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Third-Trimester Bleeding

Third-trimester bleeding occurs in 4% of all pregnancies. In 50% of cases, vaginal bleeding is secondary to placental abruption or placenta previa.

Clinical Evaluation of Late-pregnancy Bleeding

History of trauma or pain, and the amount and character of the bleeding are assessed.

Vital signs and pulse pressure are measured. Hypotension and tachycardia are signs of serious hypovolemia.

Fetal heart rate pattern and 

Placental abruption (abruptio placentae) is defined as complete orpartial placental separation from the decidua basalis after 20 weeks gestation.

Placental abruption occurs in 1 in 100 deliveries.

Factors Associated with Placental Abruption

Preeclampsia and hypertensive disorders

History of placental abruption

High multiparity

Increasing maternal age


Cigarette smoking

Illicit drug use (especially cocaine)

Excessive alcohol consumption

Preterm premature rupture of the membranes

Rapid uterine decompression after third-trimester bleeding, pregnancy, bleeding delivery of the first fetus in a twin gestation or rupture of membranes with polyhydramnios

Uterine leiomyomas

Diagnosis of Placental Abruption

Management of Placental Abruption