Placental Complications: Previa vs Abruption — Pain, Bleeding Pattern, Management
Third-trimester bleeding hits and you need to act fast — but one wrong move kills. Performing a vaginal exam on a previa can trigger fatal hemorrhage. Mistaking abruption's concealed bleeding for a stable patient delays an emergency cesarean. The pain and bleeding pattern tell you which emergency you're facing.
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- Placenta implants over/near cervical os
- Prior cesarean, multiparity, AMA
- Premature separation from uterine wall
- HTN, cocaine, trauma, PROM
- ★PAINLESS bright-red bleeding
- Soft, relaxed, nontender uterus
- ★PAINFUL sudden bleed
- Dark or concealed bleeding
- Board-like rigid uterus
- Ultrasound confirms placental location
- FHR usually reassuring
- Clinical dx; US often misses it
- FHR late decels/bradycardia
- Monitor coags/fibrinogen for DIC
- ★No vaginal exam until US rules out
- Continuous EFM
- Large-bore IV, type & crossmatch
- Large-bore IV, type & crossmatch
- Continuous EFM
- Mark fundal height (concealed bleed)
- Expectant care + betamethasone < 34 wk
- Rh Ig if Rh−
- Cesarean if placenta covers os
- Blood products, correct DIC
- Emergent cesarean if moderate–severe
- Rh Ig if Rh−
- Pelvic rest
- Report any bleeding
- Report any bleeding
- Avoid cocaine
- Control blood pressure
- Report severe abdominal pain
- Massive painless hemorrhage
- ★DIC, fetal distress, Couvelaire uterus
- Hemorrhagic shock
- Preterm birth
- Placenta accreta
- DIC
- Hemorrhagic shock
- Fetal demise
- Preterm birth
Placenta Previa
- Placenta implants over/near cervical os
- Prior cesarean, multiparity, AMA
Placental Abruption
- Premature separation from uterine wall
- HTN, cocaine, trauma, PROM
Placenta Previa
- ★PAINLESS bright-red bleeding
- Soft, relaxed, nontender uterus
Placental Abruption
- ★PAINFUL sudden bleed
- Dark or concealed bleeding
- Board-like rigid uterus
Placenta Previa
- Ultrasound confirms placental location
- FHR usually reassuring
Placental Abruption
- Clinical dx; US often misses it
- FHR late decels/bradycardia
- Monitor coags/fibrinogen for DIC
Placenta Previa
- ★No vaginal exam until US rules out
- Continuous EFM
- Large-bore IV, type & crossmatch
Placental Abruption
- Large-bore IV, type & crossmatch
- Continuous EFM
- Mark fundal height (concealed bleed)
Placenta Previa
- Expectant care + betamethasone < 34 wk
- Rh Ig if Rh−
- Cesarean if placenta covers os
Placental Abruption
- Blood products, correct DIC
- Emergent cesarean if moderate–severe
- Rh Ig if Rh−
Placenta Previa
- Pelvic rest
- Report any bleeding
Placental Abruption
- Report any bleeding
- Avoid cocaine
- Control blood pressure
- Report severe abdominal pain
Placenta Previa
- Massive painless hemorrhage
Placental Abruption
- ★DIC, fetal distress, Couvelaire uterus
Placenta Previa
- Hemorrhagic shock
- Preterm birth
- Placenta accreta
Placental Abruption
- DIC
- Hemorrhagic shock
- Fetal demise
- Preterm birth
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Painless + bright red + soft uterus = previa. Painful + dark red + rigid uterus = abruption.
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- Commonly confusedPlacenta Previa vs Placental AbruptionPainless vs painful bleeding — the OB emergency discrimination.
- TopicPlacenta PreviaPainless, bright red vaginal bleeding in the third trimester should trigger one absolute rule: no digital vaginal exam until an ultrasound confirms placental location.
- TopicPlacental AbruptionDark red vaginal bleeding with a rigid, board-like abdomen in the third trimester signals a placental emergency — but up to 20% of abruptions have no visible bleeding at all.
- GuideATI Maternal Newborn Proctored Exam (CMS): What’s on It and How to StudyWhat the ATI Maternal Newborn proctored exam covers, from antepartum to the newborn, the level you need, and a ready-made study plan.