Untimely (formerly due date) separation of the placenta from the uterus is called premature placental abruption. It can occur during childbirth or during pregnancy.
The placenta should only be separated after birth. When the placenta separates from the lining of the uterine wall, vascular damage occurs and bleeding occurs. This pathology occurs in approximately 1.5% of cases.
Premature detachment placenta occurs most often in women carrying a child for the first time. It also occurs during premature birth. This condition is considered extremely dangerous and requires immediate specialist intervention.
The baby's place or placenta is responsible for many biological processes that are responsible for the development of the child. It is the placenta that determines whether the child will develop or die.
Biological significance of the placenta
The baby's place begins to form already in the second week after conception. During this time, the fertilized egg makes a long journey through the fallopian tubes, then attaches to the wall of the uterus. The placenta reaches full maturity at approximately 12 weeks. The baby's place consists of an interlacing of blood vessels of the child and his mother. The placenta has a protective membrane through which the baby's waste products are excreted.
The placenta performs a gas exchange function. From the blood of the expectant mother, oxygen passes to the baby through the placenta, and carbon dioxide is removed from there. The baby in the womb can only breathe with the help of the placenta.
The placenta also performs excretory and nutritional functions. With the help of the placenta, food enters the baby's body, nutrients, water.
The placenta produces various hormones that are necessary for normal life future child. This means that the placenta performs a hormonal function.
Finally, the child's place plays a protective function, protecting the fetus from various viruses, bacteria, producing immune system in the fetus.
The baby's place should be separated only in the third stage of labor. If this happens earlier, the child begins to suffer from a lack of oxygen and nutrients. When placental abruption occurs, large vessels are damaged and bleeding occurs, which is life-threatening for the mother and fetus.
Causes of placental abruption
Reasons for this moment there is a huge number:
- While pregnant, a woman experiences hypertension. Frequent pressure surges can cause placental abruption. This condition can be caused by stress or compression of the inferior vena cava when lying on your back for a long time.
- If previous pregnancies have already ended in placental abruption.
- The cause of premature detachment children's place there may be multiple pregnancies or frequent births.
- Post-term pregnancy.
- A scar on the uterus after a previous caesarean section.
- Early toxicosis, gestosis, preeclampsia.
- The cause of premature placental abruption may be congenital anomalies of the uterus: saddle-shaped or bicornuate. Anomalies of blood vessels also play a significant role: they can be brittle and fragile.
- Rejection of the placenta can occur due to abnormalities in its development.
- The mother has a bleeding disorder.
- Various pathologies labor activity may cause premature placental abruption. For example, a sharp drop in pressure in the uterus, rapid release of water, the birth of the first baby during a multiple pregnancy.
- The placenta can be separated if there is trauma to the abdomen as a result of a blow, fall, or car accident.
- Drug use, alcohol and smoking lead to early placental abruption. This can also include a decrease in hemoglobin in the blood.
- Various chronic diseases can lead to detachment of a child's place: diabetes mellitus; pyelonephritis; diseases thyroid gland, adrenal glands; obesity; incompatibility of mother and fetus according to Rh factor, blood group; antiphospholipid syndrome; systemic lupus erythematosus; uterine fibroids.
Symptoms of placental abruption
During detachment of the child's place, damage to the uteroplacental vessels occurs. Bleeding appears. It can be weak or quite strong. Blood accumulates between the placenta and the wall of the uterus, which leads to the formation of a hematoma. As blood accumulates, the hematoma increases, thereby further separating the placenta from the uterine wall.
If the area of placental abruption is small, then after the formation of a retroplacental hematoma, thrombosis of the uterine vessels is possible, and further placental abruption stops. With significant placental abruption, heavy bleeding and extensive retroplacental hematoma, escaping blood can saturate the wall of the uterus, which leads to disruption of its contractility. This condition was called “Couvelaire’s uterus” after the French gynecologist A. Couvelaire, who first described a similar picture.
If placental abruption forms closer to its edge, then blood, penetrating between membranes and the wall of the uterus pours into the vagina, which is manifested by external bleeding. When bleeding occurs immediately after placental abruption, blood flowing from the vagina is usually scarlet color, dark blood with clots is noted if some time has passed from the moment of detachment to the appearance of bleeding.
When the placenta is located on back wall the pain is diffuse and unclear. The uterus is hypertonic, painful, and takes on an asymmetrical shape. Depending on the volume of blood loss, symptoms of hemorrhagic shock appear and increase: weakness, dizziness, vomiting, cold, pale and moist skin, dry mucous membranes, increased breathing and heart rate are proportional to the decrease in blood pressure.
There are three stages of placental abruption:
1. Lightweight. There are no symptoms. The beginning of the detachment process can be determined by ultrasound examination.
2. Average. A little blood is released from the genital tract, and pain is felt in the abdomen. There may be no blood. This depends on the size of the hematoma and the location of the detachment.
3. Heavy. There is anxiety, weakness, severe abdominal pain, dizziness. Bloody discharge from the vagina appears, and fainting may occur. When palpated, you can identify a protrusion on one side. There is no fetal heartbeat, parts of its body cannot be felt.
Simultaneously with the detachment, signs of an increasing lack of oxygen in the fetus appear. When the size of the retroplacental hematoma is 500 ml or more and/or the area of detachment is more than 1/3, the probability of fetal death is highest.
Tactics for placental abruption
Treatment of premature abruption of a normally located placenta is based on the choice of a method of gentle and quick delivery with simultaneous measures taken to replenish blood loss, combat hemorrhagic shock, and control the blood coagulation system.
Obstetric tactics in choosing the method of delivery are determined by the time of detachment (depending on whether it occurred during pregnancy or childbirth), the severity of bleeding, and the condition of the mother and fetus.
In case of partial, small area, non-progressive premature abruption of a normally located placenta during pregnancy up to 36 weeks, if the condition of the pregnant woman and the fetus does not suffer, the bleeding is insignificant, then the pregnancy can be prolonged under hospital treatment conditions.
In this case, the woman is prescribed bed rest, antispasmodics and hemostatics, and iron supplements. Laboratory monitoring of the blood coagulation system is mandatory. If repeated episodes of bleeding occur, indicating progression of detachment, the question of delivery is raised.
In case of mature birth canal (softening, shortening of the cervix, patency of the cervical canal), an artificial opening of the amniotic sac is performed with possible delivery through the natural birth canal. However, more often they resort to cesarean section.
When the pregnancy is at full term and the placental abruption is small in area, the question of delivery is immediately raised. In the presence of a mature birth canal and in the first stage of labor, early amniotomy (opening of the amniotic sac) is performed, which helps reduce intrauterine pressure. This prevents further placental abruption.
Childbirth is carried out under careful monitoring of the condition of the fetus and contractile activity of the uterus. If the condition of the fetus worsens, bleeding increases, uterine hypertonicity appears between contractions, or the mother’s condition worsens, surgical delivery is resorted to.
In case of physiological childbirth and pathological bleeding, a manual examination of the uterine cavity is required immediately after the birth of the child, and in the subsequent and early after birth period- prevention of bleeding with drugs that increase uterine contraction.
The causes of bleeding after delivery are a violation of the blood coagulation system and a decrease in uterine contractility. Therefore, careful monitoring of the nature of bloody discharge from the genital tract is carried out.
Simultaneously with delivery (caesarean section or physiological birth) measures are taken to restore the volume of circulating blood, maintain the vital functions of the mother, pain relief; in case of significant blood loss and severe anemia, transfusions of fresh donor blood, fresh frozen plasma, fibrinogen, and platelet mass are performed.
In case of premature abruption of a normally located placenta, a cesarean section is most often used. In case of pronounced clinical manifestations of premature placental abruption during pregnancy and in the first stage of labor, urgent delivery is performed by cesarean section, regardless of the duration of pregnancy and the condition of the fetus. During a cesarean section, after removing the fetus and placenta, the uterine cavity is cleared of blood and clots, after which all its walls are carefully examined to determine the condition of the uterine muscles. If they are soaked in blood, the uterus is removed, as it is the source of bleeding. If placental abruption occurs in the second stage of labor and there are conditions for the rapid completion of labor through the natural birth canal, the birth is completed by applying obstetric forceps or vacuum extraction of the fetus.
If you experience any abdominal pain or bleeding from the genital tract during pregnancy, you should immediately consult a doctor!
Prevention of placental abruption
The following measures are taken to prevent early detachment placenta:
- thorough examination and diagnosis of the condition of the uterus and pelvic area. Treatment of identified diseases;
- monitoring the condition of blood vessels before and after conception;
- monitoring blood pressure levels;
- try to avoid any injuries, heavy lifting, etc.;
- prevention and timely treatment of allergic reactions.
Placental abruption in early and later pregnancy is dangerous due to the development of complications, which pose a threat to the life of the child and the expectant mother.
The baby's place begins to form immediately after conception. All through nine monthly period the embryonic organ grows and develops along with the baby.
Placental abruption in early and late pregnancy can occur prematurely, which indicates the occurrence of pathological processes in the body.
What is placental abruption during pregnancy?
The placenta plays an important role in the development of the baby. In the second week, the shell begins to form ovum At the beginning of the second trimester, this process ends and only growth continues.During intrauterine development, the embryonic membrane, which contains many arteries, remains the main link between mother and child, and also has many tasks:
- supply of nutrients and oxygen through the blood;
- removal of waste products;
- production of hormones for fetal formation;
- protective barrier– protects the baby from the influence of external harmful bacteria.
Placental abruption in early pregnancy: causes, treatment
Pathology can be caused by a combination of multiple factors. Among them, those that have a direct impact are distinguished, and also risk factors become predisposing, but do not have a direct impact.Causes of rejection in the first trimester:
- hypertension, frequent and persistent increase in blood pressure;
- gestosis, provokes fragility of blood vessels, which complicates blood flow;
- bicornuate or sheer uterus;
- toxicosis;
- chronic serious illnesses;
- abnormal formation of the shell;
- exceeding the gestation period;
- multiple births with more than one fetus;
- autoimmune pathologies;
- allergy.
Treatment of placental abruption involves therapy with hemostatic drugs and medications that help preserve the life of the baby.
Pain, heaviness in the lower abdomen, and often bleeding are the main signs by which a slight detachment can be suspected.
The percentage where the risk increases significantly occurs in women over 35 years of age. If you have a history of cesarean section or for a long time therapy to eliminate infertility was carried out, the risk of pathology increases significantly.
Any injury or fall affecting the area of intrauterine development can provoke rejection. If you notice the first symptoms, you should immediately consult your doctor.
Consequences of placental abruption in early and late stages
Bleeding is distinguished between vaginal and uterine. With internal uterine bleeding, the fetus most often dies. Therefore, doctors are faced with the question of preserving the health of the mother.External bleeding can be controlled with medication. The main source of this situation lies in the formation of a blood clot.
The consequences largely depend on the area affected by the disturbance. Hyposcia or lack of oxygen occurs with 25% damage, about 30% causes heart failure in the fetus. Rejection of more than half of the area leads to a frozen pregnancy.
Placental abruption in late pregnancy: symptoms, causes
In the normal course of intrauterine development, detachment should occur only after the birth of the child. Disorders that have different etiologies lead to premature discharge. The causes of detachment in the later stages indicate the formation of pathology:- placental or uterine insufficiency leads to improper functioning of the embryonic internal organ;
- increased uterine tone;
- severe injuries;
- late toxicosis and gestosis;
- exacerbation of chronic diseases;
- aging of the child's place;
- smoking and alcohol abuse;
- uncontrolled use of potent medications.
Bleeding occurs due to rupture of the vessels that connect the uterus and the baby's place. In this case, a pain syndrome occurs in the lower abdomen, radiating to hip joint and lower limbs.
Additional symptoms include dizziness, toxicosis or nausea.
It is not uncommon for placental abruption to be detected only by ultrasound. The compensatory capabilities of the internal organ are almost exhausted, and it is very difficult to restore functionality in the third trimester.
Complete rejection indicates the onset of immediate delivery. If the area of damage is partial, then, in a hospital setting and constant monitoring, drugs are used to preserve pregnancy until natural birth.
How to avoid placental abruption during pregnancy?
When making a diagnosis, a woman is faced with the question: “how to stop abruption during pregnancy?” In order to avoid negative consequences All risk factors should be excluded. Try to lead healthy image life, protect your body from stressful situations, maintain bed rest and rest. Protect your life as much as possible from traumatic situations.Doctors prescribe drug therapy with the use of antispasmodics, vitamin complexes, drugs are used that affect blood flow and thrombus formation.
If the membrane comes off after 34 weeks, then a planned or emergency caesarean section is prescribed to save the life of the newborn and his mother. Prolonged and heavy bleeding indicates the need for a blood transfusion.
Main symptoms:
- Pain in the uterus
- Internal bleeding
- Brown vaginal discharge
Placental abruption is a pathological condition that occurs in the first or last trimester pregnancy and poses a serious danger to the life of the child and mother. The placenta is an organ through which nutrients and oxygen are supplied to the fetus from the mother’s blood. In addition, thanks to the placenta, waste products of the fetus enter the mother’s circulatory system and are excreted from her body. That is, the placenta performs a transport function and helps ensure the vital activity of the fetus in the womb. Therefore, detachment can cause serious disturbances in the life of the fetus and even cause the death of it and the mother.
Causes
To understand why premature placental abruption is so dangerous, it is necessary to understand the physiology of women during pregnancy. The placenta in the body of a pregnant woman acts as a depot of useful substances necessary for normal height and fetal development. It develops until the end of the second trimester, and after childbirth the doctor carefully examines it, which makes it possible to identify various possible anomalies in fetal development.
Thus, since this organ performs the important function of providing the fetus with nutrients and oxygen, premature placental abruption leads to abnormal development of the fetus and its death. Also, with this pathology, there is a possibility of death of the expectant mother, since premature detachment leads to the development of severe blood loss, especially during the third trimester.
If placental abruption occurs in the first trimester, minor bleeding is observed that is not life-threatening to the woman, but can lead to fetal death. When this pathology occurs in the third trimester, the probability of death of the mother and fetus without timely treatment is very high.
The causes of this disorder are external and internal. TO external reasons can be attributed to smoking by pregnant women. Despite the fact that doctors warn all women about the dangers of smoking, many representatives of the fair sex cannot get rid of the addiction and continue to poison their bodies, which causes a pathology such as placental abruption.
This pathological condition can also be caused by blunt trauma to the abdomen received by a woman during pregnancy, an act of violence committed against her while she is pregnant, as well as strong physical impact that occurs during car accidents and other emergencies.
Usually, when exposed to external factors on a woman’s body, in the first hours the detachment is insignificant and does not threaten the life of the woman and the fetus in her womb. However, after some time, extensive bleeding occurs, which can cause serious consequences - from premature birth to fetal death, and even the death of the mother.
Premature placental abruption has internal reasons. In the first place among these causes is hypertension in pregnant women - high blood pressure inside the vessels leads to the development of this disorder, and bleeding occurs.
Also, the cause of the development of such a pathological condition can be multiple pregnancies and frequent childbirth - because of this, the structure of the mucous membrane of the organ changes, which prevents the full attachment of the placenta.
In women after a second cesarean section, premature placental abruption is observed in 60% of cases. Infectious pathologies can also cause this pathological condition. urinary tract. There is a very high risk of placental abruption when twins are born. And although this condition does not threaten the life of the child, it can cause severe blood loss, which will lead to the death of the mother.
Sometimes premature detachment of a normally located placenta occurs due to capillary fragility. This occurs due to development in the body of a pregnant woman, so it is extremely important to register on time so that the doctor closely monitors the health of his patient.
In autoimmune diseases, premature placental abruption can also occur. Moreover, this condition can occur both in early and late stages. And another reason for this disorder is an allergic reaction to taking certain medications prescribed to women during pregnancy.
Note that placental abruption can occur both during pregnancy and during childbirth. The occurrence of this pathological condition during childbirth is not so much dangerous for the child as for the mother herself, because the large blood loss that characterizes this condition can lead to the death of the mother in labor.
Partial placental abruption usually occurs in the first trimester and can be treated with medication. Therefore, timely detection of this pathology allows you to save the life of the unborn baby and his mother.
Symptoms
The most important signs Placental abruption is the occurrence of bleeding and pain in the uterus. Bleeding can be visible or hidden, that is, a woman may see blood on her underwear or not (but will feel pain in the uterus).
With external bleeding, brown spotting usually occurs, and with internal bleeding, blood accumulates between the walls of the uterus and the placenta without being discharged from the vagina. However, with internal bleeding, there is tension in the uterus, as well as severe pain.
In a fetus with a pathology such as premature placental abruption, there is a disturbance in the functioning of the heart, which can be detected during examination. Severe oxygen deficiency of the fetus develops when 1/3 of the placenta is detached - this threatens not only the life of the child, but also the life of the mother.
The symptoms of this pathological condition can be mild or significantly pronounced - it all depends on the period at which placental abruption occurred, as well as on the degree of abruption. The more the placenta has separated, the more intense the symptoms will be, and the worse the prognosis for the course of the pathology.
If premature placental abruption occurs in early pregnancy, then timely treatment can eliminate the problem, and subsequent pregnancy proceeds without complications. If the pathology was not detected in time, serious complications may develop that threaten both the fetus and the mother.
The consequences of such a pathological condition can be different. Sometimes there are premature birth, and the baby is born premature, sometimes a miscarriage occurs, but most often the fetus dies, and the pregnant woman may also die.
Diagnostics
The diagnosis of a pathology such as premature placental abruption is made based on the presence of clinical manifestations in the form of bleeding and pain in the lower abdomen. At the same time, an ultrasound is required to confirm the diagnosis.
Ultrasound can diagnose:
- placental abruption in a certain area (partial), which can be eliminated by taking certain medications;
- total, when premature birth is required;
- progressive total, in which large-scale measures are necessary to make treatment effective.
Treatment
This pathology requires timely treatment– the woman is urgently hospitalized and either premature birth is induced if the abruption occurs at a period of more than 27 weeks, or drug therapy is prescribed to prevent the development of complications.
Conservative treatment is based on taking medications that stop bleeding. Treatment also involves taking antispasmodics and prescribing the woman bed rest. As a result of this treatment, a clot forms at the site of placental abruption, which does not affect the further development of the fetus.
In cases where placental abruption occurs in the second trimester (and this happens extremely rarely), disturbances in the functioning of the central nervous system are detected in the fetus, so only the woman can decide whether to leave the child or not. If the pathology develops in the third trimester, then it is an indication for an emergency cesarean section.
If measures are not taken and proper treatment is not carried out, the consequences of this pathology can be disastrous, which is why it is so important to register in a timely manner and undergo regular examinations.
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Diseases with similar symptoms:
A hematoma during pregnancy is an accumulation of blood in tissues, which most often forms after any injury. The formed vacuole contains either liquid or coagulated blood. This condition is extremely dangerous for both the expectant mother and the fetus.
Content:
Placental abruption is a complication in which the baby's place is separated from the wall of the uterus during pregnancy or childbirth. Premature detachment is accompanied by bleeding and can cause fetal death.
Classification
The anomaly can be complete or partial, central or marginal, the latter being the least dangerous. Placental abruption in the early stages can occur during pregnancy or during childbirth. If the pathology manifests itself before the 20th week, the chances of a successful outcome are higher than placental abruption in the later stages. This is due to the fact that in the early stages the baby’s place is actively growing and developing, and the affected part is compensated when it comes into contact with the wall of the organ.
Placental abruption is divided into:
- partial non-progressive;
- partial progressive;
- total.
Signs of pathology
The patient may experience heavy bleeding, but external signs may be absent. Another symptom is that the fetus stops moving. In almost all cases, lower back pain is observed.
Other symptoms of placental abruption:
- The mild form is not associated with pronounced symptoms. It is detected by ultrasound or during childbirth, when a small depression with blood clots is found in the child’s place.
- Anomaly moderate severity accompanied by pain and weakness bloody discharge. There may not be any bleeding. Palpation of the uterus reveals tension and mild local pain. When listening to the fetal heartbeat, hypoxia is detected.
- Premature placental abruption in severe form is manifested by severe pain, attacks of weakness, and anxiety. Sweating, shortness of breath, decreased blood pressure and temperature may occur. The uterus is tense and has asymmetrical contours. The fetal heartbeat cannot be heard.
The main symptoms of pathology in the first trimester:
- Placental abruption in the first trimester is accompanied by mild bleeding.
- There is pain and a feeling of heaviness in the lower abdomen.
- Fetal hypoxia.
Symptoms of pathology in the second trimester:
- Weakness.
- Dizziness.
- In addition to pain and possible bleeding, uterine tone and noticeable pain on palpation are added.
Symptoms of pathology in the third trimester and during childbirth:
- Strong pain in a stomach.
- Bleeding.
- Uterine tension.
- Detachment of the baby's place during childbirth is accompanied by the baby's meconium and the appearance of blood in the amniotic fluid.
Danger of placental abruption
If there is an anomaly, the integrity of the blood vessels is disrupted, and a hematoma forms between the walls. After this, the separation of the child's seat only accelerates.
Photo of placental abruption:
After the formation of a hematoma, thrombosis of the uterine vessels may occur, which stops the separation of the child's place. The process enters the stage of partial non-progressive anomaly. This poses little threat to the child; pregnancy and childbirth proceed normally in this case.
With progressive partial detachment, the separation process continues. The size of the hematoma increases, the detachment becomes progressive, and the child experiences oxygen starvation. With total (complete) detachment, the consequences for the child are fatal. Cardiac activity is disrupted and the fetus dies.
Complications of placental abruption
Bleeding may be strong, weak, or completely absent. This depends on the location and area of the separation, as well as on blood clotting. Visible bleeding is observed with marginal detachment. Hidden (internal) bleeding occurs with central peeling.
Uterine tone and pain syndrome are observed in almost every case. The pain may be dull, may appear in paroxysms, radiate to the hips, lower back and vaginal area. Painful sensations during palpation of the uterus can be localized at the site of separation, or can spread throughout the abdomen.
With an increase in the area of exfoliation and increased blood loss, oxygen starvation of the fetus begins. When the child's seat is separated by ¼ of the area, the first signs of hypoxia appear. When the gap increases to 1/3, hypoxia intensifies, and when peeling reaches ½ of the area, the fetus dies.
Causes of pathology
Placental abruption is a multifactorial pathology - its appearance is caused by a combination of several factors. Among the main causes of placental abruption are vascular pathologies, serious illnesses of the mother, and degenerative changes in the mucous membrane.
Other causes of placental abruption:
- High pressure at the mother's.
- Fluctuations in blood pressure caused by stress or health problems.
- Degenerative changes in the mucous membrane caused by frequent or multiple births.
- Post-term pregnancy.
- Age after 35.
- Pregnancy that occurs after prolonged infertility.
- Anomalies of the uterus - bicornuate, saddle-shaped.
- Anomalies in the location and development of a child's place.
- Pregnancy after caesarean section.
- Toxicoses, preeclampsia, especially in the 1st trimester.
- Pathologies of the structure of the uterus.
- External abdominal injuries (fall, blow).
- Drinking alcohol and smoking.
- Poor nutrition.
- Allergic reactions to medications.
- Severe chronic, endocrine and infectious diseases.
Diagnosis of pathology
Diagnosis is made based on clinical manifestations. They talk about the problem bloody issues, the uterus is in good shape, its shape is changing. Detachment is usually accompanied by abdominal pain and signs of increasing fetal oxygen deficiency. The mother’s medical history, her complaints, laboratory and laboratory results are taken into account. clinical examinations.
After examining the patient, the doctor decides how to determine the detachment of the child’s place and what examination methods to use. In the absence of pronounced symptoms, ultrasound is used.
Using ultrasound, the size of the area of the separated child's place and the size of the hematoma are determined. A blood test is required to detect signs of anemia. The presence of anemia may indicate hidden or chronic blood loss.