Acute placental abruption: warning signs and care

Possible signs include vaginal bleeding, sudden abdominal or back pain, a tender or continuously tight uterus, frequent contractions, or a change in the baby's usual movements. Bleeding may remain behind the placenta, so little or no visible blood does not exclude abruption.

The placenta carries oxygen and nutrients between the pregnant person's circulation and the baby. Separation can cause maternal bleeding and interfere with the baby's oxygen supply. The effect varies with the location and extent of separation, the pregnancy stage and how both patient and baby are responding.

Hospital assessment may include blood pressure and pulse checks, abdominal examination, blood tests, monitoring of the baby's heart rate and ultrasound. Ultrasound can identify some abruptions but may not show every one, so the clinical pattern remains important.

Contact your maternity emergency service immediately for vaginal bleeding, new constant abdominal pain, repeated contractions, a rigid or very tender abdomen, or reduced fetal movement. If symptoms are severe, call emergency services and do not drive yourself. Use a sanitary pad rather than inserting anything into the vagina.

Care depends on bleeding, gestational stage and the condition of parent and baby. The team may provide close monitoring, intravenous fluids, blood products or medicines, and may recommend birth. An urgent caesarean birth may be needed when continuing the pregnancy is unsafe or the baby shows distress.

Call emergency services for heavy bleeding, severe or persistent abdominal pain, fainting, weakness, confusion, breathing difficulty, pale clammy skin, or an urge to push. A marked reduction or absence of the baby's movements also requires immediate maternity assessment.

Do not delay because bleeding appears light or stops. Internal bleeding and placental separation can still be present, and only an urgent clinical assessment can check maternal stability and fetal wellbeing.

Ask what the monitoring shows, whether you need admission, what changes would make delivery necessary and which mode of birth is being considered. Tell the team about trauma, high blood pressure, previous placental abruption, medicines, your blood group if known and when you last felt normal fetal movement.