There is nothing worse for a pregnant woman than losing a baby. This is the worst thing that can happen. And one of the reasons for this may be placental abruption. How to identify it in time, and what is needed to save the baby.

Placental abruption: what is it

The placenta, or baby's place, connects the mother and the baby, creating the most comfortable conditions for him, and therefore for intrauterine growth and development. Any break in this connection, even a small area or edge of the placenta, can harm the baby. Sometimes a minor injury in the form of a fall or a push into the abdomen is enough for a detachment to form, but still, in most cases, nature can protect the child from external mechanical influences. However, a problem may arise inside: with some vascular diseases or with complications of pregnancy, conditions arise in which detachment occurs spontaneously. This is a high, chronic inflammation of the genitals.

The most common causes of placental abruption are:

• trauma (car accident, fall on the stomach, blow to the stomach);
• short umbilical cord in the fetus;
• excessive stretching of the uterus (twins, excess amniotic fluid);
• diagnostic and therapeutic manipulations during pregnancy;
• improper use of drugs that change the tone of the uterus;
• tumors of the uterus (fibroids, endometriosis);
• hard physical labor;
• severe stressful situation (unexpected strong fright).

What is placental abruption

1. Small and not growing in size

With this option, the baby has every chance to calmly endure the inconveniences associated with a lack of nutrients and oxygen. And the placenta will be able to gradually restore the connection with the wall of the uterus. But a favorable outcome will be only with correct and timely treatment in a hospital.

2. Partial and gradually increasing in size

In this case, the risk to the fetus is very high. An increase in the degree of detachment leads to the fact that the baby receives fewer substances necessary for life, which can cause severe suffering in the child.

3. Complete abruption of the placenta

And with this version of detachment of the child's place, the count goes on for minutes. A complete break in the connection between mother and baby becomes the cause of the rapid death of the fetus.

To predict the life of the fetus, not only the degree of detachment is important, but also factors such as the duration of pregnancy and the location of the placenta. Detachment with placenta previa is much more dangerous, and with a short pregnancy, even with an urgent operation, it is impossible to save an unviable fetus.

How will the detachment of the child's place manifest

1. Pain

The first thing that arises is pain in the abdomen above the bosom. Even if they are not very pronounced, a woman should suspect something was wrong and consult a doctor. Especially if the pain persists or increases. The pain syndrome with detachment occurs due to an increase in the tone of the uterus, and it is no less dangerous for the baby than the separation of a part of the child's seat. With hypertonicity, blood vessels are compressed, and the body of the crumbs immediately begins to experience oxygen hunger.

2. Bleeding

Any blood that comes out of the vagina is a sign of an impending condition. We need to be in the hospital in the near future. Even if it is a threat of premature termination of pregnancy, and not placental abruption. In any case, if there is bleeding, you must rush to the hospital. Blood loss is also dangerous for the expectant mother.

3. Change in fetal movements

By the movements of the fetus, a woman can always find out if the baby is good. Moreover, if the fetus is very actively moving, then this does not mean at all that the child has enough. Hyperactivity may indicate anxiety in the fetus, which is experiencing a marked lack of oxygen. And a decrease in the number of perturbations can be a sign of serious problems with providing for the baby. In any case, in case of unexpected changes in fetal movements, it is better to consult a doctor.

The diagnosis of detachment is not difficult: it is enough to do an ultrasound of the uterus to determine its exact location and size. And dopplerometry will show how seriously the blood flow in the affected area of ​​the child's place is disturbed, whether the bleeding continues or a blood clot is already forming.

What to do with placental abruption

As scary as it may seem, it is impossible to remain inactive when symptoms of placental abruption occur: the woman has little time to manage to save the baby. And in no case should he hesitate. With minimal manifestations, if you cannot get to the doctor on the next day, you must yourself go to the hospital. In the event of a decrease in fetal movements or when blood appears from the vagina, you need to call an ambulance and go to the hospital. With placental abruption, all possible help can be obtained only in an obstetric hospital.

The degree of detachment is of great importance for the provision of assistance:

• with a small and not progressive detachment, timely assistance to a baby suffering from a lack of oxygen will ensure the preservation of pregnancy and the maturity of the fetus;
• with partial and increasing detachment, you must very quickly get to the hospital, because a real threat arises for the baby's life and time goes by hours;
• with complete detachment of the child's place, it is possible to save the baby only if the pregnant woman is already in the hospital, because the fetus can live no more than 20 minutes without oxygen.

The location of the child's place and the gestational age are of great importance for preserving the life of the fetus. If the placenta is close to the exit from the uterus (placenta previa, low position), then the first manifestation of detachment will be profuse bleeding. When the baby is less than 28 weeks old, it will be very difficult for the fetus to survive due to the pronounced immaturity.

Conservative treatment

With a small detachment in favorable conditions (bleeding is insignificant, pain is not expressed, the fetus does not suffer, the degree of detachment does not increase), timely assistance will help maintain the pregnancy. In the hospital, the doctor will prescribe the following measures:

• the strictest bed rest;
• hormonal preservation therapy (morning or dyufaston);
• reducing the tone of the uterus with the help of antispasmodics and sedatives;
• effect on the vascular system to prevent thrombus formation in the small capillaries of the placenta;
• the use of drugs that improve blood flow in the placenta.

Operative treatment

In an unfavorable combination of circumstances (pronounced external bleeding, severe pain syndrome, increasing or complete detachment, a threat to the life of the fetus), the question of an urgent caesarean section will arise, the main purpose of which is to save the baby's life.

What will happen after the detachment

If everything went well and the pregnancy was saved, then the next step is to continue the treatment. As a rule, even with partial suffering, the baby needs help by providing the best conditions for growth and development. Optimal therapy will be provided at the perinatal center. At the next stage, it will be necessary to continue treatment with the antenatal clinic doctor in order to prevent recurrence of the detachment of the child's seat. It is necessary to exclude the factors due to which there was a detachment (exclude physical labor and stress, stop taking drugs that affect the tone of the uterus). The doctor will prescribe a conservative medication.

After discharge from the hospital, you need constant monitoring of the child's condition. This will require an ultrasound scan as indicated and weekly. With the help of these studies, the doctor will notice in time the developmental lag in the baby or the occurrence of a violation of blood flow between the mother and the fetus.

You won't wish this trouble to the enemy, but if there is a detachment of the placenta, then only the quick help of professionals in a maternity hospital can save the baby. When, as a result of treatment, the detachment can be dealt with, careful attention to the doctor's recommendations and the prevention of pregnancy complications will allow the expectant mother to calmly inform and give birth to a healthy child.

The placenta plays an important role in the development of the fetus. Through it, the baby eats and breathes, so deviations from the norm are dangerous at any stage. If the expectant mother suddenly has a placental abruption in the early stages of pregnancy, then surgical observation and intervention of specialists is required. The cost of delay can be the life of the baby.

Read in this article

Placenta: concept, function, possible problems

After the child is conceived, the ovum begins to form. It attaches itself to the wall of the uterus and grows continuously. At this stage, the chorion appears. These are the villi tearing the surface of the fruit. Small vessels pass through the outgrowths of the chorion, with the help of which penetration into the inner lining of the uterus and fixation in it occurs. Chorionic villi are externally immersed in blood. Such a system allows the fetus to receive oxygen, nutrients, and in return give carbon dioxide and waste products.

The placenta for the child is the lungs, kidneys, digestive organs, skin. The consequence of chorionic detachment in the early stages of pregnancy can be a miscarriage, therefore, it is impossible to do without surgical intervention.

Life cycle of a child's place

The placenta forms during the first 12 weeks of pregnancy. This is followed by its continuous growth. By 34 weeks, the baby's seat reaches its maximum size and begins to age. This is a natural process in which 4 stages can be distinguished:

• lasts up to 27-30 weeks;
• active growth from 27-34 weeks;
• maturity period, which spans 34-39 weeks;
• aging from 37 weeks to delivery.

Disruption of aging stages

Sometimes aging of the placenta occurs prematurely. It can be caused by the characteristics of the woman's body or a number of pathologies:

• the second half of the term;
• toxic substances and medicines;
• injuries to the uterus;
• multiple pregnancy;
• , drugs;
• chronic diseases;
• improper diet or diet;
• and the consequences of previous difficult childbirth;
• infections in the uterine cavity.

Early maturation of the placenta during pregnancy leads to oxygen starvation of the fetus and a lack of nutrients. He may lose weight, develop abnormally, and be born unhealthy. In order to avoid serious consequences, you need to be regularly monitored by a doctor, undergo a course of treatment.

What is a detachment?

Detachment of a child's seat is its separation from the inner surface of the uterus. It can be partial or complete. The resulting void is filled with blood, which repels the chorion even more. The separation process should take place during childbirth, but it can also be premature. Chorionic detachment in early pregnancy is dangerous for the baby, as it can leave him without oxygen and beneficial nutrients.

The degree of detachment of the child's seat:

• The discharge area is less than 1/3, which does not harm the child, can be compensated for by his growth. Pregnancy is maintained and continued.
• Half-detachment can lead to death of the fetus from oxygen deprivation.
• Complete. Almost always brings the death of the baby.

The latter ends, and the first two refer to the threat of spontaneous abortion.

Why is the chorion rejected?

According to statistics, 0.4-1.4% of pregnant women face the problem of premature rejection of the child's place. This can happen in the first or second birth period, but most often the latter is the most dangerous. Among the causes of placental abruption in early pregnancy are:

• woman's age;
• the presence of addictions;
• a large number of births;
• improper nutrition;
• infection or inflammation in the uterus;
• chronic diseases;
• trauma to the abdomen;
• pathology of the uterus or placenta;
• preeclampsia;
• a long period of infertility before conception.

Premature rejection symptoms

The main signs of placental abruption in early pregnancy are:

• - can be external or internal. If there is a separation at the edges, then discharge appears from the vagina. Internal bleeding is more difficult to detect. It occurs with a central detachment of a child's place, when the edges remain attached, and fluid accumulates in the resulting space. Urgent surgery is needed (sometimes with complete removal of the uterus). It will be about saving the mother. The fetus usually does not survive.
• Mild aching pain, provoked by increased. It can radiate to the groin or thigh area and be a clear sign of internal bleeding.
• Violation of the fetal cardiac activity. The condition will be affected by the mother's blood loss and the amount of detachment. Failure will manifest itself already when 1/4 of the area of ​​the child's place is diverted. Severe oxygen starvation occurs at 1/3 part, after which death may occur. If half of the placenta has departed, then it will be impossible to maintain the pregnancy.
• Nausea, vomiting, dizziness, anxiety.

Identification and prompt elimination of the problem with placental abruption

Small placental abruption in early pregnancy is not always accompanied by visible symptoms. It can be detected only with the help of timely diagnostics. It is important to regularly attend scheduled doctor's consultations.

Diagnostics of the state of the placenta

Rejection of the placenta in the early stages of pregnancy can be diagnosed during the procedure. This procedure reveals a retroplacental hematoma, accompanied by destroyed or oppressed tissues. In the early stages, neoplasms may not yet be present. Diagnosis is carried out by excluding diseases with similar symptoms. If the placenta is rejected, an ultrasound scan can detect blood clots behind it. The vagina is amenable to a thorough examination, to exclude their damage, the presence of infections, tumors and other abnormalities.

Predictions for the departure of the child's seat

This pathology is not uncommon. Prompt and qualified treatment can prevent its consequences. Timely detection of the problem and taking measures allow you to stop the process and give a positive prognosis for the course of pregnancy in the future.

A small detachment of the placenta requires hospital observation and treatment. The assistance provided will allow the child to develop normally. It is unacceptable to ignore any alarming symptoms during pregnancy. Departure from the child's seat is a serious pathology. It can lead to irreparable consequences.

The issue of treating a detachment in a child's place is not an easy task. Often you have to choose the operative resolution. Additionally, blood clotting is monitored. It is important to deal with the shock state of the woman and to compensate for the blood loss.

How is placental abruption treated?

The prescription of placental abruption treatment in early pregnancy and beyond depends on various factors:

• the general condition of a woman and a child;
• trimester of pregnancy or the period of childbirth;
• the volume of blood loss.

Operative delivery can be replaced by treatment if:

• pregnancy is less than 36 weeks;
• a small area of ​​detachment and there is no progression of the process;
• cessation of secretions or small volumes;
• lack of signs of a lack of oxygen for the child;
• well-being of the pregnant woman and hospital stay.

Doctors prescribe mandatory bed rest for the expectant mother, regular ultrasound, as well as dopleometry and cardiotocography. Her condition must be strictly controlled. Laboratory tests of blood coagulation are carried out.

For treatment, antispasmodic drugs (,), hemostatic (Vikasol), antianemic (with a high concentration of iron) and aimed at relaxing the uterus can be used. In the presence of other diseases or complications, concomitant therapy is additionally prescribed.

Operative delivery can be prescribed if spotting begins to appear during observation in a hospital. This is a sign of progress in placental abruption. In the later stages, an emergency caesarean section is most often used. But natural childbirth can also be stimulated. The decision is made based on the condition of the mother and baby.

Surgical intervention takes place under the continuous supervision of doctors over the state of the child's cardiac system. Natural childbirth will require a mandatory manual examination of the uterine cavity after its completion. With a caesarean section, her condition is also assessed. If the muscle layer is saturated with blood, a complete removal of the uterus will have to be done to avoid further bleeding.

Preventive measures for exfoliation of the placenta

There are no specific measures to prevent the pathology of a child's place today. This is due to the lack of confirmed causes of placental abruption in early pregnancy. Only a number of factors have been identified that can predispose a woman to the appearance of such disorders.

Typically, prevention consists of:

• regular visits to the doctor and passing the required examinations;
• timely delivery of all analyzes;
• avoiding stressful situations;
• good and;
• good rest;
• healthy lifestyle;
• prevention of possible injury;
• a sufficient number of outdoor walks;
• control.

Taking any medications should be strictly according to the doctor's prescription and only when absolutely necessary. Treatment of chronic diseases can be regarded as prevention of complications and exfoliation of the child's place.

Subsequent pregnancies: will there be a recurrence?

For women who have undergone placental abruption in early pregnancy, there is a high likelihood of a recurrence of the situation in the future. About 25% of cases end in the same way. Medicine cannot yet completely exclude the possibility of peeling off the baby's seat during the next pregnancies. However, you can try to prevent recurrence of violations yourself. To do this, it is worth adhering to the above preventive measures in order to minimize all risk factors.

Departure of the child's seat is a serious and dangerous pathology for a pregnant woman and her child. Many women face it. It is important to seek immediate help if you experience any distressing symptoms. If there is no threat to life and health, then the pregnancy will continue, but under closer control, most likely in a hospital. The progression of pathology in the later stages will require prompt delivery. According to the condition of the mother and baby, stimulation of natural childbirth or a cesarean section can be chosen. If you do not pay enough attention to the peeling of the child's seat, the consequences will be severe and irreversible. In the early stages, everything will end in miscarriage.

Take care of yourself and your child! Do not neglect to see a doctor!

The placenta is a completely unique organ that can only be found in the body of a pregnant woman. It is born with the child (10-15 minutes later than the fetus) and after that it is formed only during the next one. The placenta is popularly referred to as a "baby's place" because it serves as an inextricable link between mother and child. Breaking this connection is very dangerous for an unborn baby.

The placenta is an important and unique organ that only exists during pregnancy.

Some consider the placenta the entire shell in which the baby is inside. But this is not entirely true. The placenta is just a small section of the membrane adjacent to the back wall of the uterus. It provides a connection between the fetus and the mother's body. The rest of the shell is called the afterbirth.

The placenta has the shape of a disc, pierced by a mesh of blood vessels. Detachment of the placenta in the early stages leads to impaired blood circulation and oxygen metabolism in the body of the embryo, which can be dangerous not only for the life of the child, but also for the life of the mother.

The placenta in its final form is formed only by the 15th week, when the blood flow of the mother and the child is completely delimited.

Up to this point, the placenta does not yet have a clear structure. Until the 6th week, they speak only of the chorion, the rudimentary organ from which the placenta is then formed.

The placenta has several important functions:

• Breathing and gas exchange. It is through the placenta and the bloodstream that oxygen enters the fetus. Oxygen is actively supplied to the child, and carbon dioxide is removed.
• Excretion of waste products. Other substances from the child's body are also removed through the placenta.
• Nutrition. All nutrients, vitamins, minerals necessary for a growing body are delivered to the fetus through the placenta. Therefore, poor circulation in the placenta can lead to developmental delay.
• Development. The placenta activates the production of hormones necessary for the development of the fetus and to prepare for lactation.
• Child protection. Through the placenta, various supplies from the mother come to the fetus, which protect it from infection. The placenta also protects the fetus from the maternal immune system, which may recognize it as a threat.

It is worth remembering that in addition to nutrients through the placenta, harmful substances, toxins, nicotine, alcohol, drugs and infections enter the child's body. A pregnant woman should take care of herself and lead a healthy lifestyle, which will have a beneficial effect on the condition of the placenta and on the health of the unborn baby.

Causes of detachment of the placenta in the early stages

Placental abruption can occur at any stage of pregnancy and even during labor itself. At any time and in any situation, detachment of the placenta can be dangerous, therefore, medical attention and supervision is necessary.

Early pregnancy is considered to be up to 20 weeks. In this case, detachment can occur both at the 8th and at the 19th week. It is impossible to reliably determine the cause of what happened, since the causes of detachment have not been sufficiently studied.

However, there are certain most common causes of placental abruption:

• Numerous births. If the birth is not the first, the condition worsens, which is reflected in the placenta. It can age prematurely, causing detachment.
• Bad habits. Alcohol, smoking, fatty foods, taking medications without consulting a doctor can provoke poor circulation and placental abruption.
• Gestosis. In this condition, blood flow is disturbed, blood pressure rises. Placental vessels become more fragile, weak, which provokes detachment.
• Autoimmune diseases. With these, the human immune system responds inadequately to stimuli, recognizing the cells of its own body as foreign. The placenta and fetus can be affected in the same way.
• Intrauterine infection. Infection provokes many problems: from abnormalities in the development of the fetus to placental abruption and intrauterine death. Any infection that enters the body of a pregnant woman requires the attention of doctors and immediate treatment.
• Pathology of the uterus. In some cases, placental abruption can only be explained by pathological processes in the uterus. They are dangerous in that they are difficult to identify and prevent.
• Abdominal trauma. Injuries can occur during a fall, accident, blow to the abdomen. This can be dangerous for the baby and provoke placental abruption and premature birth.
• ... Some cardiovascular diseases, as well as chronic diseases, can lead to detachment.

Signs and diagnosis

Lower abdominal pain and spotting are signs of placental abruption

In the initial stages, placental abruption may be asymptomatic. It can only be detected when. The doctor determines the presence of a hematoma in the area of ​​attachment of the placenta.

If the placenta has moved slightly, then blood will accumulate between it and the uterus, and there will be no external bleeding. However, more often this phenomenon is accompanied by pain in the abdomen and tone of the uterus (tension, hard stomach).

The main symptoms of placental abruption in the early stages:

• Bloody vaginal discharge. Blood at any time frightens expectant mothers, they strive to see a doctor faster, and rightly so. If placental abruption occurs on the side of one edge, blood will come out, this is an alarming symptom that in no case should be ignored. With timely assistance, blood loss can be stopped and the pregnancy can be maintained. The most dangerous are internal bleeding, which can lead to the death of the mother and child.
• Stomach ache. They can occur with or without bleeding. Placental abruption is almost never complete without painful sensations. The pain can be of varying intensity, strong and constraining, or pulling and aching. In any case, the appearance of pain requires a visit to a doctor. Severe pain may indicate dangerous internal bleeding.
• Heart rhythm disturbances and oxygen deprivation. At a later date, expectant mothers note the active movement of the child or the absence of movement, but in the early stages such symptoms are impossible. Usually, the fetal heart rate is talked about during the planned one. If violations are noted and the ultrasound shows signs of detachment, the pregnant woman is placed in a hospital for preservation.

Detachment is often referred to as symptoms, after which the doctor prescribes an ultrasound supplement for confirmation. It is very important to inform the doctor on time about what worries the pregnant woman and not to avoid hospital treatment. Also, if a detachment is suspected, the doctor will examine the patient in the chair to determine if the cervix has opened.

Treatment

Treatment is prescribed by a doctor according to the situation, depending on the condition of the fetus and the patient. Placental abruption has its own stages and characteristics. With a small detachment in the early stages and timely assistance, the prognosis is very favorable. The patient is prescribed drugs that relieve the tone of the uterus, vitamins, iron preparations, hemostatic agents. With proper treatment and the absence of serious pathologies, the placenta grows to the wall of the uterus due to an increase in its area with the course of pregnancy. In the future, pregnancy can proceed without complications if all the doctor's recommendations are followed. Such detachment is called partial and non-progressive.

If placental abruption is partial, but progresses, this condition of the patient is considered more dangerous. It is necessary to stop the growing hematoma and restore nutrition to the fetus. To do this, a pregnant woman is placed in a hospital, carefully observed, prescribed bed rest, various drugs to reduce the tone of the uterus and to ease blood loss. If no means can help, the hematoma grows, the question of urgent delivery arises. In the first trimester, the child, as a rule, dies, but with timely help, the mother can be saved.

Complete placental abruption is rare.

In this case, the supply of oxygen and nutrients to the fetus completely stops, it dies. The only possible treatment in this case is emergency delivery.Doctors may refuse to stimulate labor and try to preserve the pregnancy if the gestation period is short and the baby has little chance of surviving after childbirth, and if there are no signs that the detachment is progressing, blood loss is low, and there are no obvious signs of oxygen starvation in the fetus.

Useful video - Placenta during pregnancy.

To improve the condition, a woman is prescribed antispasmodic drugs (No-shpa, Drotaverin, Papaverine in the form of suppositories, Magnesia), hemostatic drugs (Vikasol in the form of tablets or Decinone injections), as well as iron preparations to prevent development.Under no circumstances should you try to treat a detachment at home without consulting your doctor. Without professional medical care, this condition can lead to the death of the mother and child.

Complications and prevention

Undoubtedly, the most terrible consequence of detachment is the death of the mother and child. Doctors are trying with all their might to prevent such an outcome. If it is impossible to save the child, the life of the mother must be saved.

What is placental abruption during pregnancy and why does it happen?

Carrying a baby is a natural, inherent process, however, it is fraught with many risks. Both internal and external negative factors affect the health of the woman and the fetus, leading to a complicated course of pregnancy. One of the negative processes is the detachment of the placenta.

Pathology has a code according to ICD 045, occurs in 2 cases out of 100, but has a high percentage of abortion, provokes fetal death and miscarriage.

Let's figure out why placental abruption occurs, how to recognize the first signs, is it possible to keep the pregnancy.

• The placenta and its role in the fetus
• Causes and consequences of placental abruption during pregnancy at different periods
  • Detachment in the early stages: what is dangerous in the first and second trimester
  • Late and third trimester risks
• What options for placental abruption are
  • What is the danger of partial detachment in a normal location
  • What does the marginal detachment look like when the fetus is present
  • How does detachment in the area of ​​the uterine pharynx appear?
• How does placental abruption manifest?
• Symptoms and sensations of a woman in the initial stages
  • What is the characteristic pain noted in pathology
  • How to determine at a later date
  • The nature of the discharge
  • Is there any bleeding
  • If detachment occurs during childbirth
• Diagnostics
  • Is the pathology visible on ultrasound
  • What tests do they take
  • How do doctors determine
  • Emergencies for urgent medical attention
• Fetal survival with different options and degrees of placental abruption: table by week
• Treatment
  • How is it going
  • What do
  • How to give birth
• How to prevent a dangerous pathology
• Recommendations of doctors

The afterbirth and its meaning

Contrary to popular belief, the placenta (otherwise the afterbirth or the baby's place) is not a solid shell in which a child develops. It is a disc-shaped embryonic organ that normally attaches to the back of the uterus.

What are the functions of the placenta:

• provides respiration and nutrition of the fetus;
• plays the role of the immune system, protecting the baby from infectious attacks;
• participates in the synthesis of hormones necessary to maintain pregnancy and labor.

The afterbirth is rejected by the body immediately after the appearance of the child -. But her premature detachment is possible at any gestation period, as well as during childbirth.

What is placental abruption and what is the prognosis at different periods of gestation

Medicine is not yet able to pinpoint the causes of the emerging pathology and reliably determine at what time a particular woman may have detachment. But there are three directions, because of which there is a failure in the reproductive system:

1. Vascular changes, fragility and fragility of capillaries that develop with gestosis and persistent hypertension.
2. blood, increased coagulability.
3. Blunt trauma to the abdomen.

If, for no apparent reason, placental abruption occurred in the early stages of pregnancy, the reasons often remain unclear.

Early gestation prognosis

The consequences of untimely discharge of the placenta depend on the area of ​​the lesion and the duration of pregnancy. If no more than a third of the organ has been detached, this will not have a significant effect on the development of the fetus, especially in the early stages. The placenta completes its formation in the first trimester, it is able to compensate for the damage due to continued growth. The 2nd trimester is dangerous with the formation of a hematoma, compression of the fetus and the development of hypoxia.

The result of the withdrawal of ½ part becomes.

Detachment of more than 75% of the surface of the placenta leads to bleeding and the threat of intrauterine death of the child from lack of oxygen.

Forecast in the last stages of gestation

Complete detachment, especially in the third trimester of pregnancy, is dangerous not only for the embryo, but also for the woman herself. The most common complication is the development of the Kuweler uterus, a condition where the accumulated blood begins to soak in the muscle wall. Because of this, the organ loses its contractility, massive bleeding develops, which usually ends with the removal of the uterus. Another danger - DIC syndrome, disrupts the function of blood coagulation and leads to bleeding not only from the uterus, but also from other organs.

Early detachment can cause other causes, and the consequences in this case are manifested during childbirth. For example, multiple pregnancies, repeated operative delivery, polyhydramnios - become provoking factors.

Forms of placental detachment

The classification of premature detachment of the placenta allows you to determine the localization of the process and the area of ​​the lesion.

If the location of the placenta is normal

Premature detachment of a normal placenta is possible in three ways:

1. Partial non-growing differs in an insignificant area of ​​the lesion, often proceeds without clinical manifestations. The resulting hematoma does not have a negative effect on the fetus. With timely detection and appropriate treatment, the prognosis is favorable, and delivery takes place naturally.
2. Partial increasing - has a progressive course. The hematoma looks like a gradually increasing seal. The useful placental area is reduced, which leads to oxygen starvation of the fetus. Urgent medical attention is required, if the detachment occurs in the third trimester, an emergency caesarean section is performed.
3. Total detachment always leads to the death of the baby in the womb, both at a short time and before childbirth.

If presentation is diagnosed

Presentation is the placement of the placenta in the lower part of the uterus. This arrangement is especially dangerous for the 3rd trimester and the birth period. Bleeding develops in 60% of cases:

• Central flaking occurs from the center to the periphery, so it often proceeds without bleeding. In this case, a hematoma forms between the placenta and the uterine wall.
• The marginal detachment of the low-lying placenta is characterized by massive bleeding. The discharge of the placenta occurs along the periphery, from the edges to the center, therefore, the discharge of a dark red color pours out.

When the placenta is located in the area of ​​the uterine pharynx

When the placenta is low, covering the uterine pharynx, complete detachment occurs, as a rule, during childbirth. The leading factor here is the contraction of the muscle wall. With a small area of ​​lagging, smearing brown discharge of varying intensity is possible.

Clinical manifestations at different stages

Considering how the pathology manifests itself, it should be noted that the intensity of manifestations at different periods of gestation is different, but the general symptoms are similar. How to understand that premature rejection of the placenta has begun during pregnancy:

• the tone of the uterus changes, which is felt as excessive tension;
• unusual vaginal discharge appears, and the color of the discharge varies from scarlet to dark brown;
• stomach ache in the lower part;
• when detaching a significant massif, are noted.

Each stage of gestation has its own characteristics and possible consequences for the child.

What a woman feels in the early stages

1 trimester has the most favorable prognosis for the development of pathology. The thickness of the placenta during this period is no more than 18 mm, and it continues to grow.

The hematoma formed as a result of bleeding is in the stage of organization - this means that the formed blood clots are partially absorbed, partially localized. The placenta, increasing its size, increases the area of ​​"adhesion" with the wall of the uterus, with appropriate treatment, nutrition and gas exchange is restored, and nothing threatens the baby.

In the early stages, the symptoms of detachment are low-intensity:

• pulling soreness in the lower abdomen with irradiation to the lower back;
• moderate brownish discharge.

On ultrasound, a small seal or depression is determined.

The nature of pain in pathology

Sometimes women are worried about whether placental abruption can cause black stool when emptying. The color of the stool does not depend on the reproductive system, therefore it cannot be considered a sign of detachment.

Detachment at delivery

The likelihood of premature discharge during the period of contractions is high if the placenta is located incorrectly.

How does placental abruption manifest during childbirth:

• cramping severe pain;
• intense blood loss;

Why is this situation dangerous? The baby can suffocate or die from asphyxiation; for a woman, massive bleeding is a threat. Therefore, urgent care is an emergency operative delivery.

Based on what is the diagnosis

Pathology is diagnosed based on the patient's complaints, an objective examination, and data from special research methods.

Hardware surveillance

Premature placental abruption is a serious condition that can occur in any woman who is expecting a baby. It can occur at any stage of pregnancy and even during childbirth. This problem threatens the life of both the woman herself and the unborn baby, therefore, requires immediate medical attention.

What is the placenta and what is it for

The placenta, also called a child's place, is the only organ that appears in the body of the expectant mother only during pregnancy and stops working at the last stage of childbirth. From Latin, the word "placenta" is translated as "cake" because of its appearance - it really looks like a thick crimson cake with an umbilical cord extending from it. The placenta connects the organisms of the mother and the fetus, serves as a buffer between them and performs the following functions:

• respiratory - blood circulates through the uteroplacental vessels, carrying oxygen with it; after giving it away, they capture carbon dioxide released during breathing and remove it into the lungs of the mother;
• trophic - the circulatory system also transfers nutrients necessary for the growth and development of the embryo; it removes the metabolites formed during the breakdown of nutrient polymers - if this process is disturbed, the poisoning of the fetus by metabolic products is possible;
• endocrine - the placenta transfers maternal hormones to the fetus and synthesizes its own, affecting the growth and development of the child;
• protective - the "placental barrier" filters all substances transmitted to the fetus, as far as possible protecting it from potentially dangerous;
• immune - protects the organisms of the mother and the child from conflicts (for example, according to the blood group or according to the Rh factor), preventing the penetration of antigens from the mother's body to the child's body; protects the fetus from external infections with maternal antibodies.

The placenta is translated from Latin as "cake", it is named so because of its appearance

In a normal arrangement, this "cake" is attached in the upper parts of the uterus, usually on the back wall, less often on the front. Since the back wall of the uterus is less prone to deformation, the location of the placenta on it is considered normal. The attachment of the placenta along the anterior wall of the uterus is more dangerous, because the anterior wall has the ability to stretch, which can cause premature placental abruption - since the placenta itself does not have this property. But in itself, such an arrangement of the placenta is not critical, but only speaks of the possibility of the occurrence of pathologies and the need for a more attentive attitude to pregnancy both from the woman herself and from doctors.
The attachment of the placenta along the posterior wall is considered the norm, and pathology along the anterior wall.

Sometimes the placenta is located in the lower part of the uterus, partially or completely overlapping the internal pharynx, but this does not affect the development of the fetus. Low attachment of the placenta (less than 6 centimeters from the internal os of the uterus) is considered dangerous due to the fact that it can develop into partial or complete presentation, in addition, it increases pressure on the uterine walls, and with the growth of the uterus, it can provoke premature placental abruption.

At the first screening, done at 12 weeks, I was diagnosed with "low placentation" - from the lower edge of the placenta to the internal os it was about 5 centimeters. As the doctor told me, this is a fairly common phenomenon and does not carry any particular danger in itself - if precautions are taken and in the absence of problems that contribute to the lowering of the placenta, it will most likely gradually rise up, since the uterus grows with the fetus. As a prophylaxis for even greater sinking, they recommended sexual rest, exclusion of physical exertion, refusal of overheating (sauna, hot bath), refusal of flights and public transport. In general, I tried to comply with the doctors' prescriptions, but this did not always work out - so, in the second trimester I had a vacation, during which I flew to the sea, sunbathed, and moved around a lot. The second ultrasound, at 19 weeks, showed that the situation had improved somewhat - the placenta was indeed slightly raised. As a result, by the time of delivery, the attachment of the placenta was still low, but did not develop into presentation, and I gave birth on my own without any problems.

Partial presentation is lateral (overlaps most of the internal os) or marginal (overlaps about a third of the passage). With full placenta previa, the internal pharynx of the uterus is completely closed, natural childbirth is impossible.
The placenta may have a marginal presentation, sideways, or completely overlap the internal pharynx

Life cycle of a child's place

When the ovum is implanted into the uterus, the cells of the future placenta are actively dividing and form a membrane around the embryo, permeated with vessels, embedding the fetus into the mother's circulatory system. At 8-9 weeks, the formation of the placenta ends as a separate organ. By 12 weeks, the placenta already looks the way we are used to - in the form of a "cake" with an umbilical cord extending from it. By 15-16 weeks, its formation is complete, and the final transition to the placental blood supply occurs.

The baby's place grows with the fetus throughout the pregnancy. Its size and mass increase, tissue density changes.

By the end of the 8th month of pregnancy, the placenta reaches its functional maturity. From about 37 weeks, when the child is already ready for birth and independent existence, the processes of her physiological aging begin - the body of the expectant mother prepares for childbirth and for the rejection of the placenta. After childbirth, doctors examine the placenta (the placenta that has left the mother's body together with the membranes) and, based on its condition, conclude that the child is feeling in the womb.

By the end of its existence, a normal mature placenta has a disc diameter of 15–20 centimeters, a thickness of about 3 cm and a weight of about 500 grams.

Doctors distinguish 4 degrees of maturity of the placenta, and each of them corresponds to a certain stage of pregnancy:

• 0 degree of maturity - up to 30 weeks; this is the period of active work of the placenta, development and formation of the fetus;
• 1 - from 27 to 36 weeks; by the end of this stage, the placenta reaches its maximum size;
• 2 - from 34 to 39 weeks; the placenta becomes denser, by the end of the term, vascular changes usually appear that do not affect blood flow;
• 3 - from 37 to 40 weeks; there are signs of natural wear and tear; the child is finally formed, the placenta is ready for rejection and childbirth.

Disruption of aging stages

If the degree of maturity of the placenta corresponds to the gestational age, this means the normal functioning of the organ and its ability to fully fulfill its goals and provide the baby with nutrition and oxygen. With early aging of the placenta, its degree of maturity exceeds the prescribed norm, which means placental insufficiency - a pathology in which problems arise with the placenta performing the functions necessary at this stage of pregnancy. Fetoplacental insufficiency can cause a delay in the internal development of the fetus, premature birth, intrauterine fetal death and other negative consequences. Therefore, when such a diagnosis is made, doctors strengthen control over a pregnant woman, prescribe therapy, and, if necessary, hospitalize for treatment in a hospital.
The degree of maturity of the placenta - from 0 to 3 - is determined by the results of ultrasound

Earlier aging of the placenta in most cases is caused by health problems of the expectant mother or her improper lifestyle:

• smoking negatively affects the state of blood vessels, causes spasms; tobacco smoke causes an increased demand for oxygen in the fetus, as a result, the load on the vascular system of the placenta increases;
• chronic diseases of the metabolic system in the mother cause blockage of blood vessels;
• heart and / or kidney disease disrupt a woman's circulation, which impairs blood circulation in the placenta;
• latent infections have a harmful effect on the tissues of the placenta;
• previous pregnancies and / or abortions thin the endometrium, as a result of which the placenta is initially formed with a delay in development, its work is disrupted, and aging begins earlier;
• as a result of the Rh-conflict or conflict on the blood group, antibodies are formed in the mother's blood, which can also play to slag the placenta;
• multiple pregnancy increases the load on the placenta, since it needs to perform nutritional, respiratory and other functions for two or more fetuses at once;
• prolonged toxicosis leads to accelerated maturation of the placenta;
• violations of the diet do not allow the placenta to receive the substances necessary for its formation and development;
• due to excessive excess weight, all processes in the body are disrupted, including those associated with the aging of the placenta;
• unfavorable environmental conditions also affect the placenta negatively.

The consequences of early aging of the placenta:

• the placenta ceases to cope with its functions, there are problems with nutrition and oxygen delivery to the fetus;
• the work of the filtration barrier deteriorates, as a result of which the fetus becomes more vulnerable to toxins and viruses;
• with the formation of dead or calcified areas, there is a danger of placental abruption;
• at the beginning of pregnancy, problems in the work of the placenta can provoke a frozen pregnancy or a stop in the development of the fetus;
• in later stages, this can cause fetal hypertrophy or intrauterine growth retardation.

A slight inconsistency with the norm in the development of the placenta may not carry negative consequences for the fetus. But only a doctor can establish the degree of deviation and give an accurate assessment of the risks.

There is no discreteness in maturation of the placenta, which would make it possible to unambiguously determine that one condition is characterized by the second degree of maturity, and the other - by the third. Diagnosis of maturity of the placenta is based on visual (with ultrasound) changes in the tissues of the placenta, an increase in its density, vasoconstriction, the appearance of plaques inside the vessels that interfere with blood flow, the manifestation of a clearer border between the walls of the uterus and the body of the placenta itself. But all this does not allow a clear and unambiguous assessment of the phase of maturation of the placenta, so different doctors can give different answers to this question.

Since the purpose of the diagnosis is not so much to determine the degree of maturity, but to find out whether the placenta at this stage can perform all the obligatory functions and cover the needs of the fetus, in case of doubt, cardiotocography is done - a study of the state of the fetus. If the fetus does not feel suspicious, then there is no need for treatment, and the pregnant woman remains under the supervision of doctors.

At a period of 32 weeks, according to the results of ultrasound, I was diagnosed with "premature aging of the placenta" - it was of the second degree of maturity, which did not correspond to the norm at this time. Curantil was prescribed as a treatment - it improves blood microcirculation, dilates blood vessels, it improves placental blood circulation, that is, it solves the main problem of pathology. In the future, I was under the supervision of doctors and I was regularly checked the state of the placenta, it was slightly ahead of the aging period, but not so critical that it required intensified treatment. The child's condition was regularly monitored using cardiotocography. I gave birth 10 days later than the pre-set date of birth, the baby was large - more than 4 kilograms. After examining the placenta, the doctors said that her early aging and large fetus led to the fact that she could hardly perform her function of feeding the fetus, and at any time problems could begin, for example, hypoxia in a child. Therefore, even slight changes in the work of the placenta should be under the supervision of a gynecologist.

What is placental abruption

In the normal course of events, the rejection of the placenta from the walls of the uterus begins to occur at the moment of childbirth, when the child (or children - with multiple pregnancies) has already been born. But it happens that as a result of some reason, the baby's place begins to flake off earlier. This is a dangerous pathology, since with a sufficiently large area of ​​detachment, intrauterine fetal death occurs.

With detachment of the placenta from the uterus, ruptures of the vessels connecting them occur, and bleeding occurs. Blood collects between the wall of the uterus and the placenta, forming a hematoma; increasing, it provokes further detachment.

Specialists distinguish 3 degrees of placental abruption:

• mild degree - usually goes unnoticed for a woman, is visible only on ultrasound; there is usually no threat to the fetus;
• medium - there is an extensive hematoma, the uterus is in good shape, pain is felt on palpation; when listening to the fetus, disturbances in the heart rhythm are noticeable - acceleration or, on the contrary, deceleration;
• severe - sharp pains occur, health worsens - dizziness appears, sweat appears, blood pressure decreases; the uterus takes on an asymmetric shape, tense when probing ,.

With placental abruption, bleeding occurs and a hematoma forms

By the position of the detachment, it can be divided into two types:

• central - when the edges of the placenta remain attached to the uterus, and the discharge of the baby's place from the walls begins in the main part of the placenta; in these cases, the bleeding remains hidden; this type of detachment is more dangerous, since the accumulating blood presses on the placenta, aggravating the situation and provoking the detachment to progress; in addition, the absence of bleeding from the genital tract can complicate early diagnosis, while treatment is usually required urgently;
• marginal - in this case, the edge of the placenta departs from the walls of the uterus, and the blood has the ability to freely exit into the uterus and, if the internal pharynx is slightly open, outward.

At 6 weeks of pregnancy, an ultrasound scan was found on me. The doctor said that the size of the hematoma is small, the detachment is partial and does not progress, so there is no danger. Prescribed Duphaston to raise the level of progesterone, and papaverine suppositories to relieve spasms in the uterus. After taking the pills and suppositories, nothing happened, there was no pain, no tension in the uterus, no discharge. At 9 weeks, there was a second ultrasound scan for control; hematoma was no longer visible on it. In the future, the pregnancy proceeded without deviations, the delivery was successful.

Causes

Unfortunately, there is no unambiguous list of reasons for which it could be said with confidence that it is they that lead to premature placental abruption. Doctors agree that this is a multifactorial pathology, that is, it usually occurs when several factors intersect at once. List of pathologies, events and diseases that can provoke placental abruption:

• attachment along the anterior wall of the uterus - due to its ability to stretch;
• low attachment of the placenta or its presentation;
• disturbances in the vascular system - the uteroplacental vessels become thinner and become fragile and brittle;
• problems with blood pressure in the mother - hypotension, sudden fluctuations, compression of the inferior vena cava by the uterus;
• frequent and / or multiple births, especially in previous pregnancies, a cesarean section was performed;
• toxicosis and its pathological forms (preeclamsia, preeclampsia);
• anomalies in the structure of the uterus;
• bad habits - alcohol, smoking, drugs;
• post-term pregnancy - the placenta is physiologically ready for rejection;
• allergy to drug therapy;
• pathology during childbirth - rapid labor, short umbilical cord, late rupture of amniotic fluid;
• the age of the pregnant woman - the risk increases with its increase;
• various hereditary and chronic diseases, inflammatory and tumor processes, problems with the endocrine system and other health pathologies;
• autoimmune processes - a conflict over rhesus or blood group creates in the mother's body a false idea of ​​the fetus as a foreign object, and it is rejected by the uterus;
• injury to the abdomen from a fall or impact;
• a once-happened placental detachment increases the risk of this pathology in the next pregnancies.

Detachment symptoms at different stages of pregnancy

The classic triad of symptoms of premature placental abruption at any stage of pregnancy are:

• bleeding;
• pain in the lower abdomen;
• violation of the fetal heartbeat.

Bleeding can be external (from the genital tract), internal or mixed. Depends on the location of the detachment and the openness of the internal os of the uterus.
Placental abruption bleeding may be visible or hidden

When the detachment begins, the placenta is tense, when it is felt there is pain - the larger the detachment area, the stronger the pain. It can be both permanent and paroxysmal, given to the lower back, thigh and perineum.

Violation of the cardiac activity of the fetus is caused by a decrease in blood circulation between the organisms of the mother and the child. With detachment of more than 1/4 of the placenta area, the fetus begins oxygen starvation, detachment of more than 1/2 of the placenta leads to intrauterine death of the fetus.

If any of these symptoms appear, an urgent need to consult a gynecologist. Timely medical assistance can stop the incipient placental abruption and correct its consequences.

Detachment in the first trimester

As a rule, the cause of placental abruption in early pregnancy is retroplacental. Bleeding with this type of detachment is usually only internal, and with an easy stage, there are no external symptoms, the results of detachment are visible only on ultrasound. With timely and correctly prescribed therapy, there is no threat to the mother and child. In the future, the growth of the placenta compensates for the area lost during detachment and the development of the fetus does not suffer.

Detachment in the second trimester

One of the symptoms of detachment at this time is a sharp increase in fetal activity. When blood circulation decreases, oxygen supply decreases, which forces the child to move more to increase blood flow.

The shorter the period at which the detachment occurred, the higher the chances of a positive outcome, since the placenta continues to grow until about the middle of the second trimester and can compensate for the loss by increasing the area. If the detachment began in the sixth month, then the question arises of an emergency caesarean section.

Detachment in the third trimester

This period is considered the most dangerous when a detachment occurs, since the area of ​​the placenta no longer increases, respectively, its compensatory capabilities are absent. It all depends on how large the area of ​​the detachment is and whether it increases - with non-progressive partial placental abruption, it is possible to bring the pregnancy to the desired date under the supervision of doctors and with appropriate therapy, if its area grows, then immediate delivery by cesarean section is indicated.

Detachment during labor

Usually during childbirth, premature placental abruption occurs in the case of multiple or high-water pregnancies. Depending on the stage of childbirth, the doctor prescribes either a cesarean section (if the child has not yet descended into the birth canal or labor is absent for some reason), or stimulation up to pinching. Detachment symptoms during labor:

• tension in the uterus does not disappear even between contractions;
• disturbed (faster or slower) fetal heartbeat;
• there is blood or meconium in the amniotic fluid.

Diagnostics

Placental abruption is diagnosed either on the basis of symptoms (the classic triad of signs of abruption - bleeding, lower abdominal pain, impaired heart function in a child, or any others that suggest any pathology), or during routine examinations or screenings.

The main diagnostic method is ultrasound. It allows you to establish the presence of a detachment, its location (central or marginal), the area of ​​the detachment, the size of the hematoma.

In addition to ultrasound, the doctor also conducts a gynecological examination to exclude other possibilities of bleeding.

Also, the doctor will listen to the fetal heartbeat to find out if hypoxia has begun.

The combination of the results of examinations and the condition of a pregnant woman makes it possible to establish the condition of the fetus, the state of detachment, prescribe therapy and give a prognosis for the further development of the pathology.

Forecast

Predictions regarding the treatment of placental abruption and the further course of pregnancy depend on the state of the placenta at the time of the examination. There are 3 types of detachment:

• partial non-progressive - gives the maximum chances of a positive resolution; the detachment is small and does not increase, the vessels are usually capable of self-clogging and stopping bleeding, as a result, the discharge of the placenta from the uterine walls is suspended; often asymptomatic, pregnancy in the future can proceed as usual and without consequences;
• partial progressive - an increase in hematoma provokes an increase in detachment, the fetus suffers from hypoxia, a pregnant woman - from blood loss; urgent medical intervention is required up to immediate delivery;
• complete detachment - in this case, immediate death of the fetus occurs, it must be removed to save the mother's life.

With partial, non-progressive placental abruption during full-term pregnancy, natural delivery is possible - the fetal bladder is opened to start labor, this reduces pressure on the uterus and prevents further detachment.

If the gestation period has not yet come to an end, but the birth canal is already mature, and the detachment is small, then the question of natural childbirth may also be raised. If the cervix is ​​not yet shortened, and the cervical canal is not passable, then a cesarean section is performed.

Treatment

Treatment of placental abruption is possible in case of partial discharge. The choice of therapy methods depends on the following parameters:

• the time of the origin of the detachment - during pregnancy (the time is important) or in childbirth;
• total blood loss;
• well-being of mother and child.

With partial, non-progressive placental abruption, prolongation of pregnancy is permissible if:

• gestational age less than 7 months;
• there are no signs of fetal hypoxia;
• the condition of the expectant mother and child does not cause concern;
• the amount of blood lost is small.

In this case, the expectant mother is placed in a hospital under the supervision of doctors, where she will regularly monitor both the condition of the fetus using ultrasound, Doppler and cardiotocography, and her blood coagulation system using tests. Bed rest is prescribed and, if necessary, the following drugs.