Which obstetric emergency involves premature separation of the placenta from the uterus?

• A. Abruptio placentae
• B. Uterine rupture
• C. Eclampsia
• D. Amniotic fluid embolism

Answer: (A)

Premature separation of the placenta from the uterus disrupts the placenta’s blood connection to the uterus, cutting off oxygen and nutrients to the fetus and often causing vaginal bleeding. This is placental abruption, an obstetric emergency. It typically presents with painful vaginal bleeding and abdominal tenderness, and the uterus may be rigid or tender from a developing hematoma. Risk factors include hypertension, abdominal trauma, cocaine or tobacco use, and a history of previous abruption.

In contrast, uterine rupture involves a tear in the uterine wall and usually presents with sudden, very severe pain and signs of maternal instability, potentially with loss of fetal station. Eclampsia features seizures due to severe preeclampsia. Amniotic fluid embolism causes abrupt respiratory distress and shock.

When abruption is suspected, focus on rapid stabilization and transport: provide high-flow oxygen, establish two large-bore IVs, monitor mother and fetus if possible, control bleeding as much as feasible, and prepare for delivery if the mother or fetus is unstable. Position the patient on her left side to improve venous return, and avoid unnecessary vaginal exams unless specifically indicated.