Placental abruption

She is 34 weeks, she has 100 mL of dark blood on the pad, and she says the pain started an hour before the bleeding. You put your hand on her abdomen and it does not soften between contractions. Everything you need to know is already in your palm — the blood on the sheet is the least of it.^[1][3]

Overview and definition

Abruption means the placenta separates from a normally implanted site after 20 weeks and before the baby is born. The separated area no longer exchanges gas, and the space it leaves fills with blood that has three possible destinations: out through the cervix, trapped behind the placenta, or forced between the myometrial fibres.^[1][3]

It is a clinical diagnosis. There is no confirmatory test in the acute setting, no biomarker that rules it in, and no scan that rules it out. That single fact drives every management decision that follows.^[8][2]

References20ShowHide

1. [1]Oyelese Y, Ananth CV Placental abruption Obstet Gynecol, 2006.PMID 17012465
2. [2]Brandt JS, Ananth CV Placental abruption at near-term and term gestations: pathophysiology, epidemiology, diagnosis, and management Am J Obstet Gynecol, 2023.PMID 37164498
3. [3]Schneider E, Kinzler WL Placental Abruption: Pathophysiology, Diagnosis, and Management Clin Obstet Gynecol, 2025.PMID 39774455
4. [4]Chen D, Gao X, Yang T, et al. Independent risk factors for placental abruption: a systematic review and meta-analysis BMC Pregnancy Childbirth, 2025.PMID 40140972
5. [5]Ananth CV, Oyelese Y, Yeo L, Pradhan A, Vintzileos AM Placental abruption in the United States, 1979 through 2001: temporal trends and potential determinants Am J Obstet Gynecol, 2005.PMID 15672024
6. [6]Ruiter L, Ravelli AC, de Graaf IM, Mol BW, Pajkrt E Incidence and recurrence rate of placental abruption: a longitudinal linked national cohort study in the Netherlands Am J Obstet Gynecol, 2015.PMID 26071916
7. [7]Oyelese Y, Peltier M, Donovan B, et al. Placental abruption: Incidence and risk of recurrence in subsequent pregnancies J Obstet Gynaecol Res, 2024.PMID 38366767
8. [8]Glantz C, Purnell L Clinical utility of sonography in the diagnosis and treatment of placental abruption J Ultrasound Med, 2002.PMID 12164566
9. [9]Usui R, Matsubara S, Ohkuchi A, et al. Fetal heart rate pattern reflecting the severity of placental abruption Arch Gynecol Obstet, 2008.PMID 17896112
10. [10]Hiiragi K, Obata S, Miyagi E, Aoki S Clinical implications of a Couvelaire uterus with placental abruption: A retrospective study Int J Gynaecol Obstet, 2025.PMID 39056529
11. [11]Erez O, Mastrolia SA, Thachil J Disseminated intravascular coagulation in pregnancy: insights in pathophysiology, diagnosis and management Am J Obstet Gynecol, 2015.PMID 25840271
12. [12]Charbit B, Mandelbrot L, Samain E, et al. The decrease of fibrinogen is an early predictor of the severity of postpartum hemorrhage J Thromb Haemost, 2007.PMID 17087729
13. [13]Getahun D, Oyelese Y, Salihu HM, Ananth CV Previous cesarean delivery and risks of placenta previa and placental abruption Obstet Gynecol, 2006.PMID 16582111
14. [14]Ananth CV, Oyelese Y, Srinivas N, Yeo L, Vintzileos AM Preterm premature rupture of membranes, intrauterine infection, and oligohydramnios: risk factors for placental abruption Obstet Gynecol, 2004.PMID 15229003
15. [15]Anderson E, Raja EA, Shetty A, et al. Changing risk factors for placental abruption: A case crossover study using routinely collected data from Finland, Malta and Aberdeen PLoS One, 2020.PMID 32525937
16. [16]Colón I, Berletti M, Garabedian MJ, et al. Randomized, Double-Blinded Trial of Magnesium Sulfate Tocolysis versus Intravenous Normal Saline for Preterm Nonsevere Placental Abruption Am J Perinatol, 2016.PMID 26871905
17. [17]McGoldrick E, Stewart F, Parker R, Dalziel SR Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth Cochrane Database Syst Rev, 2020.PMID 33368142
18. [18]Shepherd ES, Goldsmith S, Doyle LW, et al. Magnesium sulphate for women at risk of preterm birth for neuroprotection of the fetus Cochrane Database Syst Rev, 2024.PMID 38726883
19. [19]Ananth CV, Oyelese Y, Prasad V, Getahun D, Smulian JC Evidence of placental abruption as a chronic process: associations with vaginal bleeding early in pregnancy and placental lesions Eur J Obstet Gynecol Reprod Biol, 2006.PMID 16513243
20. [20]Qureshi H, Massey E, Kirwan D, et al. BCSH guideline for the use of anti-D immunoglobulin for the prevention of haemolytic disease of the fetus and newborn Transfus Med, 2014.PMID 25121158