Placental Abruption — Management Pathway

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] Maternal-fetal status & gestational age
   Maternal-fetal status and gestational age? (Premature placental separation at >20 weeks: vaginal bleeding + abdominal pain/uterine tenderness ± contractions + abnormal fetal heart rate; bleeding can be concealed → hemorrhagic shock/DIC/fetal distress and death. Clinical diagnosis (ultrasound is insensitive, normal does not exclude); check coagulation (DIC — fibrinogen may be normal initially, monitor serially), cross-match, fetal monitoring, Kleihauer/anti-D if Rh-negative. Resuscitate and monitor serially in all preterm/suspected cases.)
   • Mother unstable / fetal distress / term → Unstable → deliver promptly
   • Maternal-fetal stable, preterm → Stable preterm · expectant
2. [End] Stable preterm · expectant
   Maternal-fetal stable, preterm, mild abruption: expectant management — admit for close monitoring (continuous fetal heart rate, bleeding, coagulation, vital signs); steroids for fetal lung maturity; anti-D if Rh-negative; cross-match. Bleeding worsening/abnormal fetal heart rate/worsening coagulation → deliver immediately.
3. [End] Unstable → deliver promptly
   Mother unstable / fetal distress / term: deliver promptly — emergency cesarean if the fetus is viable and distressed; vaginal delivery if the fetus has died or labor is established and the mother is stable. Concurrently resuscitate: large-bore IV, transfuse products to correct blood loss and DIC (PRBC/FFP/cryoprecipitate/platelets/fibrinogen), monitor coagulation serially (DIC may be delayed); anti-D if Rh-negative.

Source guidelines & references

• ACOG antepartum hemorrhage; Merck placental abruption

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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