Abrupting Abby — Placental Abruption
Sudden pain + dark bleeding + rigid uterus — fetal distress races the clock
Abby, 34 weeks and hypertensive, doubles over with sudden, constant abdominal pain after a minor car accident. Her belly feels hard as a board when her husband touches it.
Abby's placenta separates early from the uterine wall, cutting off the baby's oxygen supply behind the scenes. Classic signs are sudden abdominal pain, a rigid board-like uterus, and dark red bleeding that may be minimal even when the separation is severe — blood can be trapped behind the placenta as a concealed hemorrhage. Risk factors include hypertension, cocaine use, trauma, and prior abruption. This is an obstetric emergency requiring rapid delivery, usually by cesarean, because both mother and fetus can deteriorate within minutes.
Read Abrupting Abby's full story →The story arc
The setup
Abby has chronic hypertension and is involved in a low-speed car accident with a seatbelt across her abdomen.
The turn
She develops sudden, constant abdominal pain unrelieved by position change, unlike the intermittent cramping of labor.
The crisis
Her uterus becomes rigid and board-like, dark red blood appears, and the fetal monitor shows late decelerations with minimal variability.
The save
The nurse places her in a lateral position, applies oxygen, starts a large-bore IV, and calls for immediate emergency cesarean delivery as the team prepares blood products.
NCLEX study section — Placental Abruption
What this chapter is testing: the recognition cues, the numbers and the priority action.
Study section: Maternal & Newborn
Take this chapter into practice questions on the same topic.