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accidental haemorrhage of the placenta

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Pathological separation of the placenta from its uterine attachment results in a maternal bleed from the opened sinuses.

Initially, the decidua basalis splits, leaving a thin layer adherent to the myometrium. A decidual haematoma is formed with destruction of adjacent placenta.

There is a spectrum of presentation:

  • concealed - no actual bleeding is seen - it remains in the uterus
  • revealed - blood tracks between the membranes and the uterus and escapes vaginally
  • mixed - most usual

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