Emergency Medical Services Management of Placental Abruption: Current Clinical Practices and Prehospital Care

Abstract

Background: Placental abruption is a rare but life-threatening obstetric emergency characterized by the premature separation of the placenta from the uterine wall before delivery. It is a major cause of antepartum hemorrhage and is associated with significant maternal and fetal morbidity and mortality, requiring rapid recognition and coordinated multidisciplinary management. Aim: This review aimed to summarize the current evidence regarding the epidemiology, etiology, pathophysiology, clinical presentation, evaluation, and management of placental abruption, with particular emphasis on the role of emergency medical services and prehospital care. Methods: A comprehensive narrative review of contemporary evidence-based literature was conducted to examine current knowledge related to placental abruption. The review integrates information on risk factors, disease mechanisms, diagnostic strategies, emergency assessment, prehospital stabilization, definitive hospital management, and interprofessional collaboration to provide practical guidance for healthcare professionals. Results: Placental abruption remains an unpredictable obstetric emergency despite advances in prenatal care. Early recognition of maternal symptoms, rapid assessment of fetal well-being, prompt hemodynamic stabilization, and expedited transport to specialized obstetric centers are critical determinants of favorable outcomes. Diagnosis relies primarily on clinical assessment supported by laboratory investigations, fetal monitoring, and ultrasonography. Management varies according to disease severity, gestational age, and maternal-fetal status, ranging from close observation in stable patients to emergency delivery and massive transfusion in severe cases. Successful outcomes depend on coordinated multidisciplinary care involving emergency medical services, obstetricians, anesthesiologists, neonatologists, and critical care teams. Conclusion: Early recognition, evidence-based emergency management, and seamless multidisciplinary collaboration remain fundamental for reducing maternal and neonatal morbidity and mortality associated with placental abruption.