Abruptio Placentae



The nurse called me into the room. A thirty-year-old woman had come in by ambulance. She told the nurse she was four months pregnant and had suddenly started to bleed heavily from her vagina. She was not having a lot of pain.

When I walked in the room, she was lying on the gurney in a hospital gown that was rapidly becoming soaked with blood. Playing around the bed were the patient’s two daughters, about three years and eighteen months in age. They seemed to have enjoyed the ambulance ride and were unbothered by the excitement and all of the blood.

A lot of things happen simultaneously when I face this sort of situation. One look helps get a feeling for how sick the person is. Then vital signs come as an IV is being started and blood tests are being ordered. All of this is happening while I am talking to the patient, listening to her and feeling her abdomen.

Once I get the important information I need and get the treatment and testing started, I do a pelvic exam, which is really where the money is in a patient like this. This lady had a very large vagina and it was packed with a ton of blood and blood clots. I used a big pincher called a ring forceps with balls of gauze-wrapped cotton to remove the blood and blood clots. Over and over again I reached in, scooping blood and blood clots out which splatted onto the absorbent pad I had spread on the floor.

Eventually, I was able to get enough of the blood out to see she was still bleeding but the opening up into the uterus (womb) was still closed. That told me that even though she was bleeding heavily, she was not presently aborting. Now I knew what I needed to tell the obstetricians when I called them.

We got her vital signs fixed with IV infusions. We got blood ready for a transfusion. The obstetricians came down and did an ultrasound that showed an eighteen-week-old living fetus. They examined her down below again and found she was still bleeding. All of this pointed to abruptio placentae, which is defined as the premature separation of the placenta from the uterus.

So, the patient had a perfectly healthy baby, which she wanted, but she was going to bleed to death unless it was taken out of her. The way the OB attending physician put it to the patient was something like, “We want you to be here to take care of the two girls you already have rather than dying trying to have a third.”

The poor lady was in tears as she concented to going to the operating room to have her pregnancy aborted to save her life. Her husband was working in San Francisco and couldn’t be reached and she said she had noone else to come and support her or help her with the girls.

By the time she went to the operating room, she was stable. The girls stayed with us until morning when a social worker could come and try to get some help for them. The lady was sad but I am sure she was grateful to get medical treatment that certainly saved her life.

All of this made me think about what Rick Santorum said about why a woman shouldn’t have an abortion even if she were raped. He said something like, “It is her baby and she should accept it and love it.” I wonder if he would have advised my patient to just go ahead and die rather that have an abortion to save her life. It was very sad and very painful for that woman to have to make such a decision but it was really the only justifiable decision to be made, in my opinion.




9 responses to “Abruptio Placentae”

  1. Hilary

    Wow. Not only can I not imagine the emotional struggle of that situation, I can’t imagine not having anyone to call for help.

    Count your blessings, right?


  2. I can’t even imagine having to make that kind of a decision. I think I couldn’t even begin to make that choice for someone. I think you were right – those two girls need her. I also think that our Heavenly Father will help us decide in those tough situations and no one else can judge. Had she not been coherent, the OB would have had to make the decision for her and that would have been in favor of the mother, correct?

    1. You are right. If she had not been able to give consent and no one else could be reached to act in her behalf, we would have had to have done what we thought best for her.

  3. I wouldn’t even call that abortion. I am not sure what I would call it, but it wouldn’t be that. I love living babies, but a 19-week fetus is not viable. A lesson for politics, especially, for our sweater friend, is avoiding all or nothing statements.

    I’m glad those little girls still have a mother.

    1. You said, “I’m not sure what I would call it…” I think that is just what makes it so interesting and challenging. We have these ideas that everything is black and white, right and wrong. My life has taught me that it is just not that simple.

  4. Wow, what a night for that woman! Good thing she came in, though…definitely a mixed blessing!

    The police scanner is always on at work. In just a few short months I’ve heard “heavy vaginal bleeding” be the reason women are rushed to the hospital by paramedics at least two or three times. It’s always hard to imagine what exactly is happening during those calls, but I guess this is one of them!

    1. Vaginal bleeding can be dangerous but it is also very worrisome, as you can imagine, especially associated with pregnancy.

  5. Future Pharmer of America

    I am pro-life, and I have no problem with the abortion you described, and I suspect that it would be difficult to find a pro-lifer who would. The goal is to save lives, and when the choice is one dying versus two dying, one is less than two.

  6. Katie O

    This is so tragic. While it’s a tough story it is the kind of thing we should be talking about given the current political climate. With men like Santorum essentially accusing women of being bad or selfish mothers by choosing to live (doesn’t that cover pro-life?) it continues the discussion on when life begins and even what constitutes an abortion! I can’t imagine a woman giving up her life when she has her two children right next to her. I just hope she and her family are able to find peace and can safely grow their family if they try to do so.

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