Patient handout

Placental Abruption / Abruptio Placentae

PRODUCTION

1. Your condition

This handout is for placental abruption / abruptio placentae. Your care team identified this based on: painful vaginal bleeding in second-or-third-trimester pregnancy — gateway clinical feature; distinguishes from placenta previa (classically painless) (oyelese ananth 2006 pmid 17012465).

Other reasons your team may use this plan: uterine tenderness + tetanic / hypertonic contractions on palpation in pregnancy ≥ 20 wk (oyelese ananth 2006); maternal tachycardia / hypotension / orthostatic features or falling hemoglobin disproportionate to visible vaginal bleeding (concealed-abruption clue; oyelese ananth 2006); category ii or iii fhr pattern (late decelerations, prolonged decelerations, bradycardia, minimal variability) with antepartum bleeding (acog pb 232 2021).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
betamethasone	12 mg IM × 2 doses 24 h apart	IM	q24h × 2 doses	Antenatal corticosteroids for fetal lung maturation 24-34 wk (ACOG CO 713 2017 / NICHD 2016)
magnesium sulfate	4-6 g IV bolus over 20-30 min then 1-2 g/h IV	IV	continuous infusion until delivery or 24 h	Neuroprotection if delivery anticipated < 32 wk (ACOG CO 455 2010 reaffirmed; BEAM trial Rouse 2008 NEJM)

Plan: Acute placental abruption — resuscitation + delivery + DIC + neuroprotection + RhoGAM (ACOG PB 232 2021 + Pacheco SMFM 47 2019)

3. When to call your provider

Contact your care team if any of the following happen:

Postpartum bleeding / persistent uterine tenderness / foul lochia → endometritis or retained products workup (ED visit)
New mental health crisis (PHQ-9 ≥ 15 or suicidal ideation) → urgent mental health referral
Newborn high-risk features (persistent feeding issues, neurodevelopmental concerns) → urgent peds visit
IPV resurgence → social work + safety planning + law enforcement coordination per patient consent
Resumed substance use → addiction medicine urgent visit + harm-reduction

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Placental abruption + maternal hemorrhagic-shock features (SBP < 90 OR MAP < 65 OR HR > 120 OR lactate > 2 OR rapid Hgb decline) — life-threatening; emergent delivery + massive transfusion protocol (1:1:1 PRBC:FFP:platelets) + ICU; do NOT delay for further imaging — bedside US can confirm fetal viability + placental location but treatment cannot wait(life-threatening)
Placental abruption + Category III FHR (late decelerations, prolonged decelerations, bradycardia, sinusoidal, minimal variability) + viable GA ≥ 24-26 wk with parental wishes aligned + fetus alive on bedside US — life-threatening fetal compromise; emergent cesarean with surgical team + neonatology stand-by(life-threatening)
Sher grade 3 abruption (fetal demise + maternal DIC features — fibrinogen < 200, platelets < 100, prolonged PT/aPTT, oozing IV sites) — life-threatening; massive transfusion + cryoprecipitate + FFP + platelets per ROTEM/TEG; ICU; hysterectomy if uncontrolled hemorrhage despite uterotonics + tamponade + B-Lynch + uterine artery ligation(life-threatening)
Placental abruption + pre-eclampsia (BP ≥ 140/90 + proteinuria OR end-organ dysfunction) OR HELLP overlay — severe; routes to ob.pre-eclampsia.core.v1 with delivery indication carryover; magnesium sulfate prophylaxis 4-6 g IV bolus then 1-2 g/h; antihypertensive titration (labetalol or hydralazine first; nicardipine refractory); avoid methylergonovine; restrictive fluid strategy in PE
Cocaine / methamphetamine use in pregnancy + abruption — severe; UDS confirmation; supportive maternal-fetal management; recurrence prevention requires addiction medicine + harm-reduction + recovery support; routes to psych.opioid_use_disorder.core.v1 if applicable OR dedicated addiction-medicine sibling pathway; close surveillance in subsequent pregnancy if continued use
Trauma in pregnancy ≥ 23 wk + uterine pain / bleeding / fetal compromise / maternal hemodynamic instability — severe; ATLS framework for mother; minimum 4 h continuous EFM + tocodynamometer; Kleihauer-Betke for FMH quantification; refer level-1 trauma if severe mechanism (MVA at speed, IPV with weapon); IPV screening with safety planning; trauma surgery consult if intra-abdominal injury suspected
Preterm < 34 wk + stable maternal-fetal status + minor abruption (Sher grade 1) + reassuring Category I FHR + no DIC features — severe (still significant risk for deterioration); expectant management with antenatal corticosteroids 24-48 h (betamethasone 12 mg IM × 2 doses 24 h apart) + magnesium for neuroprotection if < 32 wk + rapid delivery readiness if deterioration; bed rest controversial; outpatient management typically NOT appropriate; inpatient surveillance until delivery
Prior placental abruption in prior pregnancy — severe future-pregnancy risk; recurrence ~ 15-25% (Tikkanen 2011); preconception MFM consultation + low-dose aspirin 81 mg starting < 16 wk in subsequent pregnancy + close surveillance starting first trimester (early dating US + thrombophilia workup if recurrent + serial growth + fetal surveillance from 32-34 wk)
Concealed abruption — retroplacental clot retained behind placenta with minimal or no visible bleeding but maternal tachycardia + falling Hgb + hypotension disproportionate to visible bleed — severe; emergent bedside ultrasound + delivery; high index of suspicion required as can mimic non-abruption etiologies (PE, sepsis, AFE)
Kleihauer-Betke positive for fetomaternal hemorrhage (FMH) — severe if FMH > 30 mL fetal blood; RhoGAM dose-adjustment if Rh-negative (300 mcg per 30 mL fetal whole blood); consider intrauterine transfusion if severe fetal anemia identified on MCA-PSV doppler; MFM consultation for fetal management decisions

5. Follow-up

6-wk postpartum visit + abruption-specific anticipatory guidance: recurrence risk 15-25% in subsequent pregnancy (Tikkanen 2011); pre-conception MFM + low-dose aspirin 81 mg starting < 16 wk in subsequent pregnancy + close surveillance starting first trimester + thrombophilia workup if recurrent; addiction medicine if cocaine / methamphetamine etiology; smoking cessation; HTN / pre-eclampsia surveillance if HTN-driven; IPV referral if trauma-driven; mental health screen (EPDS for PPD; PCL-5 for peripartum-PTSD given peripartum complication); contraception counseling; immunization review. Newborn outpatient 24-48 h post-discharge peds visit + developmental tracking for first year (preterm-abruption neonate at elevated CP / BPD risk).

6. Sources

Guideline: ACOG Practice Bulletin 232 (2021) — Antepartum Fetal Surveillance (covers placental abruption surveillance + delivery indications) + RCOG Green-top Guideline 63 (2011, in-force) Antepartum Haemorrhage + WHO 2016 Recommendations on antenatal care + SMFM/ACOG obstetric massive transfusion protocol guidance (1:1:1 PRBC:FFP:platelets framework; NEEDS_SOURCE_REVIEW — prior PMID 30447216 was fabricated; SMFM Consult Series #47 PMID 30684460 is actually Sepsis, not massive transfusion; unverified 2026-05-25) + Oyelese Y, Ananth CV — Placental abruption (Obstet Gynecol 2006; 108(4): 1005-1016; PMID 17012465) + Tikkanen M — Placental abruption: epidemiology, risk factors and consequences (Acta Obstet Gynecol Scand 2011; 90: 140-149; PMID 21241259) + Glantz C, Purnell L — US sensitivity for abruption (J Ultrasound Med 2002; PMID 12164566) + ACOG PB 222 2020 Gestational HTN and Pre-eclampsia + ACOG PB 181 2017 Anti-D Immunoprophylaxis + ACOG CO 711 2017 Trauma in Pregnancy + ACOG CO 712 2017 (chorio overlap) + WOMAN trial Shakur 2017 (PMID 28456509) — TXA in PPH (carryover to abruption-delivery PPH)