a. Signs and Symptoms. Bleeding in the last three months of pregnancy must be considered to be placenta abruptio or placenta previa until proven otherwise.

Both of these conditions may be rapidly life-threatening because of massive hemorrhaging.

(1) Placenta abruptio — premature separation of the placenta from the uterine wall resulting in bleeding from the separation site.

(2) Placenta previa — placenta that is implanted in the lower uterine segment, possibly totally or partially covering the opening of the cervix.

b. Treatment. The goal of treatment is to prevent shock. Treat as follows:

(1) Administer 100 percent oxygen.

(2) Establish an IV and run crystalloid or colloid as rapidly as necessary to maintain the patient’s blood pressure.

(3) Transport the patient rapidly to the hospital in the lateral recumbent position (also called the obstetrical position, the patient lies on her left side with her right thigh and knee drawn up).

CAUTION: NEVER do a vaginal examination on any woman with third-trimester bleeding.