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Placental Abruption

BMJ Best Practice Clinical Guideline Placental abruption. Last reviewed: Jun 2025.

Disclaimer

There is currently no dedicated NICE guideline specifically addressing placental abruption. The RCOG Green-top Guideline No. 63: Antepartum Haemorrhage (published 2011) includes placental abruption, but its coverage is non-specific and has not been updated in over 10 years.

Therefore, this article bases primarily on BMJ Best Practice clinical guidance.

Background Information

Separation of the placenta from the uterus prior to delivery.

Smoking
Cocaine use (and other stimulants)
Alcohol misuse
Low BMI

Hypertension - most common cause
Pre-eclampsia
Autoimmune disease (e.g. antiphospholipid syndrome)
Thrombophilia

Maternal age
- < 20 y/o
- >35 y/o

Previous placental abruption - strongest risk factors
Multiple pregnancy
Trauma to the abdomen
Polyhydramnios
Assisted reproductive technologies (e.g. IVF)

Classic triad of:

'Woody' tender uterus
Vaginal bleeding (may not be present)
Maternal shock (tachycardia, hypotension etc.)

20% cases are concealed where the bleeding is trapped behind the placenta so there would be no or minimal vaginal bleeding.

Concealed abruptions can be particularly dangerous, as the severity can be underestimated (visible blood loss can be little, but internal bleeding is significant).

Gudielines

FBC (including haemoglobin and haematocrit)
Clotting studies

1st line: ultrasound

NB detection rate ~12-25%

Perform continuous cardiotography

Fetal well-being is important in guiding management

Stabilise the mother and resuscitate as needed.

Definitive management depends on 1) fetal status and 2) weeks of gestation, with exceptions:

Unstable maternal status → urgent Caesarean section (regardless of fetal status and weeks of gestation)
Dead fetus → vaginal delivery (usually with induction)

References

BMJ Best Practice Placental abruption

Author: Adams Lau
Reviewer:
Last edited: 09/07/25

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