How do you differentiate abruptio placentae from placenta previa?

Abruptio Placentae vs Placenta Previa

Placental complications are critical topics in OB/GYN clerkships and are frequently tested in nursing school exams, NCLEX, and clinical rotations. Two commonly confused conditions are abruptio placentae and placenta previa. Differentiating them quickly is essential for maternal and fetal safety.

🔴 Abruptio Placentae

Definition: Premature separation of the placenta from the uterine wall, usually after 20 weeks gestation.
Classic Signs & Symptoms:

• Sudden, severe abdominal pain

• Rigid, board-like uterus

• Dark vaginal bleeding (may be concealed)

• Fetal distress (abnormal FHR, late decelerations)

• Possible maternal shock

Risk Factors:

• Hypertension

• Trauma

• Cocaine use

• Advanced maternal age

⚪ Placenta Previa

Definition: Placenta implants over or near the cervical os, partially or completely obstructing it.
Classic Signs & Symptoms:

• Painless bright red vaginal bleeding

• Soft, relaxed uterus

• Normal fetal heart tones (unless bleeding is severe)

• Recurrent bleeding episodes often in 2nd/3rd trimester

Risk Factors:

• Multiparity

• Multiple gestation

• Previous C-section

• Smoking

📊 Key Differentiation Table

🩺 NCLEX & Clinical Tip

• Do NOT perform vaginal exam if placenta previa is suspected → risk of massive hemorrhage.

• Abruptio = Painful & Rigid.

• Previa = Painless & Bright red.

📢 SBAR Example (Placenta Previa)

• S: “Patient is 32 weeks with painless bright red bleeding.”

• B: “History of 2 prior C-sections, risk factor for previa.”

• A: “Uterus soft, FHR normal.”

• R: “Request ultrasound to confirm previa, prepare for possible C-section.”

✅ Remember for exams:

• Abruptio = Painful, Rigid, Distressed Fetus

• Previa = Painless, Bright Red, Soft Uterus