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Placental abruption at 16 weeks. Causes and consequences of placental abruption in early pregnancy. Diagnosis of premature detachment of the placenta

The term "detachment" or detachment hides the most difficult condition, which is fraught with either the death of the fetus or spontaneous miscarriage. Placental abruption to early dates Pregnancy occurs according to statistics in 1.2% of all pregnant women.

Functions of the placenta

The placenta plays a huge role in the development of the child, performing many important duties:

  • Nutrition. Every woman knows this. It is through the placenta that the baby receives all the necessary nutrients from the mother's body.
  • Selection. IN children's body from the very beginning of formation, various metabolic processes take place. Residual waste products must be excreted from the body of the child. Otherwise, the strongest intoxication is simply inevitable. The placenta takes over the duty of withdrawal.
  • Breath. Without enough 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 necessary hormones, including 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 fetal membranes;
  • high pressure;
  • preeclampsia;
  • allergy to drugs;
  • pathological conditions placenta or uterus;
  • systemic diseases;
  • injury to the abdomen;
  • autoimmune conditions.

But most often placental abruption occurs due to strong uterine contractions. 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 the formation of this pathological condition.

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

Detachment of the placenta

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 can occur from the genital tract.
  • Severe degree. This condition is accompanied by severe pain, weakness, dizziness. Possible fainting, nausea, ending in vomiting, as well as violations heart rate(tachycardia). Additionally, there may be a sharp decrease blood pressure, increased sweating. The tone of the uterus is increased to the limit, but the main symptom is severe bleeding.

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

Detachment diagnosis

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

Ultrasound examination helps to confirm, and sometimes detect pathology. A specialist during the examination can detect a retroplacental hematoma, as well as see the destruction of subplacental tissues. In some cases, even blood clots differ.

But at the beginning of the formation of pathology, such a formation 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:

  • uterine hypertonicity;
  • open bleeding or bloody issues;
  • violations in the development of the child.

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

Symptoms of placental abruption

Many women worry that they will not be able to understand the alarm 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 secretions. Quite often it is accompanied by bleeding from the external genitalia. Relatively less often, a woman may open internal bleeding. At the same time, she needs emergency medical care, since it is her life that is at stake.
  • Placental abruption in early pregnancy may be accompanied by pain. A woman may experience a dull, aching pain that radiates to the thigh or groin. If internal bleeding has opened, then the pain is more pronounced.
  • The presence of pathology can speak increased tone 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 associated signs of placental abruption.

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

Treatment of pathology

If placental abruption occurs, treatment in this case can only be selected by a specialist. Even in the case of minor bleeding, the woman should call a doctor and lie down, taking horizontal position. None medicines cannot be accepted.

If bleeding has begun, placental abruption is likely to have occurred 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 pattern, since a woman needs a full medical examination. This can only be done in a hospital setting.

Treatment of mild and moderate placental abruption

The choice of therapy depends not only on the gestational age, but also on the severity of the pathology. For each case, a individual plan treatment.

In the treatment of detachment of mild and medium degree 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, assigned ascorbic acid and iron preparations. The woman is prescribed complete rest and bed rest, which excludes any physical activity.

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

Prevention of placental abruption

Specific measures that can prevent the development of pathology, medicine in this moment not known. 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 early pregnancy.

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

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

Acceptance of any medicines without the consent of the doctor is highly undesirable, since only a specialist can assess the degree of risk of its effect on the child.

Outcome

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

Declining issues maternal mortality, stillbirths and deaths of children immediately after childbirth are largely associated with the prevention and treatment of such pathologies as premature detachment of a normally located placenta (PONRP), which occurs in 0.5% -1.5% of all pregnant women. It can occur both at primary and later dates pregnancy (almost 57%), and during childbirth during the opening of the cervix and expulsion of the fetus (43%). PONRP is a premature (before the birth of the fetus) detachment of the "children's place" from the wall of the uterus in its normal location.

What threatens placental abruption

It is an organ, the laying of which occurs from the very beginning of pregnancy and the final formation - by the 16th week. The placenta provides the fetus with oxygen, nutrients, produces hormones and antibodies, and removes metabolic products. In other words, it creates the conditions for the normal growth and development of the fetus.

This is done through villous membrane or chorion. In the place of attachment of the placenta to the endometrium, there are thickenings with depressions, forming intervillous spaces filled with villi. In the thickness of the walls of the partitions separating the recesses, the maternal arterial vessels are located.

The villi secrete enzymes that melt the walls of blood vessels, so that maternal blood is constantly present in the intervillous spaces. Some villi are connected directly to the septal vessels. Thus, through the placenta and the umbilical cord extending from it, the fetus is connected with the mother's body.

Damage to blood vessels and bleeding begins at the site of its attachment to the wall of the uterus. The hematoma, increasing, separates the placenta from the uterus, resulting in:

  1. External or hidden bleeding, often significant.
  2. Development in the mother and fetus (with massive bleeding and damage to the muscular layer of the uterus) DIC (disseminated intravascular coagulation) and, as a result, multiple organ failure. They are associated with the entry of placental cells into the maternal circulation and the excessive formation of thromboplastin, which is involved in blood clotting processes. This syndrome is manifested by the formation of multiple blood clots, hemorrhages, bleeding not only from the uterus, but also from many organs, even minor skin lesions, etc.
  3. Violation of the blood supply to the fetus with the development of serious oxygen "starvation" in it, up to intrauterine asphyxia, especially with PONRP on an area of ​​​​more than 1/3.

These main causes can lead to the death of not only the fetus, but also the mother.

Causes of placental abruption

Despite significant progress in the study of premature detachment, consensus about the causes and mechanisms of development of this pathological condition is not yet available, which greatly complicates its prevention and treatment. Most researchers suggest that the cause is a systemic pathology in a pregnant woman, often occurring in a latent or erased form.

The main reasons are grouped into 3 groups

  1. Vascular, which include general or local (in the area of ​​the placental site) inflammatory processes of the endothelial (inner) membrane small vessels(vasculitis and vasculopathy), increased vascular fragility or permeability of their walls, innervation disorder vascular wall, accompanied by inadequate spasm or paresis (prolonged relaxation) of blood vessels, superficial introduction of chorionic villi into the endometrium.
  2. Changes in blood coagulation processes, which are both a cause and a consequence of placental abruption. In their development, importance is attached various forms antiphospholipid syndrome, which can be genetically determined and occur briefly or proceed secretly in acute or chronic bacterial and, especially, viral infections. In addition, changes in blood clotting can also be genetically determined by the lack of protein “C”, angiotensin-2 deficiency, etc. They predispose to the formation of microthrombi and prevent the full attachment of the placenta.
  3. Mechanical. They are associated with a sharp change in intrauterine pressure and volume of the distended uterus. At the same time, its area in the area of ​​placental attachment decreases as a result of contraction of the myometrium, and the placenta itself, unable to contract, is displaced and separated from the wall. Some researchers consider mechanical factors provoking, but not causal.

Risk factors

Risk factors contributing to the realization of the causes of PONRP during pregnancy include:

  • ectopic vascular pathological conditions - hypertonic disease, sharp infectious diseases(flu);
  • chronic infectious diseases of the urinary tract;
  • autoimmune diseases and a tendency to allergic conditions;
  • endocrine disorders, especially diabetes, hyperthyroidism;
  • severe gestosis of pregnant women, especially in combination with chronic glomerulonephritis;
  • systemic autoimmune and infectious-allergic diseases (systemic lupus erythematosus, rheumatism, vasculitis in acute infections etc.), severe allergic reactions;
  • hereditary disorders of hemostasis;
  • malformations of the uterus;
  • low location of the "children's place" (in the lower segment), its partial or complete presentation - the longer the gestational age, the faster and higher the degree of stretching of the muscle fibers, which in the lower segment, in relation to other departments, prevails;
  • neuropsychic impact, stressful conditions;
  • a large number of births in the past, the presence of fibroids, especially.

Particularly dangerous placental abruption in late pregnancy and childbirth. However, it can result from:

  • a woman's fall or direct mechanical injury;
  • psychological trauma;
  • prolongation of pregnancy, obstetric manipulations ( outer turn fetus, amniocentesis - instrumental autopsy amniotic sac for the purpose of discharge of the anterior waters and stimulation of childbirth;
  • stimulation of labor activity with oxytocin;
  • premature and early discharge of amniotic fluid with polyhydramnios;
  • late rupture of the fetal bladder;
  • excessive intensity of contractions or irregular labor activity;
  • large fetus, multiple pregnancy, polyhydramnios or short umbilical cord;
  • "rapid" childbirth, rapid birth of the first fetus with multiple pregnancies.

PONRP forms and clinical picture

In some cases, detachment may occur without any initial clinical manifestations. Most often, the main and most threatening clinical sign is spotting during placental abruption. They occur if the blood exfoliates the lower placental pole and spreads between the wall of the uterus and the membranes of the fetal bladder to the external genital tract. Detachment can be central and peripheral (marginal) in nature, be partial or complete (total).

If " children's place"is located high in the uterine cavity, and its detachment occurs on a small area or only in the center and the bleeding quickly stops before reaching the periphery, then there will be no spotting. This area is subsequently determined on the maternal surface of the placenta during ultrasound or already during its examination after childbirth.

It looks like an impression of compacted tissue with a changed color and smoothed borders between the lobules. Sometimes a blood clot (retroplacental hematoma) may remain in this depression. At the same time, partial placental abruption in a small area with minor bleeding is safer than central placental abruption without obvious bleeding and with the formation of a retroplacental hematoma.

The clinical picture depends on the area of ​​detachment, the rate and volume of blood loss that has arisen in connection with hypoxia, as well as on the reaction of the organisms of the woman and the fetus to this. There are 3 degrees of severity of PONRP:

  1. Light, in which the detachment is less than 25% of the area of ​​​​attachment of the "children's place". With this form, the symptoms of placental abruption are absent in all or the only manifestation may be a slight (less than 100 ml) short-term discharge from the genital tract dark blood. The condition of the fetus is not affected.
  2. Moderately severe - the area of ​​delamination is from 25 to 50%. The disorder is manifested initially by discomfort, and then by minor, gradually increasing pains in the abdomen and lumbar region, which become permanent. Soon after they begin, dark bloody discharge from the vagina appears, the intensity of which increases, the volume of external blood loss exceeds 100 ml and reaches 500 ml. The general or local tone of the uterus increases significantly, due to which the fetal heartbeat is not even audible. Continuous contractions may occur, passing into each other without relaxation of the uterus between them. The resulting blood loss and changes in the mother's body lead to the appearance of symptoms of increasing fetal hypoxia, its asphyxia and, in the absence of assistance, to intrauterine death.
  3. Heavy. It develops in cases where more than half of the uterine wall is separated or there is a rapid total detachment of the placenta. In this case, there is a sudden strong, “dagger”, pain in the abdomen, accompanied by a sharp pallor, severe weakness, cold sticky sweat, a decrease in blood pressure and a high heart rate, a weak filling pulse, an increase in respiratory rate, a decrease or absence of urination due to a violation kidney function, sometimes - loss of consciousness.

    On examination, the woman noted abdominal distention, high tone uterus, in which it is impossible to determine the small parts of the fetus, the absence of its heartbeat, asymmetry of the uterus is possible.

    The listed symptoms prevail over the immediate symptoms of placental abruption: despite the severity of clinical manifestations, the discharge of blood from the genital tract may be insignificant or absent altogether. Of great help in the diagnosis is the use of, which allows you to determine the presence of a retroplacental hematoma.

Is it possible to save pregnancy with placental abruption

The tactics of conducting a pregnant woman or a woman in labor depends on:

  • duration of pregnancy;
  • degree of detachment and severity of PONRP;
  • type of bleeding (external, internal or mixed);
  • the state of the fetus;
  • the state of the birth canal;
  • laboratory indicators of the state of the blood coagulation system.

For a woman's health, placental abruption in early pregnancy is less dangerous, due to the small area of ​​​​the placental site and, accordingly, less pronounced bleeding, compared with later periods. In a satisfactory condition of the pregnant woman, especially for periods up to 34-36 weeks, in the absence of obvious external or internal ongoing bleeding, with mild degree placental abruption, it is possible to maintain pregnancy in the conditions of inpatient treatment.

In this case, the hospital doctors choose expectant tactics. It is carried out with constant dynamic monitoring of the state of the pregnant woman and the fetus using ultrasound, CTG (cardiotocography - a technique for simultaneously recording fetal heartbeats and uterine tone). A woman is assigned bed rest, antispasmodic (to reduce the tone of the uterus), sedatives and microcirculatory blood circulation improving agents, vitamins.

During pregnancy, as well as during childbirth, the presence of severe symptoms of PONRP of the second or third degree, regardless of the condition of the fetus and the timing of pregnancy, is a direct indication for emergency delivery by caesarean section. This the only way saving a woman, and sometimes a child. If, as a result of this operation, the bleeding does not stop, the iliac arteries are ligated or the uterus is extirpated.

Premature detachment of the placenta during pregnancy is a very serious diagnosis, which, depending on the degree of complexity and without proper treatment, can lead to. If this problem observed along the edges, then the blood will penetrate between the membranes of the uterus and the wall - this bleeding is called "external". Signs of "internal" bleeding have more pronounced symptoms: blood begins to saturate the uterine wall and, thus, exfoliates the muscle fibers, forming a hematoma, after which the uterus takes on a peculiar shape and consistency. This pathology can be diagnosed using ultrasound on the very early stage.

Placenta and its detachment

The placenta is a special connective tissue, similar to a large cake, which directly connects the mother and her baby. It is with the help of the placenta that the baby receives all the nutrients and oxygen it needs. If the placenta does not function normally, then the life and development of the child in the womb is impossible.

Placental abruption is called its premature separation from the uterine wall, which disrupts the normal function of this organ up to complete cessation. Placental abruption can occur in different stages pregnancy: in the first weeks or immediately before childbirth. Moreover, if placental abruption occurred before the 20th week of pregnancy, then the chance to endure and give birth to a normal healthy child much higher than if it happens at a later date. The thing is that the placenta grows in the first half of pregnancy and there is a high probability that this organ can in some way compensate for part of the lost surface, in contact with the walls of the uterus.

According to statistics, premature detachment of the placenta is registered as one case in 120 pregnancies. Unfortunately, every sixth baby dies.

There are three degrees of placental abruption:

  • First: with this pathology, the child does not suffer at all. If placental abruption is less than 1/3, then there is every chance to continue the pregnancy.
  • Second: there is a risk for the baby to die from hypoxia. Detachment occurred halfway.
  • Third: the child almost always dies. Complete detachment.

Experts call a partial detachment a "threat of miscarriage", and a complete one - a miscarriage.

Symptoms:

  1. Bleeding from the genital tract (vaginal or uterine). In 80% of pregnant women with placental abruption, spotting from the vagina is observed, but bleeding can also be internal. If internal bleeding was not diagnosed in a timely manner, then the main task of physicians is to save the life of the mother, since the fetus (mostly dead by that time) is removed along with the uterus. This situation arises due to the fact that the placenta exfoliates in the center, the blood gradually fills the free space and gradually impregnates the wall of the uterus, as a result of which it loses its contractile abilities. This process was first described by Kuveler, so the state is named after him. External bleeding is usually not as heavy as internal bleeding, and if it is not secondary, then its appearance can contribute to the thrombus of damaged vessels, thereby preventing further complications.
  2. Pain in the abdomen and This symptom observed in 70% of cases of premature detachment of the placenta. Most patients describe the pain as dull, aching and radiating to the thigh or perineum. Especially severe pain happens with internal bleeding.
  3. Violation of the cardiac activity of the fetus. As mentioned earlier, the fetus receives oxygen through the placenta, therefore, with detachment of 25% of the area, hypoxia develops in the fetus, the area of ​​detachment of 30% is already threatening, and 50% leads to its death.

These symptoms are classic and depending on the duration of pregnancy, they can manifest themselves in different ways.

So, in the early stages, this complication is accompanied by minor external bleeding and, with appropriate therapy, the pregnancy proceeds without complications in the future, and in the second trimester, increased uterine tone and the development of fetal hypoxia are added to the bleeding. Until the middle of the second trimester, they are monitored and, if necessary, treated, but if detachment occurs in the second half of pregnancy, then the question of premature delivery by caesarean section is raised. It is also worth noting that the clinical picture of placental abruption, in addition to the main symptoms, also has such manifestations as rapid breathing, anxiety, dizziness and faintness, as well as bouts of nausea and even vomiting.

Causes of premature placental abruption

Until now, experts still cannot name what are the causes of placental abruption. Previously, there was an opinion that this leads to wrong image a woman's life: for example, if she smokes, drinks or uses drugs, and if her diet is not varied and future mom does not receive any vitamins, minerals and trace elements. But there aren't any scientific evidence that this is actually the case. However, scientists have good reason to believe that vascular problems lead to this defect, for example, late preeclampsia or arterial hypertension. Often, placental abruption is a consequence of a stroke, for example, when a woman receives an abdominal injury. Sometimes placental abruption occurs with polyhydramnios and with multiple pregnancies - immediately before childbirth or during childbirth. Doctors say that in this case, the cause of detachment is a sharp decrease in intrauterine pressure. By the way, not only their pathology can lead to the transformation of blood vessels, but also various ailments, such as hypovitaminosis or nephritis.

First of all, a woman who feels nausea and dizziness, which are accompanied by abdominal pain, vomiting, rapid pulse and pale skin, should suspect a serious illness and immediately go to the hospital for help.

Treatment and prognosis

  • Treatment of this problem depends on the duration of pregnancy and the degree of pathology. With a short term, they try in every possible way to save the child, and the pregnancy is carried out very conservatively. With a full-term pregnancy, doctors can stimulate a woman, while if the detachment is small, then the pregnant woman can give birth herself. If the detachment is large, and it poses a threat to the life of the baby, then the woman must have a caesarean section. During childbirth, you need to open the bladder - this, most often, stops the exfoliation of the placenta, and also accelerates the emptying of the uterus - forceps are also used for this. In this case, the placenta must be removed manually, and the uterine cavity is carefully examined.
  • Often, immediately after childbirth, a woman may begin bleeding due to the fact that there is insufficient uterine tone and there is a violation of blood clotting. If a large hemorrhage occurs in the uterus, then after a caesarean section, doctors do an amputation. That is, if the bleeding fails to stop, the uterus continues to shrink, and blood transfusion and hemostatic therapy do not work, then doctors may even decide to remove the uterus.
  • As for re-pregnancy, after placental abruption, experts advise getting pregnant no earlier than a year later. Just during this time, the uterus is able to fully recover after the operation, and the woman's body will again be ready for the birth of a new life inside. But, do not forget that doctors say that repeated pregnancy can proceed with the same complication, therefore, before it and during it, it is worth listening to the advice of doctors and fulfilling all their prescriptions.

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

Bearing a child is a natural process laid down by nature, however, it is associated with many risks. The health of the woman and the fetus is influenced by both internal and external factors. negative factors lead to complicated pregnancy. One of the negative processes is the detachment of the placenta.

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

We will figure out why placental abruption occurs, how to recognize the first signs, whether it is possible to maintain a pregnancy.

  • The placenta and its role for the fetus
  • Causes and consequences of placental abruption during pregnancy at different times
    • Detachment in the early stages: what is dangerous in the first and second trimester
    • Risks in the later stages and in the third trimester
  • What are the types of placental abruption?
    • What is the danger of partial detachment in a normal location
    • What does marginal detachment look like with fetal presentation
    • How does detachment appear in the area of ​​​​the uterine pharynx
  • How does placental abruption manifest?
  • Symptoms and sensations of a woman in the initial stages
    • What is the characteristic pain observed in pathology
    • How to determine at a later date
    • The nature of the discharge
    • Is there bleeding
    • If detachment occurred during childbirth
  • Diagnostics
    • Is the pathology visible on ultrasound
    • What tests are given
    • How doctors determine
    • Emergency cases for urgent medical care
  • The survival rate of the fetus different options and degrees of placental abruption: weekly table
  • Treatment
    • How does it go
    • What do they do
    • How they give birth
  • How to prevent a dangerous pathology
  • Doctors' recommendations

Afterbirth and its meaning

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

What are the functions of the placenta?

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

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

What is placental abruption and what is the prognosis for different gestation periods

Medicine is not yet able to accurately identify the causes of the emerging pathology and reliably determine how long a particular woman can have a detachment. But there are three directions, which causes a failure in the reproductive system:

  1. Vascular changes, fragility and fragility of capillaries that develop with preeclampsia and persistent hypertension.
  2. blood, increased clotting.
  3. Blunt abdominal trauma.

If, for no apparent reason, placental abruption occurs in early pregnancy, the causes often remain unexplained.

Prognosis in early gestation

Consequences untimely departure placenta depend on the area of ​​the lesion and the duration of pregnancy. If no more than a third of the organ has undergone exfoliation, this will not have a significant impact on the development of the fetus, especially in the early stages. The placenta completes its formation on, in the first trimester it is able to compensate for damage through 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 departure of ½ of the 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 a 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. Most frequent complication- the development of the Cuveler's uterus, a condition when the accumulated blood begins to saturate the muscle wall. Because of this, the organ loses its contractility, massive bleeding develops, ending, as a rule, with the removal of the uterus. Another danger - DIC, disrupts the function of blood clotting and leads to bleeding not only from the uterus, but also from other organs.

Other reasons can cause early detachment, and the consequences in this case appear during childbirth. For example, multiple pregnancy, repeated operative delivery, polyhydramnios - become provoking factors.

Forms of placental detachment

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 normal placenta available in three versions:

  1. Partial non-increasing is characterized by a small area of ​​​​damage, 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. Useful placental area is reduced, which leads to oxygen starvation of the fetus. Need urgent medical assistance if detachment occurred 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 in the short term and before childbirth.

If previa is diagnosed

Previa refers to 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 exfoliation 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.
  • Marginal detachment of a low-lying placenta is characterized by massive bleeding. The discharge of the placenta occurs along the periphery, from the edges to the center, so the discharge of a dark red color pours out.

When the placenta is located in the uterine os

With a low-lying placenta that covers the uterine os, complete detachment occurs, as a rule, during childbirth. The leading factor here is the contraction of the muscle wall. With a small lag area, spotting is possible brown discharge varying intensity.

Clinical manifestations at different stages

Considering how pathology manifests itself, it should be noted that the intensity of manifestations at different gestation periods is different, but the general symptoms are similar. How to understand that premature placental rejection 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 hurts in the lower part;
  • when detaching a significant array, are noted.

Each stage of gestation has its own characteristics And possible consequences for a child.

What does a woman feel 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 not 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 ​​\u200b\u200b"adhesion" with the wall of the uterus, with appropriate treatment, nutrition and gas exchange are 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 brown discharge.

On ultrasound, a small seal or depression is determined.

The nature of pain in pathology

Sometimes women worry about whether placental abruption can cause black stools to appear when emptying. Color stool does not depend on reproductive system, therefore, cannot be considered a sign of delamination.

Detachment at delivery

Probability premature discharge during the period of contractions is great at wrong location placenta

How does placental abruption occur during childbirth:

  • cramping severe pain;
  • intense blood loss;

How dangerous is this situation? The baby can suffocate or die from asphyxia, for a woman the threat is massive bleeding. Therefore, emergency care consists in emergency operative delivery.

What is the diagnosis based on?

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

Hardware surveillance

There are several classifications according to which the degree of placental abruption is distinguished, possible risk harming the baby and miscarriage. This pathology mainly occurs in women giving birth for the first time.

By time

A complication may occur during:

  • pregnancy;
  • childbirth directly.

By area of ​​detachment

Allocate:

  • partial detachment;
  • full PONRP.
There is also a lateral (marginal) compartment (accompanied by external blood loss) and a central one (with the occurrence of hematomas).

By progression

There are 2 types of such complications: progressive (the area of ​​detachment will increase over time) or non-progressive (refers to partial detachment) - the size of the delamination remains unchanged.

Did you know? During pregnancy, the uterus increases in size up to 500 times, and 2 months after childbirth, it returns to its normal state.

Causes of detachment

IN modern medicine there are quite a few reasons that can lead to such a complication. There is a certain risk group for expectant mothers who are potentially exposed to PONRP:

  • having deviations in the cardiovascular system;
  • with various congenital blood disorders;
  • having severe illness kidneys, diabetes mellitus, tuberculosis, syphilis;
  • suffering from infectious diseases;
  • experiencing neuropsychic overstrain;
  • terminated a previous pregnancy;
  • in some cases, the presence of a short umbilical cord or its injury.

The main cause of placental abruption can be considered a violation of blood formation due to rupture of blood vessels. Tissue thromboplastin, which is a blood clotting factor, comes out of the damaged tissue. As a result, a hematoma occurs and thrombosis of the uterine vessels occurs, which leads to separation of the placenta. Salt deposits may form at the site of its former attachment to the uterus.

Signs and symptoms of pathology

Placental abruption has characteristics and symptoms, so it is impossible not to recognize. This complication of any kind is accompanied by profuse blood loss, pain and tension in the uterus, as a result, there is a violation of cardiac activity in the fetus. It is noteworthy that bleeding can be of 3 types: internal, external and mixed (both inside and outside the uterus). There is a discharge of bright scarlet or dark blood, which depends on how long ago the separation occurred. It is rather difficult to determine the volume of blood lost during internal blood loss, so doctors often operate on data from external blood loss and the general condition of the patient.

Important! Pain during detachment is always present, whether it is characteristic cramps in the uterus or its compression. The gradation of the level of pain can be wide - from dull pulsating to sharp cutting. For any manifestation pain contact immediately medical care!

Light form

There is a direct correlation between the degree of placental abruption and the harm done to the baby. If only one fourth of the total area of ​​this organ has exfoliated, the child experiences hypoxia ( oxygen starvation). A mild degree may sometimes not be expressed by pronounced pain or blood loss. Often, such a pathology can be detected on or at the postpartum examination of the placenta.

Middle form

The average degree of detachment is characterized by separation by one third - the child has severe hypoxia. This degree is characterized by pain manifestations and blood loss (blood clots are released from the vagina). On examination, the doctor by touch determines the characteristic tension in the uterus and the violation of the heart rhythm of the child.

Severe form

It is characterized by strong pain sensations, uterine contractions, pushing and strong intrauterine pulsation. There is a general weakness of a strong degree up to fainting, blanching skin. Profuse bleeding from the uterus and its asymmetrical bulge are also symptoms of this degree. If there is an exfoliation of half of the placenta, then fetal death occurs. This pathology is a very dangerous disease that directly affects the life and health of your child. Therefore, it is very important to monitor the course of pregnancy and be sure to undergo scheduled examinations.

Features of the course at different stages of pregnancy

Basically, this pathology is observed precisely at an early stage, so timely detection, correct diagnosis and optimal treatment can prevent complications and save the life of the fetus.

In the early stages

Often, placental abruption in early pregnancy is detected on ultrasound due to the formation of a hematoma, which can be clearly seen during the study. Pregnancy can be saved and its normal course ensured if hemostatic therapy is prescribed at this stage. This will ensure further growth and an increase in the placenta, which, with its growing area, will cover the previous lost area, thus preventing the occurrence of pathologies and complications in the fetus.


In the second trimester

As already described above, with detachment in the period up to 26 weeks, there are pain and contraction of the uterus. When hypoxia occurs, the baby activates its movements, trying to speed up the supply of oxygen. All this is accompanied by characteristic shocks. In this period of time, everything depends on the specific gestational age - the placenta still continues to grow, and theoretically it can still compensate for the lost area of ​​​​contact with the uterus. For more late stage pregnancy, doctors may decide on an urgent one, since the placenta will no longer be able to have enough space for normal development fetus. To save the baby and save him from hypoxia, it is accepted emergency measure- surgical intervention.

In the third trimester

Placental abruption in late pregnancy is the most dangerous period. When a pathology is detected, premature birth. In very rare cases, if the detachment is not severe, it is possible to try to keep the pregnancy with careful round-the-clock supervision of a doctor. In addition, pathology can also occur during childbirth, especially in the presence of a multilayer pregnancy or. Depending on the nature of the course of childbirth (at what point it happened), either contractions are stimulated or a caesarean section is performed. Detachment at this stage is also accompanied by bleeding, the uterus does not relax in between contractions. Sometimes there is an abnormal fetal heart rate, in amniotic fluid In addition to blood, particles of feces may be present. The presence of such symptoms is the main and most significant reason for inducing premature birth.

How is the diagnosis

Fortunately, the signs of separation of the placenta are quite unambiguous in terms of symptoms, and the pathology is easy to distinguish. Diagnosis will primarily be aimed at reviewing the vagina to detect bloody. A special place in the diagnosis is taken by the patient's well-being, her complaints, the presence of pain in the abdomen and the level of uterine contraction. The physician must ultrasonography and listen to the baby's heartbeat. Even the smallest detachment can be detected by ultrasound, so treatment can begin at an early stage. Also an expert in without fail will hold the vagina and uterus.

Detachment treatment

The pathology that arose in the last trimester is more than a dangerous phenomenon. This threatens with surgery. Treatment as such will not be needed - you will have to give birth urgently. The only exceptions are isolated cases in which doctors put the patient in a hospital for the preservation of pregnancy - provided that the period is less than 36 weeks, the area of ​​detachment is small and there is no hypoxia in the mother and child. In other cases, therapy will be carried out. The doctor will prescribe drugs that relax the tone of the uterus, various antispasmodics and hemostatic agents. Please note - there is no alternative treatment for placental abruption! Only high-quality traditional medical service, only in this case it will be possible to get rid of the complication.

If the doctor has decided to keep the pregnancy, and the patient is on a hospital examination, this does not exclude a possible recurrence of hemorrhage and detachment. In this case, a decision is usually made in favor of an urgent caesarean section, without causing vaginal delivery.

In some cases, a blood transfusion is performed to improve its coagulability in the body of a pregnant woman. Remember: the treatment of placental abruption is carried out only under the supervision of a specialist!

Is a complication possible in the next pregnancy?

The risk of recurrent pathology during subsequent conception remains high - up to 15%. In modern medicine, methods have not yet been developed to reduce or completely eliminate the risk of detachment during a subsequent pregnancy. However, some measures can be taken to maximally prepare and protect the body of the mother and baby from complications:

  • Constant control of blood pressure - it should not be high. In the presence of high blood pressure, the doctor will prescribe the appropriate drugs.
  • Timely visit to all scheduled inspections at the doctor's.
  • In case of a conflict of Rh factors, internal administration of immunoglobin will be required.
  • Do not drink alcohol, tobacco and narcotic drugs, introduce more fresh vegetables and fruits into your diet.
  • Protect yourself from injury as much as possible - the smallest blow can serve as the cause of detachment.
When the first signs of pathology appear, immediately seek medical help. With late detection of pathology, hospitalization may be required.


Prevention

Preventive actions for the most part intersect with measures that need to be taken in case of a threat of a relapse of the disease. This is a timely examination by a doctor, careful monitoring general condition body and pressure, preventing reactions and avoiding injury of any kind. Buckle up in your car, avoid crowds where you might be harassed, ensure a constant supply of fresh air use only high quality healthy food rich in vitamins.