**8.4 Placental abruption**

Abruption placenta refers to the premature separation of normally situated placenta and it occurs in 0.5–1.5% of all pregnancies.

Abdominal pain may be present with or without vaginal bleeding. Fetal heart rate may be absent in sever abruption secondary to utero-placental insufficiency.

There may be varying degrees of hemodynamic compromise secondary to blood loss either vaginally or inside the uterus in the concealed variety.

Immediate senior input should be sought and management includes maternal resuscitation, correction of hypervolemia and coagulation abnormalities through a multidisciplinary approach. Emergency cesarean section should be performed in the event of suspected fetal compromise, once the woman is hemodynamically stable and her coagulation abnormality is corrected.

If an intrauterine death is confirmed, an amniotomy and oxytocin infusion may be commenced. Hemodynamic instability warrants immediate uterine evacuation to avoid morbidity and maternal mortality.
