Placental Abruption
- Nicole Hooser
- Aug 12
- 4 min read
Placental abruption doesn’t wait. Can you recognize it in time?
One minute, it’s a routine call. Next, you’re racing against the clock for two lives at once.
Placental abruption is one of the most time-critical obstetric emergencies an EMS provider can face. With sudden, often subtle warning signs and the potential for rapid maternal and fetal compromise, your actions in the field can mean the difference between life and death. This blog will break down what you need to know—how to recognize it, what to prioritize, and how to manage the chaos when seconds matter.
What is Placental Abruption?
Placental abruption occurs when the placenta partially or completely separates from the uterine wall before delivery. Within the placenta are many blood vessels that allow the transfer of nutrients to the fetus from the mother. If the placenta begins to detach during pregnancy, there is bleeding from those vessels. The larger the area that detaches, the greater the amount of bleeding. Placental abruption occurs about once in every 100 births. It is also called abruptio placenta. It’s unpredictable and often sudden, making early recognition critical for EMS providers.
Placenta Abruption is broken down into three grades;
Grade 1: Small amount of vaginal bleeding and some uterine contractions, no signs of fetal distress or low blood pressure in the mother.
Grade 2: Mild to moderate amount of bleeding, uterine contractions, and the fetal heart rate may show signs of distress.
Grade 3: Moderate to severe bleeding or concealed(hidden) bleeding, uterine contractions that do not relax(uterine tetany), abdominal pain, hypotension, fetal death.
Sometimes, placental abruption is not diagnosed until after delivery, when a clotted area of blood is found behind the placenta.
Why does it matter for EMS?
The statistics are sobering: Placental abruption is a leading cause of maternal morbidity and fetal death. In the prehospital environment, you may be the first–and only–line of defense. Rapid assessment and decisive action can dramatically change outcomes.
So, what are some key risk factors?
Hypertension or preeclampsia
Abdominal trauma (MVCs, assaults, falls)
Previous placental abruption
Multiparity
Cocaine or tobacco use
PROM (premature rupture of membranes)
A history of trauma or high-risk pregnancy should immediately put you on alert.
Recognizing the signs…
While placental abruption can be deceptive, here are some key look-out symptoms.
Sudden onset of abdominal pain or back pain
Vaginal bleeding, often dark red blood.
Uterine contractions that do not relax
Fetal distress
Uterine tenderness
Rigid abdomen, “hard like a board”
No bleeding doesn’t mean no abruption. Concealed hemorrhage can be catastrophic.
Partial Placental Abruption Vs. Complete Placental Abruption
● A partial placental abruption occurs when the placenta doesn’t completely detach from the
uterine wall.
● A complete or total placental abruption occurs when the placenta completely detaches from the uterine wall. There’s usually significantly
Complications to Anticipate
Maternal hemorrhagic shock
Fetal hypoxia or demise
DIC (disseminated intravascular coagulation) in severe cases
So, what do you do?
1: Rapid assessment and transport: This is a true “load and go” situation. Mom and baby need a much higher level of care that can be provided outside of the hospital.
2: Positioning: Place the patient in the left lateral recumbent position if possible to optimize blood flow. While the inferior vena cava is the primary concern, the uterus can also put pressure on the abdominal aorta, the main artery carrying blood from the heart to the rest of the body. This combined compression of both the aorta and vena cava is known as aortocaval compression syndrome or supine hypotensive syndrome.
3: IV/IO access: Establish two large-bore IVs. Initial resuscitation should focus on blood product administration and tranexamic acid (TXA). Vasopressor support with pressors such as NorEpi should be reserved for refractory hypotension unresponsive to volume and hemostatic resuscitation.
4: Consider the need for high-flow oxygen to optimize maternal and fetal perfusion.
5: Monitor: Continuous vitals every 5 minutes, (ECG/SpO2/EtCo2/Blood Pressure). If available, fetal heart tones.
6: Prepare for shock: Be ready for rapid decompensation; keep those blood products we talked about above in mind, if your service carries them.
7: Call ahead: Notify the receiving hospital and request obstetric or surgical services.
If an Rh-negative patient receives Rh-positive blood, whether by mistake or in an emergency, they’ll likely need RhoGAM to prevent their immune system from forming antibodies. The dose might need to be higher depending on how much Rh-positive blood they received, and they may need follow-up labs.
What NOT to do..
Do NOT attempt to deliver the fetus unless there is impending crowning and no possibility of reaching the hospital in time.
Avoid delaying transport for extensive on-scene interventions.
But, what do you say in your handoff?
Estimated gestational age
Bleeding (amount, color, presence or absence)
Maternal vitals and response to interventions
Any known trauma or risk factors
Placental abruption is rare but deadly. The key is vigilance: listen to your instincts, recognize the warning signs, and act promptly. In the field, you may be the only thing standing between the mother and baby and a catastrophic outcome.
References
