Signs of placental separation Permanent lengthening of cord Suprapubic bulge: most specific Sudden gush of blood. This may be absent in case of central separation of placenta Uterine fundus must be palpated to see if uterus is well contracted, if not, fundal massage and uterotonic must be given. An adherent placenta such as accreta or increta may lead to uterine inversion while attempting to pull the placenta out.