Placental abruption is a life-threatening complication of the third trimester of pregnancy in which an abrupt separation (partial or complete) of the placenta from the uterine wall occurs before the delivery of the infant. Risk factors include cocaine abuse, trauma, smoking, hypertension
, and preeclampsia
. Symptoms include acute onset lower abdominal pain with a 'woody-hard' uterus with or without pervaginal bleeding. Complications include disseminated intravascular coagulation
, maternal shock, and fetal distress. Management is with emergency cesarean delivery of there is fetal or maternal jeopardy. A vaginal delivery may be attempted if the bleeding is controlled. In-hospital observation may be opted for if the mother and fetus are stable and remote from term.