Placentablødning

Placentablødning refers to abnormal blood loss from the uterus that occurs during or after childbirth and is associated with the placenta. It is an obstetric emergency that can lead to significant maternal morbidity if not promptly identified and managed. The condition is usually classified by the timing of the hemorrhage: antepartum (before delivery), intrapartum (during labor), or postpartum (after delivery). The most common causes are retained placental fragments, placental abruption, uterine atony, lacerations of the cervix or vagina, and placenta previa or accreta. Hormonal and mechanical changes in the uterus after delivery can fail to collapse, leading to continued bleeding, a situation known as uterine atony. In retained placenta situations the placental villi remain attached to the uterine wall and can bleed markedly. In placenta accreta and increta, abnormal placental invasion into the uterine wall causes thickening of the myometrium and makes the placenta difficult to expel.

Clinical features of placentablødning include sudden or progressive vaginal bleeding, abdominal pain, tachycardia, hypotension, and pallor. Diagnosis is primarily clinical, but ultrasound, Doppler studies, and laboratory tests (hemoglobin, coagulation profile) help assess severity and guide treatment. Immediate management aims to control bleeding, restore volume, and preserve life; it often involves uterotonics, uterine massage, and, if necessary, surgical interventions such as curettage, uterine tamponade, or hysterectomy. Antifibrinolytics such as tranexamic acid are also used in many protocols.

Preventive measures focus on careful placental delivery, early recognition of abruption or previa, and adequate monitoring of labor progress. Because of its potential severity, placentablødning is considered a key priority for obstetric care teams.