Abruptio placentae and placenta previa explained

In an abruption, the placenta separates from the womb before birth. With placenta previa, the placenta lies low and partly or completely covers the opening of the cervix. Both can cause vaginal bleeding, but the clinical assessment, monitoring and birth plan may differ.

Abruption may present with vaginal bleeding, abdominal or back pain, a firm tender womb, contractions, or changes in the baby's movements. Some blood can remain behind the placenta, so the visible bleeding may not show how much separation has occurred.

Placenta previa more often presents with bright vaginal bleeding that can occur without pain. Ultrasound identifies the placental position. An internal digital examination is generally avoided until the maternity team knows where the placenta lies because touching the cervix may provoke bleeding.

Contact your maternity unit immediately for any vaginal bleeding. Use a pad rather than a tampon, note the colour and amount, and avoid intercourse while awaiting advice. Do not drive yourself if you feel faint, weak or unwell.

The team may check your pulse and blood pressure, assess the baby's heartbeat, perform blood tests and use ultrasound. Care depends on bleeding, pregnancy stage, placental location and the wellbeing of you and the baby. Monitoring, hospital observation or planned Caesarean birth may be discussed.

Call emergency services for heavy bleeding, severe or persistent abdominal pain, fainting, breathing difficulty, confusion, or signs of shock such as cold clammy skin. Seek urgent maternity assessment if movements are reduced or contractions begin. Even light bleeding should be reported promptly because symptoms can change.

Ask where the placenta is in relation to the cervix, whether follow-up imaging is needed, which activities to avoid, and exactly where to go if bleeding returns. Clarify how the baby's wellbeing will be monitored and what circumstances would change the timing or method of birth.