal distress. If the gestation period is less than 36 weeks, and there is no indication of maternal or fetal distress, only monitoring may be required. This is continued till the condition changes or until the maturity of the fetus, whichever comes first. Blood transfusion may be required based on blood loss.

Immediate delivery is indicated if there are signs of maternal or fetal distress, or if fetal maturity is attained. Blood transfusion is needed to maintain blood volume,  while platelet transfusion may be needed to maintain fibrinogen levels . Vaginal delivery is preferred if there are no indications of fetal distress, particularly if the mother is hemodynamically stable. Uterine tone and contractions increase, and this makes delivery rapid.

In the presence of disseminated intravascular coagulations, Cesarean section is preferred. For mothers with premature fetus and small placental separation, close observation is the method suggested. In case of excessive bleeding hysterectomy is recommended. Prior to hysterectomy, other procedures like correction of coagulopathy, ligation of uterine artery, administration of uterotonics, packing of uterus and control of hemorrhage are important.
If the fetus is premature, tocolytics are used for glucocorticoids administration. This will help to enhance maturation of fetal lungs. In case of chronic abruption this will help to delay delivery until complications are less. Tocolysis is induced by magnesium sulfate or nifedipine.

Prognosis depends on the extent of abruption, and also on promptness and quality of the treatment given. In more than half of the cases, fetal distress can be noted early in the condition. Infants have 40-50% chances of complications. Most of the complications are related to premature delivery which is done to alleviate fetal or maternal distress. Maternal morbidity may be caused by transfusion-related issues, cesarean delivery, and hysterectomy. Placental abruption may lead to shock, disseminated intravascular coagulation, acute blood loss, and failure of organs like kidney, in mother. In babies, placental abruption may lead to hypoxia and lack of nutrients, premature birth, or still birth.

The actual cause of separation is unclear. Multiple factors are known to enhance the risk of abruptio placentae [1] [2]. Trauma or injury to abdomen due to fall or an accident is one of the direct causes of abruption. Sudden reduction in uterine volume due to an amniotic fluid loss or multiple pregnancy, is also implicated in the separation of placenta from uterine wall. Factors that increase the risk of the condition include

• History of placental abruption
• Hypertension – whether primary or secondary, this is one of the most common risk factor for placental separation.
• Substance abuse – smoking and cocaine use during pregnancy increase the risk of abruption. One of the studies report that risk of abruption increase by 40% for an year indulged in smoking prior to pregnancy. Risk of abruption in cocaine users depends on the dose and is reported to range from 13% to 35% [3].
• Premature rupture of membranes – break or leak of amniotic sac before labor results in reduced amniotic fluid, increasing the risk of placental separation.
• Blood-clotting disorders 
• Multiple pregnancy – Changes in the uterus after the first delivery in a twin gestation may cause placental separation before the delivery of other babies. 
• Maternal age – risk of placental abruption is more in women above the age of 40 years. 

Incidence of abruption placentae is about 1 in 150 deliveries. This abruption is severe in approximately one in 800 to 1,600 deliveries. Separation of placentae usually occurs during the third trimester, but may also happen after 20 weeks of gestation. Placental abruption is one of the most common causes of antepartum hemorrhage accounting to 30% of all cases [4]. Risk of placental abruption is more in young women below 20 years of age, and those above 40 years.

Avulsion of placental villi from the lower uterine segment results bleeding into the decidua basalis. This abruption may be caused by any of the etiological factors. Hemorrhage into dedicua basalis pushes the placenta further away from the uterine wall and this in turn increases bleeding, resulting in a vicious cycle. Abruption of placentae may be classified into

• Class 0 – this is the asymptomatic form of placental abruption.
• Class 1 – this is characterized by vaginal bleeding with uterine tenderness . It is less serious as fetal or maternal distress is not present. This type accounts for 48% of all cases. 
• Class 2 – this is a moderate form of abruption characterized by bleeding with some amount of fetal distress. This form is seen in 27% of all cases of placental abruption.
• Class 3 – this is the most severe form of abruption placentae and is characterized by severe maternal bleeding, shock, and death of fetus. Maternal disseminated intravascular coagulation might also be noted. With forced entry of blood into the serosa, it may result in couvelaire uterus. 

Eliminating risk factors is the best way to prevent abruptions in subsequent pregnancies. Smoking and cocaine use are two most important risk factors which can be completely avoided. Rehabilitation programs and education about the risk associated with its use will help in spreading awareness.

Abruptio placentae, commonly known as placental abruption, is an uncommon complication during pregnancy, characterized by premature separation of placenta from the uterine wall. This is a serious condition as placenta is a structure developed during gestation for nourishment of developing fetus. Abruptio placentae result in heavy bleeding and also deprives the fetus of oxygen and nourishment. The two main forms of abruption placentae are
Concealed abruption – refers to a condition in which bleeding is limited to uterine cavity and hence blood loss is underrated in most of the cases. It is seen in 20% of the cases and is more serious than revealed form of abruption
Revealed abruption – this form is characterized by bleeding and incomplete separation of placenta from the uterus. It is more common than concealed form and is less serious.
This condition may be categorized on the basis of extent of separation as partial or complete abruption. On the basis of location of separation, placental abruption is grouped into marginal and central abruption. Patients with placental abruption present with heavy bleeding, contractions and fetal distress. It has a sudden onset and is a serious condition that requires medical attention.

Abruptio placentae is commonly known as placental abruption, and is characterized by the separation of placenta from the uterine lining. This is an uncommon complication in pregnancy, and reduce oxygen and nutrition for fetus. It may cause heavy bleeding and fetal distress. The actual cause of the condition is not yet known. Risk of abruption is increased by factors  like smoking, cocaine or substance abuse, age above 40 years, high blood pressure, uterine infection, water breakage before 37 weeks of pregnancy, history of abruption in earlier pregnancy, uterus or umbilical cord problems, multiple pregnancies like twins or triplets, or injury or trauma to abdomen.

Patients with placental abruption often present with heavy bleeding, abdominal pain, back pain, uterine contractions, and fetal distress. Many complain of sudden belly and back pain. They may also have discomfort or tenderness in the belly. If the blood is limited in the uterine cavity, bleeding may be absent. Physical examination is the most common diagnostic procedure to identify uterine tenderness or rigidity. The actual cause of vaginal bleeding may be checked using ultrasound. This imaging technique is useful in the diagnosis of most form of abruptions.

Abruptio placentae is  serious and requires immediate medical attention. In some cases, the doctor may be able to indicate chances of abruption even before the separation happens. Treatment is based on the gestational age and also the severity of separation. If the fetus is premature and abruption is mild, close monitoring is the only recommendation. Medications may be given for maturation of fetal lungs, of delivery is necessary. If the fetus is full-term or near full-term with minimal placental abruption, vaginal delivery is suggested. If abruption may interrupt normal delivery, C-section may be needed. Prevention of abruption is not possible. The risk of placental separation can be reduced by quitting smoking or abuse of cocaine. Controlling blood pressure and avoiding accidents also help to reduce the risk of abruption placentae.

1. Abu-Heija A, al-Chalabi H, el-Iloubani N. Abruptio placentae: risk factors and perinatal outcome. J Obstet Gynaecol Res. 1998 Apr. 24(2):141-4.
2. Oyelese Y, Ananth CV. Placental abruption. Obstet Gynecol. 2006 Oct. 108(4):1005-16.
3. Hoskins IA, Friedman DM, Frieden FJ. Relationship between antepartum cocaine abuse, abnormal umbilical artery Doppler velocimetry, and placental abruption. Obstet Gynecol. 1991 Aug. 78(2):279-82.
4. Neilson JP. Interventions for treating placental abruption. Cochrane Database Syst Rev. 2003;(1):CD003247.