Down-up sequential separation of the placenta

Objective To characterize the patterns of placental separation during the third stage of labor. Methods Continuous real-time ultrasound was performed during the third stage of labor in 101 normal deliveries. The sequence of placental separation was recorded for determining whether the process was multiphasic, the site from which separation commenced and the mode of its progression. Results Separation in 97 cases was multiphasic. Monophasic separation in which all parts of the placenta appeared to separate simultaneously occurred in two cases only. Pathological prolongation of the third stage precluded determination of separation in two cases. Ninety-two cases bad 67 uterine wall placenta (anterior or posterior); the separation commenced at one pole and progressed sequentially towards the opposite side in 89 of them. The process started at the lower pole (down-up separation) in 83192 cases (90.2%) and began front the upper pole (up-down separation) in only 6192 cases (6.5%). Nine cases had a fundal placenta; of these the separation was also multiphasic but began sequentially from either the interior or posterior pole, or simultaneously front both, in 8 (88.9%) cases so that the fundal part was separated last (bipolar separation). Conclusions Placental separation is usually an orderly multiphasic phenomenon that begins mostly from the lower pole of the placenta and propagates sequentially upwards. Fundal placentae, however, separate first at their poles with the fundal part being separated last. Recognition of the sequence of events and understanding of the mechanism of placental separation may aid in detecting cases prone to third-stage complications and in managing pathological ones.