Placental abruption occurs when the placenta prematurely separates from the uterus after 28 weeks of pregnancy. It can range from mild to severe separation. It is diagnosed using cardiotocography, ultrasound, and blood tests. Management depends on the degree of bleeding, fetal maturity, and whether labor has begun. Complications include premature delivery, fetal distress, hemorrhagic shock, renal failure, and postpartum hemorrhage. Placenta previa occurs when the placenta implants in the lower uterine segment, covering all or part of the cervical os. It is diagnosed using ultrasound and may be classified as total, partial, or low-lying. Management involves monitoring for bleeding and delivery by

1. Ajitha Unnikrishnan Nair Pooja Unni
Group - 5
Course - 6
VAGINAL BLEEDING IN LATE
PREGNANCY. PREMATURE
DETACHMENT OF A
NORMALLY LOCATED
PLACENTA . PLACENTA PREVIA

2. Antepartum haemorrhage
Bleeding from the genital tract in late
pregnancy after the 28th weeks(20 – 28) of
gestation and before delivery of the baby is
called APH
Etiology
A. Maternal:
– Placenta previa
– Apruptio placenta/placental abruption
– Incidental causes (Local causes in the
vagina & cervix)
– Blood dyscrasias – Causes never found
B. Fetal – Vasa previa
APH Effects
A. On the mother:
• Shock.
• Disseminated Intravascular coagulation
(DIC)
• Renal failure
• Permanent ill health
• Death
B.On the fetus:
• Fetal hypoxia- mentally & physically
inspired baby
• Stillbirth
• Neonatal death

3. Placenta previa
* Occurs when the placenta is implanted in the lower
segment of the uterus
* Complicated 0.4% of pregnancies at term
oAt 20 weeks the placenta is low lying in many more
pregnancies
oBUT appears to move as pregnancy continues
oThis is due to the formation of the lower segment of
the uterus in the 3rd
trimester
It is the myometrium where the placenta implants
and moves away from the cervical os

4. Etiology
• Unknown
• Slightly more
common in
oTwins — larger
placental bed
oWomen of higher
parity
oHigher maternal
age
oUterus is scarred
(previous CS)
Classification

5. Investigations
1. Ultrasound Scan
oMost placenta praevia are diagnosed prior to any
bleeding
Low lying placenta
o If diagnosed during 2nd trimester
oRepeat ultrasound (transvaginal for posterior
placenta) at 32 weeks
oExclude placenta praevia
If placenta is <2cm from internal os at 32 weeks likely
to be previa at term
2. 3-D Power USS
oIf the placenta is anterior + under a caesarean
section scar
oDetermine placenta accreta and severity
MRI may also be useful
oTo be prepared for haemorrhage at delivery
MRI may also be useful
oTo be prepared for haemorrhage at
deliver
3. CARDIOTOCOGRAPHY
oWhen presentation is bleeding
Kleihauer Test
oDetermine if there has been and
how much Fetomaternal
haemorrhage
oMeasures the amount of foetal Hb
transferred to the mother’s circulation

6. Management

7. * Premature separation of normally situated placenta
occurring after 28th (20 -28)wks of pregnancy is known as
placental abruption.

8. Classification
A.Based on the blood lost from abruation
Revealed : separation of placenta the blood is downwards between the membranes and
deciduas.
Concealed: Blood is collected behind the separated placenta or collected in between the
membranes or deciduas.
Mixed: Some of the part of the blood is collected inside (concealed) and some part is expelled
(revealed).
B.Based on Degree of abruption
1. Mild Separation
2. Moderate Separation
3. Severe Separation

9. Diagnosis
* cardiotocography
* USG
*Blood test
Management
Assessment of the blood loss, maturity of the fetus & whether the patient is in labor or
not.
• 5% dextrose is started and arrangement for blood transfusion
• If necessary oxytocin drip may be started.
• If after 38th wks of gestation induction of labour to be done by artificial rupture of
membranes or with oxytocin
If before 38th wks of gestation if bleeding is sever LSCS to be done
If Bleeding is less or shght or stopped only oxytcoin may be started.
•Sedation is ensured by giving inj. morphine 15mg IM or Inj. Pethedin 100-150mg.
Complications
1. Premature delivery.
2. Fetal distress and death.
3. Haemorrhagicshock.
4. Acute renal failure: acute tubular
or cortical necrosis.
5. DIC (release of tissue
thromboplastin).
5. Uterine atony (Couvelaire
uterus).
6. PPH

10. Complication of placenta abrutio
1. Premature delivery.
2. Fetal distress and death.
3. Haemorrhagicshock.
4. Acute renal failure: acute tubular or cortical necrosis.
5. DIC (release of tissue thromboplastin).
5. Uterine atony (Couvelaire uterus).
6. PPH

11. Vasa previa
*Vasa previa is an obstetric complication in which the fetal blood vessels
cross or run near the internal orifice of the uterus.
*These vessels are at risk of rupture when the supporting membranes rupture
as they are unsupported by the umbilical cord or placental tissue.
*This complication can happen during labour.
Cause
1. A low lying placenta.
• It can be due to scarring of the uterus as a result of previous miscarriage
and D/C ( Dilatation and Curettage)
2. An abnormally or unusually form placenta.
• It can be a bilobed placenta or succenturiate- low placenta.
3.In cases of in-vitro fertilization pregnancies and multiple pregnancies (
twins, triplets, etc)
4. In case of velamentous insertion of umbilical cord

12. Symptoms
• Painless vaginal bleeding (2nd f 3rd trimester)
• Darker red color blood (as the baby blood is dark in color, bright red
blood signifies blood from the mother.)
• Fetal bradycardia
Treatment
• The only treatment plan to be followed is a healthy delivery by cesarean
section.
• Cesarean section should be planned as early enough to avoid an
emergency and should be late enough in orde to prevent the problems
related with prematurity.
• Usually cesarean section is recommonded at 35-36 weeks provided the
mother is normal without any risk.