What are the signs of placental abruption? Forecast and prevention of premature placental abruption. Abdominal pain and uterine tension

A serious complication that a pregnant woman may encounter is placental abruption during pregnancy.

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

An organ that arises during pregnancy in the uterus and connects mother and fetus is connected by the placenta (baby place). Its significance is very great. The organ is responsible for the biological processes due to which the baby develops normally in the tummy. The life of a child depends on the placenta. Deviations and pathologies associated with it can lead to his death.

You can select following functions placenta:

gas exchange. The baby in the womb needs oxygen: it enters the fetal blood from the maternal blood through the placenta. Through it, carbon dioxide is also transferred from the child to the mother. A small placental abruption can disrupt gas exchange;
nutritional and excretory. For the normal development of a baby, vitamins are required, useful material, water. He receives all this through the placenta. Through it, waste products are removed;
hormonal. The placenta can be compared to an endocrine gland. It produces very important hormones ( human chorionic gonadotropin, placental lactogen, prolactin, progesterone, etc.), without which the normal course of pregnancy is impossible;
protective. The placenta provides the fetus with immunological protection. 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?

Placental abruption is its separation (partial or complete) from the lining of the uterus. In this case, blood accumulates between the baby's place and the wall of the uterus, which pushes the placenta away from the uterus. The placenta should not be expelled during pregnancy. Its separation from the uterus should occur in the third birth period. However, there are cases when the placenta leaves prematurely.

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

Causes of premature abruption of a normally located placenta

Women experience premature expulsion of the placenta in 0.4-1.4% of cases. It can occur both during pregnancy and during childbirth in the first or second stage. Why does placental abruption occur? The reasons for this process are various.

Separating a child seat may be caused by violations in vascular system . The capillaries of the uterus and placenta may become more fragile and brittle. Because of this, blood flow may be impaired. Similar changes in the female body can occur when. They are also observed in the presence of certain diseases: cardiovascular pathology, hypertension, kidney disease, obesity, diabetes mellitus and etc.

The threat of placental abruption can come from inflammatory, degenerative and other pathological processes , occurring in the child's place and uterus. Disturbances can be observed with uterine fibroids, malformations, and post-maturity.

Predisposes to premature expulsion of the placenta bad habits : excessive consumption of drinks containing alcohol, addiction to cigarettes, drugs. The situation may worsen with anemia (anemia, decreased number of red blood cells, low hemoglobin).

Most often, the symptoms of placental abruption are early stages pregnancy or later are observed in women for whom the upcoming not the first birth. The reason for this lies in changes in the uterine mucosa.

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 later or early ones. Typically, pregnant women experience an allergic reaction when transfusion of donor blood and its components, or administration of protein solutions.

Complications can result from abdominal trauma caused by a fall, blow, or accident. Placental abruption may also be caused by sudden changes blood pressure arising from stress and other neuropsychic influences.

Symptoms of placental abruption

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

bleeding;
uterine tension and pain during placental abruption;
cardiac dysfunction in a baby.

Bleeding can be external (visible), internal (hidden) or mixed. External bleeding is easy to notice, as it appears from the vagina during placental abruption brown discharge. It is observed when the edges of the placenta are detached. 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 accumulate between the uterus and placenta.

When a child's place is detached, it is felt uterine tension. When palpated it is felt pain. It can be dull and parsimonious. Sometimes the pain radiates to the hip and pubic area, as well as to 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 the size of the placental abruption. Signs of intrauterine suffering begin to appear when 1/4 of the placenta is separated. If 1/3 of it leaves, the child begins to experience severe oxygen deficiency. His death occurs when 1/3-1/2 of the placenta is detached.

Placental abruption at different stages of pregnancy

The separation of the baby's place from the uterus manifests itself differently depending on the stage of pregnancy. Quite often, doctors encounter premature placental abruption in the first trimester. With timely diagnosis and proper treatment terrible consequences can be avoided. Pregnancy may continue, but there will be no discharge. In the future, the lost area of contact between the placenta and the uterine wall can be compensated by the growth of the placenta (its increased area).

Placental abruption in the second trimester characterized by such characteristics as high muscle tone and tension. Actions medical workers are directly dependent on the duration of pregnancy. For example, the placenta may continue to grow until the middle of the second trimester and compensate for previously lost space.

The most dangerous thing is separating a child's seat in 3rd trimester, because all her compensatory capabilities are completely exhausted, and she can no longer grow. Signs of placental abruption in the later stages are typical: abdominal pain, tension and soreness of the uterus, bleeding, fetal suffering.

The only way out is delivery. However, it is worth noting that if the area of the detachment is not large, there is no bleeding and the process does not progress, then it is possible to carry the child to the term prescribed by nature, while being in a hospital under close medical supervision.

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

Diagnosis of premature placental abruption

If you have pronounced symptoms, it is not at all difficult to find out that the placenta is detached. If the symptoms are not fully manifested, for example, there is no pain factor, external bleeding is not observed, then the diagnosis is made, excluding the presence of other diseases that can cause similar symptoms. Ultrasound assists in diagnosing placental abruption. Thanks to it, it is possible to determine the area of the placenta that has moved away from the uterine wall and the size of the retroplacental hematoma.

During the examination, one of three possible diagnoses of the separation of a child’s place can be made:

non-progressive partial;
progressive partial;
total.

The placenta may partially detach from the wall of the uterus in a small area. In such situations, damaged blood vessels quite often become clogged. The bleeding stops and further detachment does not occur. Pregnancy can proceed completely without any complications, and the child will be born healthy.

Progressive partial detachment placenta poses a danger to the fetus. The size of the hematoma increases. If most of the placenta leaves the uterine wall, the fetus will die. In such a situation, the fair sex who is carrying the baby suffers greatly, because she loses a large amount of blood. Blood loss can lead to hemorrhagic shock. This situation can be dealt with through emergency delivery.

It may also be observed total(complete) detachment of the child's place. This happens in very rare cases. The fetus dies almost immediately, as gas exchange between it and the mother stops.

Treatment of placental abruption

The question of how to treat placental abruption causes a lot of anxiety. When diagnosing premature separation of a child's place, the doctor faces not an easy task– 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 method for placental abruption in the early stages of pregnancy and later depends on several parameters:

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

Doctors may refuse the option of early delivery if:

the placenta separated in a small area, and this state does not progress;
pregnancy period is no more than 36 weeks;
discharge has stopped due to placental abruption and the amount of blood loss is small;
there are no signs of oxygen starvation in the fetus;
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, and monitor blood clotting (it is determined on the basis of special laboratory tests).

For placental abruption, the following drugs can be used:

medicines that have a relaxing effect on the uterus;
antispasmodics;
hemostatic agents;
medications to combat anemia.

If there are any accompanying illnesses and complications, then appropriate therapy must be carried out.

From wait-and-see tactics you will have to refuse if, during your stay in the hospital, bleeding begins to appear after placental abruption. They may indicate that the detachment is progressing. IN similar cases most often decide to carry out. Childbirth can also be carried out through natural ways. This 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 over the child’s cardiac activity. If a woman gives birth naturally, then after the baby is born, 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 soaked in blood, then the uterus is removed, since in the future it can become a source of bleeding.

Pregnancy after placental abruption

Women who have suffered placental abruption previous pregnancy, the question of interest is whether it will happen again similar situation at the next pregnancy. It is worth noting that the likelihood of a child’s seat being removed is high. In 20-25% of the fair sex, the situation repeats itself again.

Unfortunately, modern medicine is not yet able to completely eliminate 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;
It is mandatory to attend scheduled examinations;
periodically undergo ultrasound examination, thanks to which even a small hematoma of placental abruption can be detected;
observe healthy image life (abstain from alcoholic beverages, tobacco products, drugs, junk food);
protect yourself from injury, wear seat belts in the car;
during exacerbation chronic diseases, occurrence inflammatory processes you need not turn a blind eye to them, but start treatment;
prevent the occurrence of allergic reactions.

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

When the first signs of placental abruption occur ( vaginal bleeding or discharge of the same color, uterine pain, pain in the back or lower abdomen, lack of movement of the baby in the womb) you should immediately seek help from a doctor. If the health of the mother and baby is not threatened, then the pregnancy will continue, but under the supervision of specialists.

If placental abruption progresses, then immediate surgical resolution is required by cesarean section or naturally, since the consequences of placental abruption in the early stages of pregnancy or later can be very sad if proper attention is not paid to this.

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Placenta plays important role in fetal development. Through it the baby eats and breathes, so deviations from the norm are dangerous at any stage. If expectant mother Suddenly, placental abruption is discovered in the early stages of pregnancy, then prompt observation and intervention by specialists is required. The cost of delay may be the baby's life.

Read in this article

Placenta: concept, functions, possible problems

After the baby is conceived, the fertilized egg begins to form. It attaches to the wall of the uterus and grows continuously. At this stage, the chorion appears. These are villi that tear the surface of the fruit. Through the outgrowths of the chorion pass small vessels, with the help of which it penetrates into the inner lining of the uterus and secures it in it. The chorionic villi are immersed in blood on the outside. This system allows the fetus to receive oxygen, nutrients, and in return give away carbon dioxide and waste products.

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

Life cycle of a child's place

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

lasts up to 27-30 weeks;
active growth from 27-34 weeks;
the period of maturity, which covers 34-39 weeks;
aging from 37 weeks until birth.

Disruption of the stages of aging

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

second half of the term;
toxic substances and medical supplies;
uterine injuries;
multiple pregnancy;
, drugs;
chronic diseases;
poor nutrition or diet;
and consequences of previous difficult births;
infections in the uterine cavity.

Early maturation of the placenta during pregnancy leads to oxygen starvation of the fetus and lack of nutrients. He may lose weight, develop abnormally, and be born unhealthy. To avoid severe consequences You need to see a doctor regularly and undergo a course of treatment.

What is a detachment?

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

Degrees of detachment of the child's seat:

The discharge area is less than 1/3, which does not harm the child, and can be compensated for by its growth. Pregnancy is maintained and continued.
Detachment by half can lead to the death of the fetus from oxygen starvation.
Full. Almost always results in the death of the baby.

The last one ends, and the first two are attributed to the threat of spontaneous abortion.

Why is the chorion rejected?

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

woman's age;
the presence of harmful addictions;
a large number of births;
poor nutrition;
infection or inflammation in the uterus;
chronic diseases;
abdominal injuries;
pathologies of the uterus or placenta;
gestosis;
long period of infertility before conception.

Symptoms of premature rejection

The main signs of placental abruption in early pregnancy:

– can be external or internal. If separation occurs at the edges, then discharge appears from the vagina. Internal bleeding is more difficult to detect. It occurs when there is a central detachment of the child's place, when the edges remain attached, and fluid accumulates in the resulting space. Need urgent surgery(sometimes with complete removal of the uterus). It will be about saving the mother. The fetus usually does not survive.
Mild aching pain, provoked by increased... May radiate to the groin or thigh area and be a clear sign internal bleeding.
Violation of fetal cardiac activity. The condition will be influenced by maternal blood loss and the size of the detachment. Insufficiency will appear when 1/4 of the area of the child's seat has been removed. Strong oxygen starvation occurs at 1/3 part, after which death may occur. If half of the placenta has separated, it will be impossible to maintain the pregnancy.
Nausea, vomiting, dizziness, anxiety.

Identification and prompt elimination of problems with placental abruption

A small placental abruption in early pregnancy is not always accompanied by visible symptoms. It can only be detected using timely diagnosis. It is important to attend regularly scheduled consultations with your doctor.

Diagnosing the condition of the placenta

Rejection of the placenta in the early stages of pregnancy can be diagnosed by carrying out. This procedure allows you to identify retroplacental hematoma, accompanied by destroyed or oppressed tissue. On early stages the neoplasm may not yet exist. Diagnosis is made by excluding diseases with similar symptoms. If the placenta is rejected, an ultrasound may detect blood clots behind it. The vagina can be thoroughly examined to rule out damage, infections, tumors, and other abnormalities.

Forecasts for the departure of a child's place

This pathology is a common occurrence. Prompt and qualified treatment can prevent its consequences. Timely detection of the problem and taking measures can stop the process and give a positive prognosis for the course of pregnancy in the future.

Minor placental abruption requires hospital observation and treatment. The assistance provided will allow the child to develop normally. It is unacceptable to ignore any alarming symptoms during pregnancy. The removal of a child's place is a serious pathology. It can lead to irreparable consequences.

The issue of treating detachment of a child’s place is not an easy task. Often you have to choose an operative solution. Additionally, blood clotting is monitored. It is important to combat the woman’s state of shock and replenish blood loss.

How is placental abruption treated?

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

general condition women and children;
trimester of pregnancy or childbirth;
volume of blood loss.

Surgical delivery can be replaced with treatment if:

pregnancy is less than 36 weeks;
small area of detachment and no progression of the process;
cessation of discharge or small volumes;
no signs of oxygen deficiency for the child;
good health of the pregnant woman and hospital stay.

Doctors prescribe mandatory bed rest for the expectant mother, regular ultrasound examinations, as well as dopleometry and cardiotocography. Her condition must be strictly monitored. Conducted laboratory research blood for clotting.

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

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

The surgical intervention takes place under the continuous monitoring of doctors over the state of the child’s cardiac system. Natural childbirth will require a mandatory examination of the uterine cavity manually after they are completed. During a caesarean section, her condition is also assessed. If the muscle layer is saturated with blood, the uterus must be completely removed to avoid further bleeding.

Preventive measures for placental abruption

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

Typically prevention involves:

regularly visiting the doctor and undergoing the required examinations;
timely completion of all tests;
avoiding stressful situations;
good and ;
proper rest;
healthy lifestyle;
preventing possible injuries;
enough walks in the air;
control

Taking any medications should be strictly as prescribed by a doctor and only when absolutely necessary. Treatment of chronic diseases can be regarded as preventing the occurrence of complications and peeling of the child's place.

Subsequent pregnancies: will there be a recurrence?

For women who have suffered placental abruption in early pregnancy, there is a high probability of the situation repeating in the future. About 25% of cases end similarly. Medicine cannot yet completely exclude the possibility of peeling off a child’s place when next pregnancies. However, you can try to prevent the recurrence of violations on your own. To do this, you should adhere to the above preventive measures to minimize all risk factors.

Loss of a child's place is a serious and dangerous pathology for a pregnant woman and her child. Many women face it. It is important to seek help immediately if any alarming symptoms appear. If there is no threat to life and health, then the pregnancy will continue, but under closer supervision, most likely in a hospital. Progression of pathology in later stages will require operative delivery. Depending on the condition of the mother and baby, stimulation can be selected natural birth or caesarean section. If you do not pay due attention to the peeling of the child's place, the consequences will be severe and irreversible. In the early stages, everything will end in miscarriage.

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

Update: October 2018

Pregnancy proceeding without complications and ending successfully with the birth of a live and healthy baby, a great rarity, especially nowadays. One of the most serious complications of gestation is rightfully considered premature placental abruption, which does not always end successfully, without consequences for the mother and fetus.

This complication, fortunately, is quite rare and occurs in 0.3 - 1.5% of cases. The highest frequency of this obstetric pathology occurs in the 1st trimester, but the prognosis in such cases is more favorable.

Placenta as an organ and its functions

The placenta is a provisional or temporary organ that forms during pregnancy. Another name for the placenta is the baby’s place, and after the end of the pushing period the separation of the placenta (placenta) begins, therefore the third stage of labor is called the placenta (see).

The placenta (translated from Latin as flat cake) is necessary for the connection between the body of the mother and the fetus. The formation of this organ begins 10–13 days after fertilization of the egg. The final completion of the development of the child's place occurs by 16–18 weeks, when the transition from histotrophic nutrition of the embryo to hematotrophic nutrition occurs. As a result of this transition, a hematoplacental barrier is formed, due to which the placenta performs its functions. The “responsibilities” of a child’s place include:

Gas exchange

From the mother's blood, oxygen enters the blood of the fetus, and carbon dioxide, formed during the breathing process of the unborn child, enters back into the woman's blood. Thus, the placenta carries out fetal breathing (respiratory function).

Nutritious

The intervillous space, located between the wall of the uterus and the villi of the placenta, receives maternal blood containing nutrients, vitamins and minerals, from where the listed components enter the placental vessels and are delivered to the fetus.

excretory

During the life of the unborn child, metabolic metabolites (urea, creatinine, creatine) are formed, which are removed by the placenta.

Hormonal

The child's place also plays the role of the endocrine gland. The placenta synthesizes a number of hormones that are necessary for normal course gestational period. These include human chorionic gonadotropin, which supports the functions of the placenta and promotes the synthesis of progesterone yellow body. Placental lactogen is involved in the development of the mammary glands during gestation; in addition, this hormone prepares the mammary glands for milk production. , which is responsible for the synthesis of milk, and serotonin, relaxin and other hormones that stimulate the growth of the uterine lining and prevent new ovulations.

Protective

The baby's place allows maternal antibodies to pass to the fetus, thereby providing immunity to the still unformed child. In most cases, the placenta prevents the development of an immune conflict between the maternal and fetal organisms. Also, the child’s place is involved in the formation and regulation of immunity in the woman and the fetus. However, it should be remembered that the placenta is not able to protect the child from the penetration of a number of drugs, drugs, ethyl alcohol, nicotine and viruses.

The normal localization of the placenta is the area of the fundus of the uterus with a transition to the posterior (usually) or anterior wall.

What is placental abruption?

Abruption of a normally located placenta is a dangerous pregnancy complication when this organ is separated from the uterine walls before the birth of the fetus, which can occur both during pregnancy and during childbirth.

The baby's place is under constant pressure from the muscular layer of the uterus “outside” and the fertilized egg and amniotic fluid “from the inside,” that is, on the other side. But both opposing forces are balanced, in addition, due to the spongy structure of the placental tissue, the placenta has significant elasticity, which allows it to stretch during the growth of the uterus without the risk of detachment. Also, the part of the uterine wall where the placenta is attached is able to contract less, which also reduces the risk of developing the described complication.

Why is this happening?

Medicine has not been able to explain exactly why placental abruption occurs. It is impossible to name one specific cause for this complication, since such a disorder is a manifestation of a systemic pathology in a woman, and in some cases it occurs hidden. Typically, there is a combination of several factors:

vascular pathology (vasculopathy)
bleeding disorder
mechanical factor.

The following factors predispose to the development of complications:

During childbirth, the development of the described pathology is caused by: anomalies of labor forces (discoordination, cervical dystocia), a rapid drop in intrauterine pressure (during amniotomy and rupture of water), the birth of the first child in a multiple pregnancy, which “pulls” the placenta towards itself, fast and rapid childbirth. Short umbilical cord or delayed opening amniotic sac also lead to this complication. There is a high risk of premature rejection of a child's place during labor stimulation with oxytocin.

The risk of developing complications will also increase if obstetric manipulations are used during childbirth (external rotation on the leg, extraction of the fetus by the pelvic end).

Classification

Depending on the period when the child’s place was rejected:

early placental abruption;
detachment during childbirth (pushing period and period of contractions);
placental abruption in late stages (see);

Depending on the area of detachment:

complete (the entire placenta exfoliates, the child dies instantly);
partial (only part of the baby’s place is separated from the wall of the uterus);

Depending on the location of the separated placenta:

marginal detachment or peripheral - detachment of the placental tissue occurs along the periphery, from the edge (in this case, external bleeding occurs);
central detachment (the placenta lags behind the uterine wall in its center, while there may be no external bleeding);

According to the course of the pathological process:

progressive detachment (growing retrochorial hematoma aggravates the process of placental abruption and aggravates the condition of the mother and fetus);
non-progressive (uterine vessels thrombose, internal bleeding stops, subsequently calcifications are deposited in the hematoma and, in general, pregnancy proceeds normally).

Clinical picture

Placental abruption has a very characteristic symptoms, on the basis of which a diagnosis can be made even without additional examination.

In the first trimester

As noted, this pathology can occur at any stage of gestation, but in the first trimester it has a favorable prognosis. Placental abruption in the early stages is a consequence of the threat of abortion and manifests itself:

aching pain or stretching in the lower abdomen and lower back
slight to moderate bleeding
decrease in basal temperature.

With timely and adequate treatment, in many cases it is possible to stop the onset of detachment of the ovum and prolong pregnancy. The consequences for pregnancy as it progresses are practically reduced to zero, since the growing placenta eventually compensates for the area of lost contact with the uterine wall.

This complication in a short time is determined by ultrasound in the form of a retrochorial hematoma, which does not increase and is in a stable condition. Although it is not always possible to visualize a retrochorial hematoma using ultrasound, the diagnosis is made post factum when a dark red blood clot is detected on the placenta in the placenta small color and/or a depression (pit) of a gray-burgundy color.

Signs of placental abruption in the second and third trimesters

Uterine bleeding

Bleeding is caused by ruptures of the vessels connecting the wall of the uterus and the placenta; as a result, the released blood begins to accumulate in the uteroplacental space, which contributes to the continuation of exfoliation, the formation of a hematoma, which puts pressure on the baby's place and disrupts its functioning.

The intensity of discharge during detachment can vary from insignificant to very heavy. Their severity depends on:

places where detachment occurred
the size of the detachment area and the state of the blood coagulation system.

In addition, bleeding can be of three types:

external or visible
internal
mixed.

External bleeding- in four out of five cases of the development of this complication, external bleeding occurs (which does not exclude the presence of internal bleeding). External hemorrhage is characteristic of marginal detachment of the child's place, when blood comes out of the uteroplacental space and pours into the vagina.

Internal - if the retroplacental hematoma is located in the fundus of the uterus, then the color of the discharge will be dark; the lower the placenta is located and the fresher its detachment, the brighter the bloody discharge. In the case of accumulation of blood in the uteroplacental space and the inability to shed it, they speak of internal bleeding, which is typical for central detachment of the child’s place.

At the same time, along the edge the placenta is still connected to the walls of the uterus, and in the zither there is a hematoma, which grows over time (counting by hours, and sometimes by minutes), as the accumulating blood increasingly separates the placenta from the uterus.

In this case, not only the baby’s place itself is saturated with blood, which, accordingly, disrupts its functioning, but also the wall of the uterus, which leads to a disruption of its contractile activity. Imbibition (soaking) of the uterus with blood is called Cuveler's uterus. As the detachment continues, and, accordingly, bleeding, the condition of the pregnant woman worsens, hemorrhagic shock and blood coagulation disorders (DIC) develop.

Pain syndrome

Another characteristic sign of detachment of a child's place is pain. The pain is constant, dull and/or bursting. Depending on the location of the placenta, the localization of pain also varies. If the baby's place is attached mostly along the posterior uterine wall, then the pain is localized in the lumbar region. When the placenta is attached to the anterior wall, the pain is expressed in the front; in some cases, a tense and painful swelling can be felt. The pain is also accompanied by uterine hypertonicity, since the retroplacental hematoma irritates the uterus, in response it begins to contract, but is able to relax.

The pain is caused by the pressure of the retroplacental hematoma on the uterine walls, their stretching, soaking in blood and irritation of the peritoneum.

Intrauterine fetal hypoxia

Violation of the child’s cardiac activity is another obligatory symptom of this complication. Due to dysfunction of the placenta due to ruptures of blood vessels and its saturation with blood, the fetus does not receive enough oxygen, which manifests itself intrauterine hypoxia(brady- and tachycardia). Moreover, the more massive the area of detachment, the worse the prognosis for the child.

According to the flow, detachment of the child's place has 3 degrees of severity

Mild degree

It is diagnosed either after childbirth or by ultrasound signs, while the condition of the woman and the fetus does not suffer, and there is no characteristic clinical picture.

Moderate degree

Peeling of the child's seat occurs on a quarter to a third of the total area. There is slight or moderate bleeding from the genital tract, uterine hypertonicity, abdominal pain, fetal suffering (bradycardia), and signs of hemorrhagic shock increase.

Severe degree

Abdominal pain is very strong, bursting, appeared suddenly, the woman notes dizziness, severe weakness, even loss of consciousness. Bloody issues insignificant or moderate, the uterus is dense, severely painful, and has an asymmetrical shape. The volume of the area of detachment of the child's place is half or more. The fetus suffers and, in the absence of immediate help, dies in utero. Signs of disseminated intravascular coagulation syndrome rapidly increase, the woman’s condition deteriorates sharply and threatens death.

Treatment

What to do if such a complication develops depends on the situation in which the following indicators are assessed:

intensity of bleeding and volume of blood loss;
condition of mother and fetus;
gestational age;
when detachment occurred (during childbirth or pregnancy);
hemostasis indicators.

In the early stages

If the placenta abruptly occurs in the early stages, the woman must be hospitalized with the prescription of preservative therapy and hemostatic drugs:

Antispasmodics (magne-B6) are used to relax the uterus.
progesterone-containing products (utrozhestan, duphaston)
physical (bed rest) and emotional peace
hemostatic agents used include dicynon, vikasol, vitamin C
At the same time, antianemic therapy with iron preparations (sorbifer-durules, tardiferon, fenyuls) is also carried out.

In the later stages

At a later date (less than 36 weeks), it is possible to conservative treatment, if the situation meets the following conditions:

the general condition of both the woman and the child is satisfactory (no signs of intrauterine hypoxia);
detachment of the child's place is partial and has no tendency to progress;
minor bleeding;
the total volume of blood loss is small (there are no signs of disruption of the hemostatic system and hemorrhagic shock).

In this case, the woman is under continuous observation in the hospital, the condition of the fetus is monitored:

through regular ultrasound, cardiotocography and Doppler measurements
the woman is prescribed bed rest
tocolytics (partusisten, ginipral intravenously)
antispasmodics (magnesia, no-spa and others)
disaggregants to improve blood rheology and uteroplacental circulation (Trental, Kurantil)
iron supplements
sedatives
If indicated, fresh frozen plasma is transfused.

Severe and moderate degree

In case of moderate and severe placental abruption, the pregnant woman is subject to immediate delivery, regardless of gestational age. The satisfactory condition of the fetus or its intrauterine death do not matter in the matter of delivery; a cesarean section is performed according to vital indications on the part of the mother.

During surgical intervention The uterus is carefully examined; if Couveler's uterus is diagnosed, then expansion of the operation is indicated before extirpation of the organ. At the same time, the fight against DIC syndrome and restoration of blood loss (transfusion of plasma, platelets and red blood cells) are carried out.

In case of detachment during childbirth and satisfactory condition of the fetus and the woman in labor, minor bleeding, childbirth continues to be carried out naturally, monitoring the fetus. Early amniotomy allows in some cases to stop bleeding and progression of abruption.
If placental abruption occurs during the pushing period, then the birth is either completed by a cesarean section (the head is located in the wide part of the small pelvis) or by the application of obstetric forceps (the head is already in the narrow part or lower).

Placental abruption is an unfavorable process characterized by the separation of the placenta from the wall of the uterus, which can occur during pregnancy or childbirth. Normally, it peels off after the baby is born. Often this process is accompanied by bleeding, hematoma and other unpleasant phenomena that can harm the health of the expectant mother and lead to the death of the fetus. This is why placental abruption is very dangerous and requires an immediate response from doctors and the pregnant woman in order to save the child. This phenomenon occurs quite rarely - 1% out of 100 in the early and late stages. It is possible to treat the pathology, but this requires a constant stay in the hospital and compliance with all the doctor’s recommendations.

What is placental abruption

Placental abruption is its premature separation from the walls of the uterus, which violates the integrity blood vessels, provokes bleeding or the formation of a hematoma (dried blood). The main danger is the death of the fetus, since with such a negative process all metabolic processes between the body of mother and child.
As a rule, the placenta is located on the upper layer of the uterus - on the anterior or back wall, less often - at its bottom. There is constant pressure on it - from the uterus (since it is a muscle that is characterized by contractions), the fetus and amniotic fluid. By maintaining a balance between these two forces, the integrity and normal development and location of the placenta are maintained.

Placental abruption is classified according to several criteria.
Development time:

Placental abruption in the early stages. With proper assistance, pregnancy can be maintained and symptoms can be relieved. In the early stages, the placenta is still growing, so the lost contact area will be compensated.
At a later date. In the third trimester, this phenomenon is especially dangerous and the only correct solution would be delivery (naturally or via cesarean section).
During childbirth.

Peeling area:

Complete - there is a total detachment of the placenta over the entire area, which causes immediate death of the fetus and requires immediate medical attention to help the woman.
Partial - detachment occurs in a small area, where a hematoma is formed, which clogs the vessels and prevents further spread of the process.

Progression:

Progressive – the scale of rejection is constantly expanding and threatens to develop from a partial form into a complete one.
Non-progressive – placental abruption has a small area and does not grow.

Causes of placental abruption

To date, the exact reasons that provoke placental abruption have not been established. Many experts believe that a complex of several factors contributes to the development of such a negative phenomenon. To the most probable reasons applies:

Placental abruption is often observed directly during childbirth. Reasons for this may include:

Late rupture or puncture of the amniotic sac, especially if the cervix is fully dilated.
Rush of water during polyhydramnios - the balance between the uterus and amniotic sac, which provokes the detachment of the latter.
Stimulation labor activity with the help of oxytocin.
The baby has a short umbilical cord.
The birth of the first baby during multiple pregnancy.

Symptoms and consequences of placental abruption

The main signs of premature placental abruption are:

Increased uterine tone occurs due to overstretching of the uterus, its constant contraction and lack of relaxation.
Severe pain in the abdominal area, which occurs as a result of internal bleeding and stretching of the abdominal cavity.
Opening uterine bleeding, which can be internal (blood from damaged vessels accumulates in the uterine area, forming a hematoma) and external (blood discharge from the vagina).
Fetal hypoxia occurs as a result of impaired blood flow, the child does not receive required amount oxygen and nutrients.

The severity and severity of symptoms depends on the size of the placental abruption and the progression of the process.
In medicine, there are three degrees of severity of placental abruption:

The mild form is characterized by separation small area placenta, while slight bleeding from the vagina is observed, the general condition of the woman and fetus remains satisfactory. At ultrasound examination You can identify a small hematoma, which was formed as a result of internal bleeding.
Average degree. Placental abruption occurs by 1/3, observed copious discharge blood clots from the genital tract, uterine tone and abdominal pain appear. With this degree, there is a high chance of developing fetal hypoxia and if timely assistance is not provided, the fetus will die.
Severe degree. Placental abruption occurs by ½ or more, the general health of the pregnant woman deteriorates sharply. A woman is bothered by strong sharp pains, profuse bleeding. In 90% of cases, the fetus dies due to hypoxia.

Diagnosis of the disease

If you experience abdominal pain, discharge and constant uterine tone, contact your doctor immediately for examination and identification of the causes of such phenomena. As a rule, an accurate diagnosis does not cause any particular difficulties, since the clear symptoms speak for themselves.

To confirm the diagnosis, the following diagnostic procedures are performed:

Ultrasound examination of the fetus, in which you can see placental abruption, assess the extent of the lesion and the volume of the retroplacental hematoma.
CTG is a study of the baby’s heartbeat to ensure the absence of hypoxia and other pathologies.

Treatment of the disease

The choice of treatment depends on many factors: the degree of the disease, the general health of the pregnant woman, the duration of pregnancy, etc. A prerequisite for a favorable outcome is a constant stay in the hospital under the supervision of doctors before birth. At this time, fetal CTG, ultrasound and Doppler sonography are performed daily. This will allow you to monitor the child’s development and promptly identify the slightest changes.

Treatment for placental abruption includes:

Maintain strict bed rest.
Taking multivitamin complexes.
Taking medications to reduce uterine hypertonicity (Papaverine, No-shpa, Drotaverine), treatment or prevention of anemia (Sorbifer), medications to prevent the formation of blood clots (disaggregants).
If indicated, blood plasma transfusion is performed.
Taking medications to normalize uteroplacental blood flow (Actovegin).
Elimination of the causes that provoked the disease (hypertension, diseases endocrine system or kidneys, etc.).

For moderate to severe placental abruption, an emergency cesarean section is performed, regardless of the stage of pregnancy.

Prevention of placental abruption

In order to avoid the development of pathology, preventive measures should be observed:

Placental abruption is dangerous phenomenon, which can cause fetal death or harm a woman’s health and her future ability to have children. If you follow preventive measures, regularly visit your doctor and undergo all diagnostic procedures, you can prevent this pathology.