[Hemorrhage during the 3d trimester of pregnancy]

Bleeding during the final three months is a serious event. Mortality is very slight in developed countries but morbidity remains considerable. Fetal mortality and morbidity are notable, linked to resultant pathology or prematurity. Their existence requires hospitalisation in a department of gynecology/obstetrics, with a team including an obstetrician, anesthetist/intensive care specialist, and pediatrician. Bleeding is due to placental separation involving the inter-villous chamber (basal decidual hematoma) or the marginal region (marginal decidual hematoma). Precise diagnosis of refractory bleeding is essential and must be obtained simultaneously with treatment. Maternal and fetal prognosis can only be improved by early and appropriate management. The treatment of serious cases is based upon intensive therapy including the replacement of losses, the correction of possible hemostasis problems and fetal extraction. Delivery is a critical phase, with the risk of extremely heavy bleeding and decompensation. This stage of labour requires careful monitoring and intensive therapy without delay.