Partial placental abruption in early pregnancy. The consequences of placental abruption. Detachment of the placenta in the early stages

15.08.2019

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

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 setting.

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.

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 a threatening 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 the provision of 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 bleeding continues or a blood clot is already forming.

What to do with placental abruption

No matter how scary 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 the next day, you must yourself go to the hospital. In case 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 assistance 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 location), 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 must be helped 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 doctor of the antenatal clinic 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 will not wish this trouble to the enemy, but if there was a detachment of the placenta, then only the quick help of professionals in the conditions of the 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 term "detachment" or detachment hides behind itself a complex condition, which is fraught with either fetal death or spontaneous miscarriage. Placental abruption in early pregnancy occurs, according to statistics, in 1.2% of all pregnant women.

Placenta functions

The placenta plays a huge role in the development of the baby, performing many important responsibilities:

Nutrition. Every woman knows about it. It is through the placenta that the baby receives all the necessary nutrients from the mother's body.
Selection. In the child's body, from the very beginning of formation, various metabolic processes take place. Residual waste products must be removed from the child's body. Otherwise, the strongest intoxication is simply inevitable. The responsibility of withdrawal and the placenta takes over.
Breath. Without sufficient oxygen, the baby will not be able to fully develop. Its delivery is also provided by the placenta.
Hormonal function. In order for pregnancy to develop correctly, a certain hormonal balance must be observed in a woman's body. The placenta produces many of the essential hormones, in particular progesterone, hCG, placental lactogen, and others.
Protection. The baby's body is far from perfect, and is not able to withstand various negativity. To fully develop, the baby needs reliable protection. And the placenta takes on the role of such a protector, preventing infections and toxins from the mother's body from entering the blood of the fetus.

Reasons for the formation of pathology

Placental abruption during early pregnancy can occur for the following reasons:

the woman had several births;
mature age;
alcohol abuse;
smoking;
improperly constructed diet;
inflammatory processes of the membranes;
high pressure;
gestosis;
allergy to drugs;
pathological conditions of the placenta or uterus;
systemic diseases;
trauma to the abdomen;
autoimmune conditions.

But most often, placental abruption occurs due to strong contractions of the uterus. The placenta itself does not contain muscles and cannot contract on its own. That is why gynecologists recommend giving up sex in the first trimester. Insufficient blood supply to the child's place or a small amount of progesterone produced by the body of the expectant mother can also cause this pathological condition to form.

In this case, partial placental abruption can occur when there is a threat of miscarriage, or complete - spontaneous abortion. Therefore, in the first three months of the "interesting situation" it is worth being more careful.

Placental abruption

Placental abruption in early pregnancy is divided into several degrees of severity. Depending on the complexity of the condition, the clinical symptoms also change:

Easy degree. It is characterized by the absence of the main signs of the development of pathology.
Average degree. The woman feels quite severe pain in the lower abdomen. Localization of painful sensations indicates the place of the pathological process. At the same time, the tone of the uterus increases, and bleeding may occur from the genital tract.
Severe degree. This condition is accompanied by severe pain, weakness, dizziness. Fainting, nausea, ending with vomiting, as well as heart rhythm disturbances (tachycardia) are possible. Additionally, there may be a sharp drop in blood pressure, increased sweating. The tone of the uterus is increased to the limit, but the main symptom is severe bleeding.

If there is a complete abruption of the placenta, the consequences for the child will be dire. As a rule, pregnancy cannot be saved in this case.

Detachment diagnostics

Detachment of the placenta, which occurred in the 1st trimester, most often does without serious consequences. That is why it is important to diagnose the development of pathology at the time, and then undergo an adequate course of treatment.

An ultrasound examination helps to confirm and sometimes detect pathology. A specialist in the process of examination can detect a retroplacental hematoma, as well as see destruction of subplacental tissues. In some cases, even blood clots are different.

But at the beginning of the formation of pathology, such an education may be absent. In this case, the diagnosis is based on the method of excluding other probable diseases with similar symptoms. It is produced based on the following indicators:

hypertonicity of the uterus;
open bleeding or spotting;
disorders in the development of the child.

To exclude other possible diseases, the doctor examines the cervix and vagina during a pelvic examination. This allows you to exclude such causes of bleeding or smearing discharge, such as damage to the genitals, various infections or swelling. The next step will be the appointment of a full diagnostic examination, since it is possible to establish the true cause of the detachment only after a comprehensive study.

Symptoms of placental abruption

Many women worry that they will not be able to understand the alarming signals of their body, which is why it is so important to know all the signs of placental abruption. Pathology can manifest itself in the form of:

Bloody discharge. Quite often it is accompanied by bleeding from the external genital organs. Relatively less often, a woman may experience internal bleeding. At the same time, she needs emergency medical care, since we are talking about her life.
Placental abruption in early pregnancy can be painful. A woman may experience a dull, aching pain radiating to the thigh or groin. If internal bleeding has opened, then the pain is more pronounced.
The presence of pathology can be indicated by an increased tone of the uterus.
Oxygen starvation of the baby. If the detachment has touched more than 50% of the placenta, then the pregnancy can no longer be saved.
Nausea, heart rhythm disturbances, dizziness, vomiting, unreasonable anxiety are accompanying signs of placental abruption.

Sometimes the process that has begun can take place without characteristic symptoms. A doctor can detect pathology during a routine ultrasound scan.

Pathology treatment

If placental abruption occurs, treatment in this case can only be selected by a specialist. Even in the case of minor bleeding, a woman should call a doctor and lie down in a horizontal position. No medicines should be taken.

If bleeding has begun, placental abruption is likely to occur and the woman needs urgent hospitalization. And only in very rare cases, a pregnant woman can be left at home, prescribing full bed rest. But this is more an exception than a regularity, since a woman needs a full medical examination. This can be done only in a hospital setting.

Treatment of mild to moderate placental abruption

The choice of therapy depends not only on the gestational period, but also on the severity of the pathology. An individual treatment plan is drawn up for each case.

In the treatment of mild to moderate detachment, the following drugs may be prescribed:

tocolytic agents that prevent uterine contractions (drugs "Ritodrin" and "Partusisten");
medicines from the category of antispasmodics ("Magnesia sulfate", "Papaverine", "No-shpa" and "Metacin");
hemostatic drugs ("Aminocaproic acid", "Vikasol", "Ditsinon").

In addition, ascorbic acid is prescribed, as well as iron preparations. The woman is prescribed complete rest and adherence to bed rest, excluding any physical activity.

Hormone therapy is prescribed only if placental abruption in early pregnancy is due to progesterone deficiency. In this case, the administration of the drug "Duphaston" or "Utrozhestan" is additionally prescribed.

Prevention of placental abruption

At the moment, medicine is not aware of specific measures that can prevent the development of pathology. There is also no answer to the question of what provokes such a state. Medicine knows only the most probable causes, which may be provocateurs of detachment in the early stages of pregnancy.

Prevention of the formation of pathology is reduced to the following measures:

regular visits to a gynecologist who monitors pregnancy;
passing the necessary tests, which makes it possible to control the work of the body of a pregnant woman;
maintaining a healthy lifestyle and quitting smoking, alcohol;
daily walks in the fresh air;
taking precautions to avoid injury to the abdomen.

Taking any medications without the agreement of a doctor is highly undesirable, since only a specialist can assess the degree of risk of its effect on a child.

Outcome

Placental abruption is a rather difficult condition. But it must be remembered that such a diagnosis is not always a verdict. With the development of pathology, affecting less than 50% of the surface of the placenta, the chances of maintaining pregnancy are very high.

The placenta is a special organ formed in the female body during pregnancy. Its main function is to provide communication between the child and the mother. Life, full development and nutrition of the fetus depends on the normal functioning of the placenta, since it is a kind of conductor of nutrients, oxygen, maternal antibodies to the child.

The baby's place begins to develop approximately in the second week after the conception has occurred, and then grows over a long period. At this time, the fertilized egg, which has made a difficult and long journey through the fallopian tubes, enters the uterus, where it is fixed. Over the next two and a half months, the organ will grow and form rather quickly. It will reach maturity by about 12 weeks after conception.

Currently, not all pregnancies end successfully and proceed without complications, and one of the most dangerous of them is premature placental abruption, which does not always end successfully and without consequences, both for the mother and the fetus. This complication is quite rare and occurs in no more than one and a half percent of cases. Most often, the pathology manifests itself in the first three months of pregnancy, and has a fairly favorable prognosis.

What is the placenta

The placenta, which in Latin means a cake, is an organ necessary for the implementation and maintenance of communication between the mother and the fetus. Refers to temporarily forming structures, since it is formed during pregnancy and exists only during its duration.

The placenta is a rather complexly organized organ, which consists of intertwined blood vessels of the fetus and the mother. Between them is the hemoplacental barrier, which is a special protective membrane. This barrier prevents harmful substances from entering the fetus from the mother's body. In addition, it promotes the elimination of metabolic products of the child into the woman's blood, from where they are subsequently excreted through her kidneys.

The development of the placenta in the body of a pregnant woman finally stops by 16-18 weeks, when the transition from histotrophic nutrition of the embryo to hematotrophic one occurs. As a result, the hematoplacental barrier is formed.

The main functions of the body include:

Gas exchange. As you know, the blood of a mother and a child does not mix. But the oxygen carried by the pregnant woman's blood enters the fetal bloodstream, and the carbon dioxide formed during the breathing of the unborn child enters the woman's bloodstream. So, thanks to the placenta, the breathing of the unborn child occurs;
Nutritious. Between the wall of the uterus and the villi of the placenta, there is a special intervillous space into which the mother's blood flows. It contains nutrients, vitamins and minerals, which from this space enter the placental vessels and are delivered to the fetus;
Excretory. Like any living being, the unborn child in the process of life forms a number of metabolic products that are removed due to the presence of the placenta;
Protective. The baby seat provides maternal antibodies to the fetus. Thanks to this, the unborn child develops primary immunity. The organ is a means that prevents the emergence of an immune conflict between maternal and child organisms. In addition, the placenta is involved in the formation and regulation of immunity in women and the fetus.
Hormonal function of the placenta. It is based on the fulfillment of the functions of the endocrine gland by the placenta, which synthesizes a number of hormones necessary for the normal course of pregnancy:

HCG, the task of which is to maintain the fulfillment of its purpose by the placenta and to participate in the synthesis of progesterone by the corpus luteum;
placental lactogen, which takes part in the development of the mammary glands in a woman during the gestational period and prepares them for milk production;
prolactin, the function of which is milk synthesis;
progesterone and estrogens, which are actively involved in stimulating the growth of the uterine mucosa, and also prevent the occurrence of ovulation during gestation;
serotonin;
relaxin.

It should be remembered that, despite its properties, the placenta cannot protect the fetus from the penetration of most drugs, drugs, alcohols, nicotine and all kinds of viruses into its body.

Placental abruption in a pregnant woman

To date, one of the dangerous complications that a pregnant woman can face is placental abruption. This process is accompanied by the separation of the organ from the walls of the uterus even before the birth of the child. This process can occur not only during pregnancy, but also during childbirth.

The baby's place is under constant pressure from the layer of muscle fibers of the uterus, which is outside of it, and the ovum with amniotic fluid from the inside. Both of these forces are balanced. In addition, the placenta has a spongy structure, which makes it very elastic and allows for significant stretching during the growth of the uterus without the risk of detachment. The area of the uterine wall, where the placenta is attached, is reduced to a much lesser extent. It also reduces the risk of developing pathology.

Placental abruption classification

There are several classifications of this pathology, which are based on the time, place, area of the complication that has arisen.

Depending on the period in which the child's organ was rejected, it is subdivided:

Early detachment;
Detachment at a later date;
Detachment during labor, which occurs during pushing and laboring.

Depending on the size:

Complete. In this case, the entire placenta exfoliates, which leads to instant fetal death;
Partial. The separation of only a certain part of the child's place from the walls of the uterus is characteristic.

Depending on the location:

Peripheral. In this case, detachment of the placenta occurs from the edge. It is accompanied by external bleeding;
Central, in which the exfoliation of tissue from the uterus occurs in the center. External bleeding may not occur.

In the course of the pathological process:

Progressive, in which the growing hematoma further enhances the process of exfoliation of the placenta and makes the condition of the mother and child heavier;
Non-progressive. In this case, internal bleeding is stopped due to the fact that the uterine vessels are clogged with blood clots. The pregnancy then proceeds normally.

Causes of pathology in pregnant women

At present, doctors cannot clearly and confidently identify the factor that provokes the development of this pathology in pregnant women. It is believed that this violation is caused not by one, but by a combination of reasons. Doctors identify a fairly large number of predisposing points that every expectant mother should pay attention to. The main causes of placental abruption are:

One of the most significant factors is the presence of high blood pressure in the mother - hypertension. Detachment of a child's seat can cause sharp jumps in blood pressure, which appear during stress. Also, blood pressure can change if the enlarging uterus compresses the inferior vena cava. This condition most often appears after a long stay in the supine position;
The development of this pathology in previous pregnancies greatly increases the possibility of its appearance in the present;
Multiple or multiple births, as a result of which pathological changes occur in the membranes of the uterus, also increase the risk of developing this pathology;
Postterm pregnancy can cause placental abruption;
With increasing age of the expectant mother, the risk of placental abruption also increases. In women over 35 years old, the development of an additional lobule of the placenta is quite often observed, which often breaks off during childbirth, and this can contribute to the detachment of the entire organ;
If a woman has at least one previous birth ended with a cesarean section, the chance of pathology increases;
A long period of infertility prior to conceiving a child increases the risk of developing an anomaly;
Preeclampsia, gestosis and toxicosis, especially in the first trimester of pregnancy. It must be remembered that with gestosis, the vessels become more fragile and fragile, and it is from them that the placenta consists;
Anomalies in the structure of the internal genital organs of a woman can lead to the appearance of pathology of the placenta. An important factor is the anomalies of the vessels located in the muscular layer of the uterus, in which it is possible to change the vascular walls and their permeability. Capillaries become more fragile and fragile, which is associated with a decrease in elasticity and impaired permeability for blood;
The emergence of pathologies in the development of the placenta itself;
Placental abruption during childbirth can be triggered by abnormalities in labor;
The presence of a short umbilical cord or a late opened fetal bladder. Since the unexploded membranes or short umbilical cord pulls the placenta down, it can begin to exfoliate;
All kinds of external injuries, abdominal bruises;
The danger is the presence of bad habits in the expectant mother. Tobacco smoking, consumption of large amounts of alcoholic beverages, as well as cocaine, can provoke tissue rejection;
Development of anemic conditions. These include anemia, a decrease in the number of red blood cells and hemoglobin;
All kinds of allergic reactions to drugs, transfusion of blood components;
Rarely is the autoimmune form of detachment, in which a woman's body produces antibodies to its own tissues and rejects them.
All kinds of chronic diseases, including diabetes mellitus, as well as infectious inflammation. This also includes various tumors in a woman's body, obesity, thyroid diseases, all kinds of blood pathologies. This is due to the fact that the course of all these diseases can be complicated to a considerable extent during pregnancy, because it itself is a serious stress for the female body.

Symptoms of placental abruption at different stages of pregnancy

Symptoms of placental abruption during early and late pregnancy include:

The appearance of bleeding, which can be external, internal or mixed. External bleeding is easy to see with brownish discharge. Such bleeding is typical for the detachment of the peripheral parts of the child's place. Internal bleeding occurs when the placenta has become detached from the center of the uterus. In this case, the edges remain attached to its wall. Fluid builds up between the uterus and placenta;
Perceptible tension of the uterus and the occurrence of a feeling of pain with placental abruption, which a woman experiences during examination and palpation. It is felt most strongly with internal bleeding;
Violation of the baby's cardiac activity. The child's condition depends on the volume of blood that the woman has lost, and on the level of progression of the pathology. Detachment of one quarter of the organ leads to a lack of oxygen in the baby. When a third of the placenta peels off, the baby experiences severe oxygen starvation. The death of a child occurs when 1 / 3-1 / 2 of the child's seat is peeled off.

Placental abruption treatment

Placental abruption treatment raises a significant number of questions and concerns not only for women, but also for medical personnel. When diagnosing premature discharge of the placenta, the doctor faces a rather difficult and responsible task - to choose the method of the most gentle and quick delivery. It is also necessary to provide timely assistance to the woman and take actions aimed at increasing blood clotting, combating shock and blood loss.

The choice of a method for treating pathology in the early stages of pregnancy and later depends on several parameters:

The period in which the rejection occurred (it happened during childbirth or before its onset);
The amount of blood lost and the intensity of bleeding;
The general condition of the expectant mother and fetus.

Doctors may opt out of the prompt delivery option if:

Placental discharge occurred in a small area, and this condition does not progress;
Pregnancy does not exceed 36 weeks;
The discharge has stopped and the amount of blood loss is small;
There are no signs of oxygen starvation in the fetus;
The pregnant woman feels well and is in the hospital under the supervision of doctors.

The patient must comply with bed rest. The condition of the expectant mother and baby is under constant supervision. It is necessary to regularly undergo a number of diagnostic examinations, among which the most important are ultrasound, cardiotocography, and dopplerometry. It is important to monitor blood clotting, the level of which is determined on the basis of special laboratory tests. With this pathology, the following drugs can be used:

Medicines with a relaxing effect;
Antispasmodics;
Hemostatic agents;
Medicines to combat anemia.

In the case when, during a woman's stay in the hospital, she has spotting after placental abruption, the doctor should not hesitate, but promptly decide on the advisability of giving birth by emergency cesarean section, since such discharge may indicate that the process is progressing.

Childbirth should take place under the constant and vigilant supervision of medical workers for the condition of the fetus, its cardiac activity. In case of natural childbirth, a woman must undergo a manual examination of the uterine cavity.

After the caesarean section, the uterus is also examined. This is done in order to accurately assess the state of her muscle layer. In cases where it is soaked in blood, the uterus is removed. The reason for this is its possible becoming a source of bleeding in the future.

Placental abruption at different stages of pregnancy

The medical manifestations of pathology will be expressed and manifested in different ways, depending on the duration of the pregnancy in which it occurred.

Premature organ rejection in early pregnancy

Rejection of the placenta is quite common during the first trimester of the gestational period. Timely diagnosis and implementation of therapeutic measures most often prevent it.

In this case, a retroplacental hematoma is formed, which is quite clearly visible during ultrasound. In this case, there will be no discharge.

To treat this condition, hemostatic therapy must be used, the pregnant woman must be at rest. In the case of timely medical measures, the pregnancy will continue its normal development and the complication suffered will not in any way affect the child's health.

Second trimester of pregnancy

With placental abruption in the period from 12 to 27 weeks of pregnancy, a fairly strong tension and a high tone of the uterus are added to all the above symptoms. If hypoxia begins in the fetus, the child becomes more active, moves more often and more. This is due to the fact that in this way it accelerates blood flow and provides oxygen to the blood.

The structure of the placenta is such that it is able to grow up to the middle of the second trimester, due to which compensation for the lost area of contact with the uterus can occur. In case of rejection at a later date, it is advisable to consider an emergency caesarean section. In this case, it is necessary to prevent the death of the child inside the mother's body from progressive hypoxia.

Late gestation

In the third trimester of pregnancy, organ rejection poses the maximum danger, since the growth of the child's place is stopped, and there is no way to cover the lost area of contact with the uterus. If such a situation arises, the gynecologist decides on the possibility of a surgical delivery for health reasons.

If the detachment does not progress, has a small area, is characterized by the absence of bleeding in some cases, pregnancy can be reported, but this must be done strictly in a medical institution and under the constant supervision of specialists.

Detachment of the baby seat during childbirth

With polyhydramnios or multiple pregnancies, placental abruption can occur directly during childbirth. The completion of the birth process depends on the stage at which it occurred. The doctor decides to either induce labor or proceed to delivery by caesarean section.

Prevention of placental abruption

The most important and most significant measures that will prevent the appearance of premature organ rejection are:

Thorough examination by professional specialists, which includes diagnosis and timely treatment of pathological processes in the uterus and pelvic organs;
Constant monitoring of the state of blood vessels, not only during pregnancy, but also before its onset;
Control and regulation of blood pressure. If possible, you should avoid any psychological and physical trauma;
Prevention of allergic reactions.

Thus, an important point to prevent the appearance of pathological conditions in which the child's place is rejected is to observe preventive measures and maintain a healthy lifestyle both during pregnancy and before it.

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Of great importance is the organ that occurs during pregnancy in the uterine cavity and connects the organisms of the mother and the fetus. The placenta is responsible for the biological processes of the child, thanks to which he has the ability to develop normally in the tummy. The health and life of the baby depends on this organ, therefore, placental abruption at an early or late stage of pregnancy is considered a dangerous phenomenon, the diagnosis and treatment of which is best done as early as possible.

What is placental abruption

The condition, the main symptom of which is the untimely rejection of the child's place from the uterine membrane, is called premature detachment of the placenta. Pathology can develop both during pregnancy and during labor. Normally, the placenta is separated only after the baby is born. Premature detachments are accompanied by damage to blood vessels, which causes uterine bleeding of varying severity. A dangerous complication occurs in 0.5-1.5% of pregnancy cases and, according to statistics, develops more often in primiparous women.

Pathology, as a rule, develops during premature birth and always requires urgent medical intervention. The state of the child's place determines the normal development of the fetus or its death. Normally, the organ is located on the uterine wall in the upper part of the body of the uterus (at the anterior and posterior walls or at the bottom), otherwise placenta previa is diagnosed - its incorrect location. On the one hand, the uterine muscles press on the afterbirth, on the other, the fetus and amniotic fluid. Normally, the balance of pressure prevents premature detachment of the organ.

Symptoms

The pathological process is accompanied by bleeding resulting from damage to the uterine and placental vessels. As a result, the afterbirth begins to separate, the blood between it and the wall of the uterus accumulates and a hematoma is formed. Gradually, it increases in size and causes the progression of detachment, which entails squeezing and organ dysfunction. Doctors distinguish three degrees of severity of premature placental abruption, each of which is characterized by certain symptoms:

The mild form, as a rule, does not have clear signs, therefore, the pathology can only be diagnosed during a planned ultrasound scan or after childbirth, when a small deformation (depression) filled with blood clots is found on the surface of the bladder.
Signs of moderate placental abruption are characterized by abdominal pain and small bleeding from the genital tract. In some cases, external bleeding is absent altogether, which depends on the size of the hematoma and the localization of the site of violation. On palpation, a slightly tense uterus is revealed, sometimes there is moderate soreness.
A severe form of detachment is characterized by sudden intense pain in the peritoneum, severe weakness, dizziness, and anxiety. Sometimes women experience a fainting state, possibly increased sweating, a decrease in body temperature and blood pressure, and an increase in heart rate. In addition, as a rule, pallor of the skin and the appearance of dark spotting from the vagina are noted. During examination, the uterus is tense and has an asymmetric shape (there is a protrusion on either side, when this area is pressed, pain occurs). Fetal body parts are not palpated, and the heartbeat is not heard.

Reasons for placental abruption

It is extremely difficult to determine which factor caused the partial or total detachment of the child's place. It is believed that this pathology occurs due to the presence of several negative aspects and predisposing factors. To date, doctors identify the following possible reasons for the detachment of the placenta during pregnancy and childbirth:

hypertension in the mother, strong fluctuations in blood pressure during stress and neuropsychic influences (sometimes pressure changes occur due to compression of the inferior vena cava by the uterus, which occurs with prolonged lying on the back);
pathology has already been observed in a previous pregnancy (while the risk of premature rejection of the placental bladder is increasing);
multiple or frequent childbirth (detachment is observed in women who have given birth several times, which is associated with changes in the mucous membrane of the uterus);
post-term pregnancy;
the age of the pregnant woman (the older the woman, the higher the risk of pathology);
period of infertility before conception;
toxicosis, gestoch, preeclampsia, especially in the first trimester of the term;
anomalies in the structure of the uterus;
vascular diseases located deep in the muscular layer of the uterus, changes in the walls of blood vessels, an increase in their permeability, impaired blood permeability;
anomalies of maturation and location of the placenta;
violation of blood clotting;
pathology of labor (a rapid decrease in pressure in the uterus, which, as a rule, occurs when the birth bladder is opened or the rapid outpouring of water);
fast delivery;
late opening of the fetal bladder;
short umbilical cord;
blunt external trauma to the abdomen (due to a fall, impact, etc.);
bad habits, addiction (alcohol consumption, smoking, drug use);
anemia, a decrease in hemoglobin levels, the number of erythrocytes;
an allergic reaction to medicines, transfusion of blood components or protein preparations;
autoimmune factors (occasionally the female body produces antibodies to tissues, after which they begin to be rejected; as a rule, this occurs in the presence of systemic diseases such as rheumatism or lupus);
diabetes mellitus, other hereditary, infectious or chronic diseases;
obesity, presence of tumors, etc.

Manifestation at different stages of pregnancy

Detachment of the placental sac is the process of its separation from the uterine wall, while complete and partial detachment is isolated. In the course of the pathological process, blood accumulates between the fetus and the walls of the uterus, which repels the afterbirth. This process is natural and occurs in the last trimester of pregnancy, however, under the influence of various negative factors, detachment can occur ahead of time.

Detachment of the placenta in the early stages

In the first trimester, the pathological process is diagnosed relatively often, but with timely detection and treatment, negative consequences can be prevented. As a rule, the cause of the detachment of the placenta is a retroplacental hematoma, which is visible on ultrasound examination. Detachment of the placenta in early pregnancy is not accompanied by discharge. With adequate and timely therapy, there is no threat to the mother or baby. The placenta, which continues to grow, gradually compensates for the lost area and the complication does not affect the child's health.

In the second trimester

Placental abruption from 13 to 26 weeks of pregnancy is characterized by tension and high tone of the uterine muscles. At the onset of fetal hypoxia, the baby can begin to move more actively in the intrauterine bladder, which stimulates the acceleration of blood flow and, as a result, the supply of fresh oxygen. At this time, the positive outcome of the pathology depends on the duration of pregnancy, since the placenta is able to continue to grow until the middle of the second trimester, thereby compensating for the area of contact with the uterus. In the later stages, the question arises of an emergency caesarean section.

Placental abruption in late pregnancy

The most dangerous is the premature detachment of the normally located placenta in the third trimester of the term. This is due to the fact that the organ is no longer growing, therefore, its compensatory capabilities are absent. In this case, the patients are shown operative delivery in terms of vital signs. Nevertheless, progressive partial placental detachment with little or no bleeding sometimes makes it possible to deliver the fetus in a hospital setting and under medical supervision.

During childbirth

Pregnancy complications such as polyhydramnios or multiple pregnancies increase the risk of detachment of the baby's seat during labor. At the same time, depending on the stage of childbirth, the doctor decides on their stimulation (up to the use of forceps) or, if there is no labor at all, a cesarean section is performed. In the first stage, premature detachment is usually manifested by bloody discharge with clots. With external bleeding during contractions, blood loss does not increase, but stops.

In women with placental abruption during labor, there is a tension in the uterus that does not ease between contractions. When examining the vagina, the doctor determines the tension of the fetal bladder, upon opening which blood-stained fetal waters are found. In addition, there may be signs of fetal disruption, for example, a slowdown or increased heart rate. In the amniotic fluid, an admixture of meconium (primary feces) is sometimes found. Such symptoms are evidence of premature placental abruption in the second stage of labor.

Diagnosis of placental abruption

If symptoms of marginal or central detachment are present, an examination is performed to confirm the diagnosis. The main method is ultrasound, thanks to which it is possible to establish the area of the part of the placenta that has moved away from the uterine wall and the size of the retroplacental hematoma. In addition, blood tests and gynecological examinations are performed. It is important in the diagnostic process to establish the condition of the fetus, whether it is alive. During the examination, the doctor can establish one of 3 possible diagnoses:

progressive partial (uterine vessels burst, the size of the hematoma gradually increases, as a result of which the woman loses a lot of blood, which can lead to hemorrhagic shock; in this case, urgent delivery is indicated);
non-progressive partial (minor marginal detachments are often accompanied by blockage of blood vessels, as a result of which bleeding stops, as well as further separation of the baby's place from the uterine wall; at the same time, pregnancy can proceed normally, and the child is born healthy);
total detachment (the prognosis is disappointing - the fetus dies almost immediately, since gas exchange between it and the mother stops).

How to treat a detachment

If a premature rejection of the placenta is detected, the doctor is faced with the task of choosing the appropriate method of treatment aimed at increasing blood clotting, combating blood loss, and shock. Therapy for placental abruption in the early and later stages of pregnancy depends on the following factors:

time of development of pathology;
the amount of blood loss, the intensity of bleeding;
the general health of the baby and mother.

The doctor may refuse the option of operative delivery if:

a small area of the placenta has exfoliated and this condition does not progress;
the term is no more than 36 weeks;
there are no signs of hypoxia in the child;
the discharge has stopped, the volume of blood loss is insignificant;
the woman feels well and is under the supervision of doctors in a hospital setting.

A patient with afterbirth detachment must comply with bed rest, while her state of health is subject to constant medical supervision. You should regularly undergo ultrasound, dopplerometry, cardiotocography, monitor blood clotting, which is determined through laboratory tests. With placental detachment, the following drugs can be prescribed:

hemostatic agents;
antispasmodics;
medications that relax the uterus;
hormones;
remedies for the treatment of anemia.

Consequences for the child

Premature placental abruption is a common cause of stillbirth in the last weeks of pregnancy. About 15% of children die from this pathology. The cause of death is serious disorders that the fetus faces as a result of the detachment of the placenta. These include hypoxia (oxygen deficiency) and other problems caused by prematurity in the event of premature labor. The consequence of pathology is often neurological disorders and developmental lag in the child.

Preventive measures

There are no methods that are guaranteed to help the normal attachment of the placenta during conception. The causes of placental abruption are difficult to determine, so you can only try to reduce the risk of pathology by using the following measures:

when planning a pregnancy, a woman is recommended to undergo a full examination, which will check her fertility, the presence of any diseases and infections in the body, which are treated before pregnancy;
during gestation, you need to regularly undergo examinations, visit a doctor;
any medications are allowed to be taken only with the consent of the doctor;
a pregnant woman needs to avoid injuries, give up bad habits, monitor her own health;
a woman is advised to regularly walk in the fresh air, eat right, and avoid stress.

Video

A serious complication that a woman in a position can face is placental abruption during pregnancy.

This condition requires urgent medical attention, since delay can cost the life of an unborn baby.

The organ that occurs during pregnancy in the uterus and binds the mother and the fetus is bound by the placenta (baby seat). Its significance is very great. The organ is responsible for the biological processes due to which the baby develops normally in the tummy. The child's life depends on the placenta. Deviations, pathologies associated with it, can lead to his death.

The following functions of the placenta can be distinguished:

gas exchange. The baby in the womb needs oxygen: it enters the fetal blood from the mother's blood through the placenta. Through it, carbon dioxide is also transmitted from the child to the mother. A slight placental abruption can disrupt gas exchange;
nutritious and excretory. For the normal development of the baby, vitamins, nutrients, and water are required. All this he receives through the placenta. Waste products are removed through it;
hormonal. The placenta can be compared to the endocrine gland. It produces very important hormones (chorionic gonadotropin, placental lactogen, prolactin progesterone, etc.), without which the normal course of pregnancy is impossible;
protective. The placenta provides immunological protection to the fetus. The mother's antibodies passing through the baby's place protect the baby from various diseases.

Placental abruption: what is it, what does it look like and what happens?

Detachment of the placenta is its separation (partial or complete) from the lining of the uterus. At the same time, blood accumulates between the child's place and the wall of the uterus, which pushes the placenta away from the uterus. The placenta should not move away during pregnancy. Its separation from the uterus should take place in the third labor period. However, there are times when the placenta departs prematurely.

What is the risk of placental abruption during childbirth? This process is dangerous for the baby, as it can deprive him of oxygen and nutrients.

Causes of premature detachment of a normally located placenta

Premature discharge of the placenta is experienced by women in 0.4-1.4% of cases. It can occur both during pregnancy and during childbirth in the first or second period. Why does placental abruption occur? The reasons for this process are different.

The separation of the child's seat can be caused disorders in the vascular system... The capillaries of the uterus and placenta may become more fragile and brittle. Because of this, a violation of the permeability of the blood is possible. Similar changes in the female body can occur with. They are also observed in the presence of certain diseases: cardiovascular disease, hypertension, kidney disease, obesity, diabetes mellitus, etc.

The threat of placental abruption can come from inflammatory, degenerative and other pathological processes flowing in the baby's place and the uterus. Violations can be observed with uterine fibroids, malformations, and prolonged pregnancy.

To premature discharge of the placenta predispose bad habits: excessive consumption of beverages containing alcohol, addiction to cigarettes, drugs. The situation may worsen with anemia (anemia, a decrease in the number of red blood cells, low hemoglobin).

Most often, symptoms of placental abruption in early pregnancy or later are observed in women for whom the forthcoming childbirth is not the first... The reason for this lies in the change in the lining of the uterus.

The most rare cases of placental abruption are due to autoimmune conditions, in which the female body produces antibodies to its own cells. This can be observed with a disease such as lupus erythematosus.

Allergy to drug therapy - another reason for placental abruption in the late or early stages. Usually, pregnant women develop an allergic reaction during transfusion of donor blood and its components, the introduction of protein solutions.

Injury to the abdomen from a fall, impact or accident can lead to complications. Placental abruption can also be promoted by abrupt changes in blood pressure arising from stress and other neuropsychic influences.

Placental abruption symptoms

In early pregnancy and later in pregnancy, symptoms of placental abruption may be as follows:

bleeding;
uterine tension and pain with placental abruption;
violation of cardiac activity in a baby.

Bleeding can be external (visible), internal (hidden) or mixed. External bleeding is easy to notice, as it appears from the vagina with placental abruption brown discharge... It is observed with detachment of the edges of the placenta. If the baby's place is disconnected from the uterus in the center, and the edges remain attached to its wall, then the bleeding in this case will be called internal. Fluid will build up between the uterus and the placenta.

When detaching a child's place, it is felt tension of the uterus... When it is palpated, it is felt pain... She can be dumb, jerky. Sometimes the pain radiates in the thigh and bosom, as well as in the lumbar region. It is felt most strongly with internal bleeding.

A fetus with premature placental abruption may have cardiac dysfunction... Its condition depends on the volume of blood that the woman has lost and on the size of placental abruption. Signs of intrauterine suffering begin to appear with detachment of 1/4 of the placenta area. If 1/3 of it leaves, then the child begins to experience severe oxygen deficiency. His death occurs when 1 / 3-1 / 2 of the placenta is exfoliated.

Placental abruption at different stages of pregnancy

The separation of the child's place from the uterus manifests itself in different ways depending on the duration of pregnancy. Quite often, doctors are faced with premature placental abruption in the first trimester... With a timely diagnosis and proper treatment, dire consequences can be avoided. Pregnancy can continue further, and there will be no discharge. In the future, the lost area of contact of the placenta with the uterine wall can be compensated for by the growth of the placenta (its increased area).

Placental abruption in the second trimester symptoms such as high muscle tone and tension are characteristic. The actions of medical workers are in direct proportion to the duration of pregnancy. For example, the placenta can continue to grow until the middle of the second trimester and compensate for previously lost area.

The most dangerous is the separation of a child's place in 3 trimester, because all its compensatory capabilities are completely exhausted, and it can no longer grow. Signs of placental abruption in the later stages are typical: the presence of abdominal pain, tension and soreness of the uterus, bleeding, fetal distress.

The only way out is to carry out delivery. However, it should be noted that if the area of detachment is not large, there is no bleeding and the process does not progress, then it is possible to bring the child to the due date, while being in the hospital under close medical supervision.

Premature placental abruption in childbirth Is a fairly common phenomenon. Ideally, this should happen in the third step of this natural process. However, it also happens that the detachment occurs at the first or second stage. In such a situation, doctors either induce labor or begin a caesarean section.

Diagnosis of premature placental abruption

In the presence of pronounced symptoms, it is not at all difficult to find out that the placenta is exfoliating. If the symptoms are not fully manifested, for example, there is no pain factor, no external bleeding is observed, then the diagnosis is made, excluding the presence of other diseases that can cause similar symptoms. Provides assistance in diagnosing placental abruption by ultrasound. Thanks to him, it is possible to determine the area of the placenta, which has moved away from the wall of the uterus, the size of the retroplacental hematoma.

During the examination, one of three possible diagnoses of the separation of the child's seat can be made:

not progressive partial;
progressive partial;
total.

The placenta can partially move away from the wall of the uterus in a small area. In such situations, it is quite common for damaged blood vessels to become clogged. The bleeding stops and no further detachment occurs. Pregnancy can proceed completely without any complications, and the baby will be born healthy.

Progressive partial detachment the placenta is dangerous to the fetus. The size of the hematoma increases. If most of the placenta leaves the wall of the uterus, the fetus will die. In such a situation, the fair sex herself, carrying the baby, suffers greatly, because she loses a large volume of blood. Blood loss can lead to hemorrhagic shock. You can cope with this situation thanks to urgent delivery.

Can be observed and total(complete) detachment of the child's seat. This happens on very rare occasions. The fetus dies almost immediately, as gas exchange between it and the mother stops.

Placental abruption treatment

The question of how to treat placental abruption is a lot of concern. When diagnosing a premature departure of the child's seat, the doctor faces a difficult task - to choose a method of gentle and quick delivery. You also need to take additional actions aimed at increasing blood clotting, combating shock and blood loss.

The choice of treatment for placental abruption in early pregnancy and later depends on several parameters:

The moment of detachment (during pregnancy or during childbirth);
The volume of blood loss and the severity of bleeding;
The general condition of the expectant mother and fetus.

Doctors may opt out of the prompt delivery option if:

the placenta has exfoliated in a small area, and this condition does not progress;
pregnancy period is not more than 36 weeks;
the discharge has stopped during placental abruption and the volume of blood loss is small;
signs of oxygen starvation in the fetus are absent;
the pregnant woman feels well and will be in the hospital under the supervision of doctors.

The patient must comply bed rest... The condition of the expectant mother and baby should be monitored. It is necessary to regularly undergo ultrasound examination, cardiotocography, dopplerometry, monitor blood coagulation (it is determined on the basis of special laboratory tests).

For placental abruption, the following drugs can be used:

medicines that relax the uterus;
antispasmodics;
hemostatic agents;
medicines to combat anemia.

If there are any concomitant diseases and complications, then appropriate therapy must be carried out.

The expectant tactics will have to be abandoned if spotting after placental abruption begins to appear during the hospital stay. They may indicate that the detachment is progressing. In such cases, the decision is most often made to conduct. Childbirth can also take place through natural routes. It already depends on the condition of the pregnant woman and the fetus.

In any case, childbirth should take place under the close supervision of medical workers for the child's cardiac activity. If a woman gave birth naturally, then after the birth of the baby, a manual examination of the uterine cavity is required.

After a cesarean section, the uterus is also examined to assess the condition of its muscle layer. If it is saturated with blood, then the uterus is removed, since in the future it can become a source of bleeding.

Pregnancy after placental abruption

Women who have undergone placental abruption during a previous pregnancy are interested in the question of whether a similar situation will recur during the next gestation. It is worth noting that the likelihood of leaving the child's seat is high. In 20-25% of the fair sex, the situation repeats again.

Unfortunately, modern medicine is not yet able to completely exclude the possibility of placental abruption during pregnancy during subsequent gestations.

You can try to avoid placental abruption without the help of doctors. To do this, you need to prevent the occurrence of risk factors in early pregnancy:

control your blood pressure;
without fail to attend scheduled examinations;
periodically undergo an ultrasound examination, thanks to which even a small hematoma of placental abruption can be detected;
observe a healthy lifestyle (give up alcoholic beverages, tobacco products, drugs, junk food);
protect yourself from injury, fasten your seat belt in the car;
with an exacerbation of chronic diseases, the occurrence of inflammatory processes, you should not close your eyes to them, but start treatment;
prevent the occurrence of allergic reactions.

In conclusion, it should be noted that premature placental abruption is a very serious condition that threatens the life of a child. Any representative of the fair sex can encounter him.

If the first signs of placental abruption occur (vaginal bleeding or discharge of the corresponding color, uterine pain, back or lower abdominal pain, lack of movement of the baby in the womb), you should immediately seek medical help. If nothing threatens the health of the mother and baby, then the pregnancy will continue, but under the supervision of specialists.

If placental abruption progresses, then immediate rad resolution is required using a cesarean section or naturally, since the consequences of placental abruption in early pregnancy or later can be very sad if you do not pay enough attention to this.

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