Once diagnosis is established and cardiovascular resuscitation is well under way, a rational plan for delivery of the fetus must be done. This is the single most therapeutic goal. The method and timing of delivery depend on the condition and gestational age of the fetus, the condition of the mother, and status of cervix. Amniotomy is advantageous in nearly all cases. It probably reduces extravasation of blood into the myometrium and entry of thromboplastic substances into maternal circulation, and it may stimulate labor. A major advantage is that amniotomy allows placement of a fetal scalp electrode for heart rate monitoring and an intra-amniotic catheter. Numerous studies of abruption over the past 25 years have demonstrated improved perinatal survival with increased and early use of cesarean section for delivery. If the fetus is dead, vaginal delivery should be attempted in order to minimize maternal morbidity. The clinician must consider each case as unique in deciding the appropriate method of delivery. Meticulous attention to correct surgical technique is more important than "shotgun" prophylactic therapy for coagulopathy in avoiding major intraoperative and postoperative complications. Particular emphasis should be placed on ligation or cautery of small bleeding points that might be overlooked in the routine case.