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ob.placental-abruption.v1PRODUCTION
ob.placental-abruption.v1

Placental Abruption / Abruptio Placentae

obstetricsacuteadultpregnancy
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Acute obstetric emergency — premature separation of normally implanted placenta from uterine wall before delivery; spectrum from minor revealed-only abruption with stable maternal-fetal status to grade-3 abruption with fetal demise + maternal DIC. Partition by gestational age (extreme preterm < 28 / preterm 28-36 / late preterm 36-37 / term ≥ 37 wk) + Sher clinical grade (0 retrospective / 1 minor / 2 distress without DIC / 3 demise + DIC) + type (revealed / concealed / mixed). Distinguishes from placenta previa (classically painless bleed) + uterine rupture + vasa previa + lower-tract bleeding.

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GA cohort + Sher grade + revealed/concealed type tagged

Patient inputs (24)

Tachypnea > 22 is qSOFA / shock-index component; pregnant baseline ~ 16-22 so > 24 is concerning

Hypoxemia raises suspicion for AFE (mimics severe abruption — sudden hypoxia + hypotension + DIC at delivery) or pulmonary edema with overlap

Category I/II/III FHR interpretation drives delivery urgency — Category III demands emergent cesarean if viable GA

Quantify visible vaginal blood loss + character (bright red vs dark vs clots); compare to maternal hemodynamic picture (concealed component if disproportionate)

Painful bleeding (vs painless placenta previa); tetanic / hypertonic uterus is classic abruption finding

Hypertensive disorders are the strongest risk factor for abruption; pre-eclampsia overlap drives concurrent ob.pre-eclampsia.core.v1 pathway

Trauma in pregnancy ≥ 23 wk → ≥ 4 h minimum fetal monitoring + uterine tocodynamometer + Kleihauer-Betke; IPV screening per ACOG CO 518 2012

Cocaine + methamphetamine are top vasoactive substance abruption triggers; UDS in pregnancy bleed; addiction-medicine referral for recurrence prevention

Smoking is a dose-dependent abruption risk factor; cessation counseling for current + future pregnancy

Extreme preterm < 28 / preterm 28-36 / late preterm 36-37 / term ≥ 37 wk drives delivery threshold + steroid + magnesium + NICU planning

Baseline hemoglobin + serial trend (falling Hgb disproportionate to visible bleed = concealed abruption); platelet count for DIC surveillance

Type + screen on arrival; crossmatch ≥ 2 units PRBC if active bleeding or unstable; massive transfusion protocol activation if EBL > 1500 mL (SMFM/ACOG obstetric massive transfusion guidance; NEEDS_SOURCE_REVIEW — PMID unverified 2026-05-25)

DIC surveillance — fibrinogen < 200 mg/dL in pregnancy is concerning (normal pregnancy fibrinogen 350-650); PT/INR + aPTT prolonged; routes to cryoprecipitate + FFP

Renal function (sepsis-AKI cross-reference if shock) + liver function (HELLP overlap if pre-eclampsia)

Quantifies fetomaternal hemorrhage (FMH); critical for Rh-negative mother RhoGAM dose-adjustment; can inform fetal anemia management

Confirm placental location (rule out placenta previa) + retroplacental clot when visible (sensitivity 25-60% only) + fetal viability + GA + fluid; non-visualisation does NOT rule out abruption (Glantz Purnell 2002 PMID 12164566)

Hypotension is a hemorrhagic-shock flag; MAP < 65 in pregnant patient demands rapid resuscitation + potential emergent delivery; concealed abruption can mask hypovolemia until decompensation

Maternal tachycardia > 110 disproportionate to visible bleed is a concealed-abruption clue; obstetric hypovolemia presents with tachycardia before hypotension

Rh-negative mother with abruption requires RhoGAM ± dose-adjustment per Kleihauer-Betke quantification

PROM ± chorio is an antecedent abruption risk; routes to ob.chorioamnionitis.v1 if fever + secondary criteria emerge

Recurrence rate 15-25% in subsequent pregnancy (Tikkanen 2011); pre-conception MFM + low-dose aspirin for next pregnancy if recurrent

Multiple gestation + polyhydramnios are abruption risk factors (rapid uterine decompression); informs pretest probability

UDS for cocaine + methamphetamine (top abruption risk); informs addiction-medicine referral + recurrence prevention

Lactate > 2 with shock features is a hemorrhagic-shock marker; drives massive transfusion + emergent delivery decision

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Severity triggers (10)

10 need judgement
  • informationallife_threateningplacental_abruption_with_maternal_instability
    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
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationallife_threateningplacental_abruption_with_fetal_distress
    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
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationallife_threateningplacental_abruption_grade_3_with_dic
    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
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalsevereabruption_with_pre_eclampsia_overlap
    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
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalseverecocaine_methamphetamine_associated_abruption
    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
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalseveretrauma_associated_abruption
    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
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalseverepreterm_abruption_with_expectant_management
    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
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalsevererecurrent_abruption_in_subsequent_pregnancy
    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)
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalsevereconcealed_abruption_with_hypovolemic_signs_despite_minimal_bleed
    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)
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalseverekleihauer_betke_with_fetomaternal_hemorrhage
    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
    Trigger could not be auto-evaluated — needs clinician judgement.

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Recommended regimen

Acute placental abruption — resuscitation + delivery + DIC + neuroprotection + RhoGAM (ACOG PB 232 2021 + Pacheco SMFM 47 2019)
axis: placental_abruption_acute_managementstep expectant_preterm_stable - Expectant management — preterm + stable + minor + reassuring fetus (ACOG PB 232 2021)
Selected step "Expectant management — preterm + stable + minor + reassuring fetus (ACOG PB 232 2021)" — GA < 34 wk + maternal stable + Sher grade 1 + Category I FHR + no DIC features + no progressive bleeding
  • betamethasone
    first line
    corticosteroid
    12 mg IM × 2 doses 24 h apart • IM • q24h × 2 doses
    triggers: preterm_24_to_34_wk_with_stable_abruption
    Antenatal corticosteroids for fetal lung maturation 24-34 wk (ACOG CO 713 2017 / NICHD 2016)
    rxcui 1514
  • magnesium sulfate
    first line
    antiseizure_neuroprotection
    4-6 g IV bolus over 20-30 min then 1-2 g/h IV • IV • continuous infusion until delivery or 24 h
    triggers: preterm_lt_32_wk_with_delivery_anticipated
    Neuroprotection if delivery anticipated < 32 wk (ACOG CO 455 2010 reaffirmed; BEAM trial Rouse 2008 NEJM)
    rxcui 6585

outpatient playbook — drug actions (6)

  1. 1. iron repletion if postpartum anemia
    rxcui 24947
    Ferrous sulfate 325 mg PO TID; IV iron if severe anemia (Hgb < 8) or non-tolerant • PO/IV • TID PO or per infusion protocol
    trigger: Postpartum Hgb < 11 g/dL (abruption + hemorrhage often → significant anemia)
    Restore iron stores; reduce fatigue + improve recovery (ACOG general postpartum guidance)
  2. 2. low-dose aspirin for next pregnancy if recurrent or HTN-driven
    rxcui 1191
    81 mg PO daily starting before 16 wk in next pregnancy • PO • daily preconception + early pregnancy
    trigger: Recurrent abruption OR HTN/pre-eclampsia-associated abruption planning next pregnancy
    USPSTF + ACOG 2018 — low-dose aspirin reduces pre-eclampsia + may reduce recurrent abruption in HTN-driven cohort
  3. 3. contraception
    Per ACOG MEC + patient preference (LARC, COC, POP, DMPA, etc.) • PO/IM/implant/IUD • per agent
    trigger: Patient request + medical eligibility
    Avoid short interpregnancy interval (< 18 mo associated with worse outcomes); ACOG MEC
  4. 4. tobacco cessation pharmacotherapy
    Nicotine replacement OR varenicline OR bupropion per USPHS / USPSTF • PO / transdermal / lozenge • per agent
    trigger: Continued tobacco use postpartum
    Smoking is dose-dependent abruption risk; cessation strongly indicated
  5. 5. antihypertensive maintenance
    Labetalol, nifedipine ER, methyldopa per ACOG (compatible with breastfeeding) • PO • per agent
    trigger: Chronic HTN postpartum requiring control
    ACOG PB 203 2019 chronic hypertension in pregnancy guidance (extends to postpartum + breastfeeding compatibility)
  6. 6. influenza + COVID + Tdap vaccines per ACIP
    Per ACIP • IM • per schedule
    trigger: Postpartum
    Standard ACIP recommendations

Auto-drafted A&P note

outpatient

Subjective

- Possible entry pathways: Painful vaginal bleeding in second-or-third-trimester pregnancy — gateway clinical feature; distinguishes from placenta previa (classically painless) (Oyelese Ananth 2006 PMID 17012465); 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).

Objective

- No vitals, labs, or imaging entered for this encounter.

Assessment

**Placental Abruption / Abruptio Placentae** (ob.placental-abruption.v1).
Phenotype framing: Placenta previa (PAINLESS bleed; US-confirmed low placental location), vasa previa (fetal-vessel bleed at ROM; APT or Kleihauer for fetal Hgb), uterine rupture (prior cesarean; loss of station; severe pain; tachysystole then absent contractions), bloody show with labor (small amount + mucus + cervical change), lower-genital-tract bleed (cervicitis, polyp, trauma, cervical CA), amniotic fluid embolism (AFE — sudden hypoxia + hypotension + DIC at delivery; obstetric emergency), HELLP / pre-eclampsia with thrombocytopenia + DIC pattern.
Scope: Acute obstetric emergency — premature separation of normally implanted placenta from uterine wall before delivery; spectrum from minor revealed-only abruption with stable maternal-fetal status to grade-3 abruption with fetal demise + maternal DIC. Partition by gestational age (extreme preterm < 28 / preterm 28-36 / late preterm 36-37 / term ≥ 37 wk) + Sher clinical grade (0 retrospective / 1 minor / 2 distress without DIC / 3 demise + DIC) + type (revealed / concealed / mixed). Distinguishes from placenta previa (classically painless bleed) + uterine rupture + vasa previa + lower-tract bleeding.

No severity triggers fired against current inputs.

Plan

Regimen axis: **Acute placental abruption — resuscitation + delivery + DIC + neuroprotection + RhoGAM (ACOG PB 232 2021 + Pacheco SMFM 47 2019)** — step "Expectant management — preterm + stable + minor + reassuring fetus (ACOG PB 232 2021)".
1. betamethasone 12 mg IM × 2 doses 24 h apart IM q24h × 2 doses (corticosteroid, first line) — Antenatal corticosteroids for fetal lung maturation 24-34 wk (ACOG CO 713 2017 / NICHD 2016)
2. 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 (antiseizure_neuroprotection, first line) — Neuroprotection if delivery anticipated < 32 wk (ACOG CO 455 2010 reaffirmed; BEAM trial Rouse 2008 NEJM)

Setting playbook (outpatient) — Routine postpartum 6-wk visit + abruption-specific anticipatory guidance (recurrence 15-25%; pre-conception MFM + low-dose aspirin in next pregnancy + close surveillance + thrombophilia workup if recurrent) + addiction medicine if cocaine/meth etiology + IPV referral if trauma-driven + smoking cessation + HTN surveillance + mental health screen + immunization + newborn outpatient peds 24-48 h post-discharge with high-risk-followup
3. iron repletion if postpartum anemia Ferrous sulfate 325 mg PO TID; IV iron if severe anemia (Hgb < 8) or non-tolerant PO/IV TID PO or per infusion protocol — Postpartum Hgb < 11 g/dL (abruption + hemorrhage often → significant anemia) (Restore iron stores; reduce fatigue + improve recovery (ACOG general postpartum guidance))
4. low-dose aspirin for next pregnancy if recurrent or HTN-driven 81 mg PO daily starting before 16 wk in next pregnancy PO daily preconception + early pregnancy — Recurrent abruption OR HTN/pre-eclampsia-associated abruption planning next pregnancy (USPSTF + ACOG 2018 — low-dose aspirin reduces pre-eclampsia + may reduce recurrent abruption in HTN-driven cohort)
5. contraception Per ACOG MEC + patient preference (LARC, COC, POP, DMPA, etc.) PO/IM/implant/IUD per agent — Patient request + medical eligibility (Avoid short interpregnancy interval (< 18 mo associated with worse outcomes); ACOG MEC)
6. tobacco cessation pharmacotherapy Nicotine replacement OR varenicline OR bupropion per USPHS / USPSTF PO / transdermal / lozenge per agent — Continued tobacco use postpartum (Smoking is dose-dependent abruption risk; cessation strongly indicated)
7. antihypertensive maintenance Labetalol, nifedipine ER, methyldopa per ACOG (compatible with breastfeeding) PO per agent — Chronic HTN postpartum requiring control (ACOG PB 203 2019 chronic hypertension in pregnancy guidance (extends to postpartum + breastfeeding compatibility))
8. influenza + COVID + Tdap vaccines per ACIP Per ACIP IM per schedule — Postpartum (Standard ACIP recommendations)

Non-pharmacologic actions:
- Mental health counseling / therapy if EPDS ≥ 10 or PCL-5 elevated
- Lactation continued support if breastfeeding (compatible with all abruption-related medications per LactMed)
- Postpartum exercise progression per ACOG (8 wks to gradual return; immediate light activity OK)
- Future-pregnancy preconception counseling — encourage 18+ mo interpregnancy interval, optimize maternal health (HTN, weight, smoking, substance use), close 1st-trimester surveillance + MFM + early aspirin if HTN-driven
- Pediatric follow-up coordination for high-risk newborn — 24-48 h post-discharge peds visit, then 1 wk + 1 mo developmental + immunization tracking
- Addiction medicine + IPV social-work support continued
- Thrombophilia workup if recurrent (factor V Leiden, APS, protein C/S)

AVOID / contraindication checks:
- NSAIDs avoid antepartum PDA constriction and bleeding (ACOG general guidance)
- Methylergonovine contraindicated in hypertension or preeclampsia (ACOG PB 183 2017)
- Carboprost contraindicated in asthma (ACOG PB 183 2017)
- Do not delay emergent delivery for imaging in unstable abruption (ACOG PB 232 2021)
- Ultrasound non visualisation does not rule out abruption sensitivity 25 to 60 percent (Glantz Purnell 2002 PMID 12164566)
- Painful bleeding distinguishes from painless placenta previa (Oyelese Ananth 2006 PMID 17012465)
- Concealed abruption maternal hypovolemia can exceed visible bleed (Oyelese Ananth 2006)
- Kleihauer betke required for Rh negative mother RhoGAM dose adjustment (ACOG PB 181 2017)
- Massive transfusion 1to1to1 PRBC FFP platelets with cryo for fibrinogen lt 200 (SMFM/ACOG obstetric massive transfusion guidance; NEEDS_SOURCE_REVIEW — PMID unverified 2026 05 25)
- Tranexamic acid within 3 hours of birth only (WOMAN 2017 PMID 28456509)

Monitoring

Regimen monitoring:
- Maternal vitals q15 min while bleeding; q1 h once stable; q4 h ≥ 24 h post-delivery
- Continuous EFM until delivery (Category I/II/III interpretation)
- Serial Hgb + coag panel q1-2 h while active bleeding; q4-6 h while stabilising
- Fibrinogen target ≥ 200 mg/dL — cryoprecipitate replacement if below
- Platelet target > 50K intrapartum; > 100K if active hemorrhage
- Urine output ≥ 0.5 mL/kg/h
- Lactate trend (≥ 2 with shock features → escalate)
- Kleihauer-Betke for Rh-negative mother — RhoGAM dose-adjustment per result
- Fundal tone q15 min × 2 h then q1 h × 4 h postpartum (atony surveillance — abruption known risk factor)
- Lochia + uterine tenderness q15-60 min postpartum
- Newborn handoff: abruption + GA + maternal antibiotics if chorio overlap → peds / neonatology

Setting (outpatient) monitoring:
- 6-wk postpartum visit; additional visit at 1-2 wk if cesarean wound concern
- Newborn outpatient peds at 24-48 h then 1 wk then 1 mo
- Maternal mental health re-screen at 6 wk + 3 mo + 6 mo
- Future-pregnancy preconception visit when contemplated
- Tobacco cessation follow-up at each visit

Follow-up plan: 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).
- Close-out criterion: Postpartum visit complete; future-pregnancy counseling delivered; addiction / IPV / HTN referrals placed; newborn followup arranged

Monitoring phase: Intrapartum: continuous EFM (Category I/II/III), maternal vitals q15 min, serial Hgb + coag panel q1-2 h while active, fluid balance, urine output ≥ 0.5 mL/kg/h. Postpartum: vitals q15 min × 2 h then q1 h × 4 h then q4 h × 24 h, fundal tone q15 min × 2 h then q1 h × 4 h (atony surveillance — abruption is risk factor), lochia + uterine tenderness, repeat CBC + coag q4-6 h until stable, urine output, mental status. ICU: continuous arterial line + central venous catheter, lactate q2-4 h until normalised, daily SOFA + cultures + antimicrobial review, CAM-ICU.

Disposition

Current setting: outpatient — Routine postpartum 6-wk visit + abruption-specific anticipatory guidance (recurrence 15-25%; pre-conception MFM + low-dose aspirin in next pregnancy + close surveillance + thrombophilia workup if recurrent) + addiction medicine if cocaine/meth etiology + IPV referral if trauma-driven + smoking cessation + HTN surveillance + mental health screen + immunization + newborn outpatient peds 24-48 h post-discharge with high-risk-followup

Disposition criteria:
- Resolution: 6-wk postpartum visit complete, mental health stable, contraception in place, immunizations up to date, substance use / IPV / HTN follow-ups arranged, newborn developmental tracking ongoing → discharge from abruption-specific surveillance back to routine primary care + preconception planning with MFM referral for next pregnancy

Escalation triggers (move to higher acuity):
- 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

Earlier-Return Triggers

Return-precaution thresholds (watch for):
- [LIFE_THREATENING] 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

Citations

- 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) [PMID:17012465](https://pubmed.ncbi.nlm.nih.gov/17012465/)
- Cited evidence (PMID 21241259) [PMID:21241259](https://pubmed.ncbi.nlm.nih.gov/21241259/)
- Cited evidence (PMID 11207150) [PMID:11207150](https://pubmed.ncbi.nlm.nih.gov/11207150/)
- Cited evidence (PMID 12164566) [PMID:12164566](https://pubmed.ncbi.nlm.nih.gov/12164566/)
- Cited evidence (PMID 28456509) [PMID:28456509](https://pubmed.ncbi.nlm.nih.gov/28456509/)

Last reconciled with current guidelines: 2026-05-25.
References
  • 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) — PMID:17012465
  • Cited evidence (PMID 21241259) — PMID:21241259
  • Cited evidence (PMID 11207150) — PMID:11207150
  • Cited evidence (PMID 12164566) — PMID:12164566
  • Cited evidence (PMID 28456509) — PMID:28456509