Placental abruption – diagnosis and assessment

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Content Placental abruption is primarily a clinical diagnosis based on the maternal presentation and examination findings. Typical clinical features include vaginal bleeding, abdominal or back pain, uterine tenderness and increased uterine activity; bleeding may be absent when haemorrhage is concealed. Maternal assessment should include the amount and character of bleeding together with pulse, blood pressure and other evidence of haemodynamic compromise; visible blood loss may underestimate the true severity. Fetal assessment forms part of the evaluation once maternal assessment and resuscitation are underway, because placental abruption may be associated with fetal compromise. Ultrasound is useful for determining placental location and diagnosing placenta praevia, but it has limited sensitivity for placental abruption; a negative ultrasound therefore does not exclude abruption. Laboratory investigation is guided by the severity of haemorrhage and clinical condition and may include full blood count, coagulation studies, blood grouping and compatibility testing.

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