Background: Placental abruption (abruptio placentae) is an obstetric emergency caused by premature separation of a normally implanted placenta and may result in substantial maternal hemorrhage, coagulopathy, fetal compromise, preterm birth, and perinatal death. This study assessed the clinical profile, associated risk factors, management, and maternal and fetal outcomes among women with placental abruption managed at a tertiary care center.

Methods: This prospective observational study was conducted in the Department of Obstetrics and Gynecology, National Institute of Medical Sciences and Research, Jaipur, over 18 months. Sixty-six pregnant women with clinically diagnosed placental abruption at ≥28 weeks of gestation who provided informed consent were included. Women with other causes of antepartum bleeding or specified bleeding disorders were excluded. Sociodemographic and obstetric characteristics, risk factors, clinical presentation, laboratory and ultrasonographic findings, mode of delivery, maternal complications, and fetal/neonatal outcomes were recorded using a semi-structured proforma. Data thus analyzed categorically and p-value < 0.05 was set as statistically significant.

Results: Of 66 participants, 44 (66.67%) were aged 20–25 years, 49 (74.24%) were from rural areas, 44 (66.67%) were unbooked, and 48 (72.73%) had fewer than four antenatal visits. Maternal anemia was present in 49 (74.24%) women and hypertensive disorders of pregnancy in 38 (57.58%). Most women presented at 33–36 weeks (35, 53.03%), with abdominal pain (52, 78.79%) and bleeding of <6 hours’ duration (42, 63.64%). Revealed abruption was the commonest type (36, 54.55%), and mild abruption was the most frequent severity category (30, 45.45%). Vaginal delivery occurred in 37 (56.06%) and LSCS in 29 (43.94%); fetal distress was the leading documented indication for LSCS. Blood transfusion was required in 38 (57.58%), postpartum anemia occurred in 42 (63.64%), and 12 (18.18%) required ICU admission. One maternal death occurred (1.52%). There were 42 (63.64%) live births, 8 (12.12%) IUFDs, and 16 (24.24%) stillbirths; 46 (69.70%) deliveries were preterm and 40 (60.61%) neonates required NICU admission. In the recorded association analyses, hypertensive disorders, maternal anemia, and PROM were significantly associated with maternal complications (p<0.05), while abruption severity was significantly associated with fetal outcome (p<0.01).

Conclusion: In this tertiary-care cohort, placental abruption was accompanied by substantial maternal morbidity and adverse perinatal outcomes. High frequencies of hypertensive disorders, anemia, inadequate antenatal care, preterm birth, fetal loss, and NICU admission underscore the importance of antenatal risk recognition, timely referral, rapid maternal stabilization, and coordinated obstetric and neonatal care.