Diagnosis
If your health care provider suspects placental abruption, he or she will do a physical exam to check for uterine tenderness or rigidity. To help identify possible sources of vaginal bleeding, your provider will likely recommend blood and urine tests and ultrasound.
During an ultrasound, high-frequency sound waves create an image of your uterus on a monitor. It's not always possible to see a placental abruption on an ultrasound, however.
Treatment
It isn't possible to reattach a placenta that's separated from the wall of the uterus. Treatment options for placental abruption depend on the circumstances:
The baby isn't close to full term. If the abruption seems mild, your baby's heart rate is normal and it's too early for the baby to be born, you might be hospitalized for close monitoring. If the bleeding stops and your baby's condition is stable, you might be able to rest at home.
You might be given medication to help your baby's lungs mature and to protect the baby's brain, in case early delivery becomes necessary.
- The baby is close to full term. Generally after 34 weeks of pregnancy, if the placental abruption seems minimal, a closely monitored vaginal delivery might be possible. If the abruption worsens or jeopardizes your or your baby's health, you'll need an immediate delivery — usually by C-section.
For severe bleeding, you might need a blood transfusion.
Preparing for your appointment
Placental abruption is often a medical emergency, leaving you no time to prepare. However, it's possible that your health care provider might notice signs of a coming abruption.
Depending on the suspected severity of your placental abruption, you might be admitted to the hospital and monitored. Or you might be admitted for emergency surgery to deliver the baby.
If you and the baby are being monitored in the hospital, here's some information to help you prepare for what's to come.
What you can do
While you're in the hospital:
- Pay attention to changes. Alert your health care team immediately if there's a change in your symptoms or their frequency.
- Let your doctor know about all medications you've been taking, including vitamins and supplements. Include whether you've smoked during your pregnancy or used illegal drugs.
- Ask a loved one or friend to be with you, if possible. Someone who's with you can help you remember the information provided, especially in an emergency.
Some questions you might want to ask your doctor include:
- What tests do I need?
- Is the baby in danger? Am I?
- What are the treatment options?
- What are the possible complications?
- What can I expect if the baby is born now?
- Will I need a blood transfusion?
- What are the chances of my needing a hysterectomy after the delivery?
What to expect from your doctor
Your doctor is likely to ask you questions, including:
- When did your signs and symptoms begin?
- Have you noticed changes in your signs and symptoms?
- How much bleeding have you noticed?
- Can you feel your baby moving?
- Have you noticed clear fluid leaking from your vagina?
- Have you had nausea, vomiting or lightheadedness?
- Are you having contractions? If so, how close together are they?
Feb. 25, 2022
- Ananth CV, et al. Placental abruption: Pathophysiology, clinical features, diagnosis and consequences. //www.uptodate.com/contents/search. Accessed Nov. 16, 2019.
- Abruptio placentae. Merck Manual Professional Version. //www.merckmanuals.com/professional/gynecology-and-obstetrics/abnormalities-of-pregnancy/abruptio-placentae. Accessed Nov. 16, 2019.
- Magowan BA, et al, eds. Obstetric haemorrhage. In: Clinical Obstetrics & Gynaecology. 4th ed. Elsevier; 2019. //www.clinicalkey.com. Accessed Nov. 16, 2019.
- Oyelese Y, et al. Placental abruption: Management and long-term prognosis. //www.uptodate.com/contents/search. Accessed Nov. 16, 2019.
- Downes KL. Maternal, labor, delivery and perinatal outcomes associated with placental abruption: A systematic review. American Journal of Perinatology. 2017; doi:10.1055/s-0037-1599149.
Related
Associated Procedures
Products & Services
223. The nurse is performing an assessment on a client diagnosed with
placenta previa. Which assessment findings should the nurse expect to
note? Select all that apply.
1. Uterine rigidity
2. Uterine tenderness
3. Severe abdominal pain
4. Bright red vaginal bleeding
5. Soft, relaxed, nontender uterus
6. Fundal height may be greater than expected for gestational age
Rationale: Placenta previa is an improperly implanted placenta in the lower
uterine segment near or over the internal cervical os. Painless, bright red
vaginal bleeding in the second or third trimester of pregnancy is a sign of
placenta previa. The client has a soft, relaxed, nontender uterus, and
fundal height may be more than expected for gestational age. In
abruptio placentae, severe abdominal pain is present. Uterine tenderness
accompanies placental abruption. In addition, in abruptio placentae, the
abdomen feels hard and board-like on palpation, as the blood penetrates the
myometrium and causes uterine irritability.
Labor and birth
224. The nurse is caring for a client in labor. Which assessment findings
indicate to the nurse that the client is beginning the second stage of
labor? Select all that apply.
1. The contractions are regular.
2. The membranes have ruptured.
3. The cervix is dilated completely.
4. The client begins to expel clear vaginal fluid.
5. The Ferguson reflex is initiated from perineal pressure.
Rationale: The second stage of labor begins when the cervix is dilated
completely and ends with birth of the neonate. The woman has a strong urge
to push in stage 2 when the Ferguson reflex is activated. Options 1, 2, and 4
are not specific assessment findings of the second stage of labor and occur
in stage 1.
225. The nurse in the labor room is caring for a client in the active stage of
the first phaseof labor. The nurse is assessing the fetal patterns and