Clinical features of placental abruption

The pain may be continuous rather than coming only with contractions. Visible bleeding varies because some blood can remain trapped behind the placenta, so the amount seen does not show how serious the separation is.

Placental abruption means that part or all of the placenta separates from the wall of the uterus before birth. This can reduce the baby's oxygen supply and cause blood loss in the pregnant person. The condition may progress quickly even when vaginal bleeding appears modest.

Hospital assessment focuses on maternal pulse, blood pressure, pain and blood loss, as well as the baby's heart-rate pattern. Ultrasound can help assess the placenta and exclude other causes, but a normal-looking scan does not by itself rule out an abruption.

Seek urgent maternity assessment for any vaginal bleeding accompanied by abdominal pain, back pain, uterine tenderness, repeated tightening or reduced fetal movement. Use a sanitary pad rather than inserting anything into the vagina, and note when the symptoms began.

At hospital, the team may place intravenous access, take blood samples and continuously monitor the baby when appropriate. The next steps depend on the amount of separation suspected, your condition, the baby's condition and the stage of pregnancy; close observation or urgent birth may be considered.

Call emergency services for heavy bleeding, severe or constant abdominal pain, fainting, marked weakness, breathing difficulty, confusion, pale clammy skin or a major reduction in fetal movement. Do not drive yourself if you are dizzy, faint or bleeding heavily.

Treat painful bleeding in pregnancy as urgent even if the bleeding stops. Blood can remain concealed inside the uterus, and only prompt clinical assessment can evaluate the pregnant person and baby together.

You may want to ask how you and the baby are being monitored, whether blood loss has affected your blood count or clotting, what would prompt delivery, and whether vaginal birth or caesarean birth is being considered.