Van Vleuten had been part of a four-woman breakaway group on the final climb of the extremely hilly 137 kilometres long course.

She had been joined in the move by Van der Breggen, Italy’s Elisa Longo Borghini and the United States' Mara Abbott, with their effort proving the key move on a day full of dangerous attacks.

The Dutchwoman accelerated clear of her breakaway companions as they approached the summit of the Canoas-Vista Chinesa climb and aimed to pull further clear on the descent.

Similar to the men’s race, which saw leaders Vincenzo Nibali and Sergio Henao crash, the treacherous downhill section also ended Van Vleuten chances of gold, with the Dutchwoman falling and lying motionless by the side of the road.

It left Abbott - who had been the closet to Van Vleuten - in the lead and the American rider looked to time trial the remaining 15 kilometres of the race to secure the gold.

Van der Breggen, Borghini and Sweden’s Emma Johansson, who had bridged across to the two riders, joined forces to try to close the gap, while another chasing group were also vying to get back into contention.

Abbott proved unable to hold on for the victory, just as solo men’s leader Poland’s Rafal Majka had done yesterday, with the American eventually being caught by the three chasers in the final kilometre.

It would eventually see her finish outside of the medals, with Van der Breggen having the finishing speed to win gold in a time of 3hr 51min and 27sec ahead of Johansson, who replicated her silver medal finish from Beijing 2008.

Borghini settled for the bronze medal, ending on the same time as the winner.

"The chase started after I saw Annemiek,” Van der Breggen, who made it two consecutive women’s road race Olympic titles for The Netherlands after Marianne Vos’ triumph at London 2012.

“I think she crashed pretty hard and I was pretty shocked.

“I realised that I was the first one from the team so I had to chase, I did it also for Annemiek.

“The team work was really good because we knew that we had to do it.

”Annemiek was in front and I was riding for third place at that moment and then suddenly I saw her [having crashed] and it changes everything.

“Of course, when you see her like that it is a big shock."

According to the Dutch broadcaster NOS, Van Vleuten has has a severe concussion and three small fractures on her spine, while she must remain in intensive care for 24 hours.

Britain’s world champion Lizzie Armitstead led home the chasing group, ending in fifth place.

She had been able to compete having been afforded a reprieve in spite of missing three drugs tests within a 12-month period, with the Court of Arbitration for Sport ruling that the first of the missed tests was not valid.