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SEMINAR 3 :   PREGNANCY INDUCED HYPERTENSION AND OBSTETRICAL HEMORRHAGE
A.  A1.  A2.  A3.  A4.  B.  B1.  B2. 

Case Histories- Third Trimester Bleeding : Placental Abruption

The other major cause of third trimester bleeding is placental abruption. Placental abruption is separation of the placenta from the implantation site. This may be partial, or it may be complete. Initially partial abruption may progress to complete abruption at any time. Abruptions occur anywhere from 1/200 to 3/200 pregnancies.

Ultrasound of placental abruption
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Ultrasound of placental abruption. The fetal body and bladder are labeled FB, and BL, respectively.
Credits: C. Matthew Peterson, M.D.

Abruptio placenta
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Abruptio placenta. This large retroplacental blood clot is known as abruptio placenta. Such abnormal hemorrhage prior to delivery can lead to sudden onset of pain in the mother.
Credits: C. Matthew Peterson, M.D.

Abruptio placenta
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Abruptio placenta. Microscopically, this abruptio placenta is seen to have extensive hemorrhage at the top of the photograph at the decidual plate, with placental villi below.
Credits: C. Matthew Peterson, M.D.

Placental abruption
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Placental abruption.
Credits: C. Matthew Peterson, M.D.

The characteristic findings of placental abruption are the following:


  • Vaginal bleeding (often heavy)

  • Uterine tenderness

  • Tetanic uterine contraction

  • Rapid labor

  • Fetal distress or demise

  • Disseminated intravascular coagulation (DIC)

The following risk factors for placental abruption have been identified:







Placental abruption does not mandate cesarean section. If circumstances allow, vaginal delivery should be the goal. A cesarean section is appropriate if fetal distress develop, or if bleeding is severe. Coagulation factors (platelets and fresh frozen plasma) are administered during labor and post partum if needed.

The following are some other causes of third trimester bleeding:






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