Placental abruption is a common occurrence. Placental abruption is a serious threat to pregnancy

When childbirth approaches, a woman, although she waits impatiently for this moment, really wants to carry the baby to birth. the required period. Unfortunately, on later, when it would seem that all pregnancy tests have been completed, complications may arise. One of them is placental abruption. To understand what it is and what the threat is to mother and baby, you need to understand what the placenta is.

Organ and its functions

The placenta is a completely unique organ. Firstly, it exists temporarily - only during pregnancy. Secondly, the placenta is considered an organ of the fetus, but it can be considered that it belongs to two people at once - the baby and the mother. This is exactly the place where the blood of the mother and the fetus meet, but they do not mix thanks to the placental barrier. The placenta primarily performs nutritional and respiratory functions. Through it, the baby receives the necessary water, vitamins, minerals, glucose, and oxygen. Carbon dioxide and waste products of his rapidly growing body are removed from his body. In addition, it provides immune protection to the fetus. Mother's antibodies reach it through the placenta. But the work of the placenta is important not only for the child, but also for the body of the woman herself. It produces hormones that help to properly regulate pregnancy, as well as prepare the mammary glands for upcoming feeding. Dr. Michel Oden called the placenta the baby's advocate. While, for example, the roots of a plant absorb the substances that are in the soil, the placenta can partly “control” the process, extracting everything necessary from the mother’s blood. Providing the baby with nutrients and oxygen is so important that the placenta can even come into conflict with the mother's body. People say that the child will take what is his.

True, one should not overestimate the capabilities of this organ. Otherwise, there would be no low birth weight children, children with developmental delays, or those suffering from a deficiency of any necessary substances. In addition, the placenta cannot protect the child from the influence of alcohol, nicotine, drugs and viruses. Therefore, pregnant women are advised to lead a healthy lifestyle and avoid colds and infections.

Structure of the placenta

The placenta has the shape of a disk with a diameter of about fifteen to twenty centimeters and a maximum thickness of 2.5 to 3 cm; it is somewhat narrowed towards the edges. By the way, the name of the organ comes from the Latin placenta - flat cake, flatbread. In the cuisine of some peoples, for example Moldovans, there are placinda pies that have a round flat shape. Their name is also related to the Latin word.

The placenta is attached to the wall of the uterus. Its formation begins already on the seventh day, when the membranes of the embryo - the chorion and amnion - are formed. The chorion transforms into the placenta, which at week 12 looks like a round cake with thinned edges, and at week 16 it is already formed. Thus, this organ overtakes the formation of the fetus in its development.

The umbilical cord departs from the placenta, which normally contains three vessels. Interestingly, arteries and veins change roles here. Arterial blood rich in oxygen enters the child's body through the umbilical vein. Carbon dioxide and waste products leave his body through two umbilical arteries. These arteries are wound in a spiral around a thicker vein.

The placenta consists of lobules densely penetrated by small vessels. The maternal vascular system is connected to the vessels of the uterus, and on the fetal side it is separated from it by the amnion, so the blood of the mother and child only exchange substances, but do not mix. After the birth of a child, doctors always examine the placenta that has left the mother’s body. The two sides of the placenta look different. The fetal side is covered with a smooth, slightly grayish shell, while the maternal side has a pronounced lobular structure.

Placental abruption

This pathology is the separation of an organ from the mucous membrane of the uterus, complete or partial. Blood accumulates in the resulting narrow cavity, which further pushes the placenta away from the uterine wall. All this is normal in the third stage of labor, when the placenta should come out, but it is dangerous during pregnancy.

Placental abruption at different stages of pregnancy

The risk of consequences of this phenomenon depends on the duration of pregnancy. In the first trimester, with timely diagnosis and treatment, it may not harm mother and baby. After all, the placenta is still growing and developing, so its increase in area and volume compensates for the damage.

In the second trimester, high muscle tone and tension. Treatment depends on the specific situation and duration. For example, at the beginning of the second trimester, compensation due to the growth of the placenta is quite possible.

In the third trimester, late in pregnancy, the consequences of placental abruption are most serious. This organ has already stopped growing, so the loss of substances supplied to the child with the blood is no longer replenished. And yet, depending on the amount of damage, there are two outcomes of events. In some cases, it is impossible to do without childbirth, especially premature baby At such a time it is already realistic to go out. Under more successful circumstances, a woman can carry the child to term, although she will have to go to the hospital for preservation. This happens if the area of detachment is relatively small, there is no bleeding and the process does not progress.

Finally, placental abruption can occur during labor, but several hours ahead of time. While normally this should only happen in the third stage, sometimes it happens in the first or second - during contractions or pushing. In this case, doctors may prescribe C-section or induce labor. After all, even during birth, the baby still receives energy through the umbilical cord. necessary substances, primarily oxygen, and can suffer from hypoxia. In addition, bleeding can be dangerous for the mother.

Causes of placental abruption

Why does placental abruption occur in later stages? There is no clear answer to this question.

Disturbances in the vascular system can make capillaries fragile, which can greatly impair blood flow and cause bleeding. This can occur with gestosis, as well as with diseases not related to pregnancy - diseases of the cardiovascular system, kidneys, obesity, diabetes.

Another cause of placental abruption in late pregnancy can be degenerative or inflammatory processes in the uterus and child's place. This happens, for example, with uterine fibroids or post-maturity, when the placenta is aging and the baby has not yet been born.

This disorder can be caused by toxins that enter the body through bad habits - drinking alcohol, smoking, drug addiction. However, during pregnancy it is important in any case to refuse bad habits. They entail a huge number of consequences and become causes of placental abruption in the later stages. Moreover, an incorrect lifestyle can cause harm much earlier, causing pathologies in the fetus - from prematurity to mental retardation. Only alcohol consumption is questionable: some sources advise categorically to abstain from alcoholic beverages and alcohol-containing medications, others allow the consumption of red wine in very small doses. But it's still better to be safe. Living 9 months without wine, which you shouldn’t drink a lot anyway, is quite possible, and the child’s health is worth it!

Anemia also predisposes to pathological processes. However, it is worth understanding that a slight decrease in hemoglobin is acceptable during pregnancy. After all, the amount of fluid in the mother’s body increases greatly, so the blood can become “diluted.”

More often, placental abruption occurs when repeated births, which is associated with changes in the uterine mucosa. Its risk increases with multiple pregnancy.

It is also provoked by autoimmune diseases and allergies, especially to donor blood and protein solutions. It can also be dangerous side effect taking certain medications.

Of course, mechanical damage to the abdomen can also have an effect, which can occur during a fall, domestic injury, or accident.

Causes of placental abruption in later stages are also identified as heavy physical exertion and emotional stress. Therefore, pregnant women are advised to treat themselves with care, and their relatives are advised to help expectant mothers in everyday life and avoid conflicts.

If there are any harmful factors It is important to regularly see a doctor, follow his instructions and be attentive to your health.

All these reasons are typical for different stages of pregnancy.

Symptoms

The three main signs of placental abruption in late pregnancy, as well as in earlier stages, are bleeding, tension and pain in the uterus, and abnormal heartbeat in the fetus.

Bleeding depends on how exactly the placenta separated. If its edge has separated from the wall of the uterus, the bleeding will be external and visible. In this case, a symptom of placental abruption in the later stages will be brownish vaginal discharge. If a pregnant woman discovers such discharge, she should not consult a doctor. This happens in most cases of placental abruption in late pregnancy, but internal bleeding also occurs. If the middle of the placenta is separated, but the edges remain in place, blood accumulates inside in the form of a hematoma, and there is no discharge. This option occurs in 20% of cases. True, even in this situation, placental abruption in the later stages will not remain completely unnoticed. The pain that is characteristic of this pathology is stronger with internal bleeding. It may be accompanied general malaise- weakness, nausea, dizziness. Such symptoms can occur with any bleeding in the body. The uterus is tense; when palpated, the woman feels pain. These signs of placental abruption in late stages may be different character. The pain may be dull or paroxysmal. It may not be felt in the stomach, but radiate to the thigh and perineum.

Heartbeat and movements

It is no coincidence that obstetricians and gynecologists listen to the baby’s heart rate during every examination. Fetal cardiac dysfunction may be evidence of many various pathologies pregnancy, including placental abruption in the later stages. The severity of fetal suffering depends on the area of the separated placenta and the amount of blood lost from the mother. If 1/4 of the placenta has moved away from the wall, disturbances in the baby’s heart become noticeable, but if 1/3, the fetus experiences severe oxygen deficiency. After all, the placenta carries not only nutrients, but also oxygen, and its lack affects the body’s functioning very quickly. Detachment of half the placenta can be fatal for the fetus.

By the movement of the fetus, you can guess what is happening to it. At slight drawback oxygen, the baby begins to move very actively. With these movements, he massages the placenta and stimulates the flow of oxygen-rich blood. If the situation worsens and hypoxia intensifies, the fetus calms down - it simply does not have enough strength to move. A particularly alarming sign is the absence of movement during the day. After 30 weeks, it is highly likely that this may be a symptom of placental abruption in late pregnancy.

Diagnostics

If there are suspicious signs, such as bleeding, pain and discomfort in the abdomen, increased tone, changes in the child’s movements, additional studies are carried out. In such cases, an ultrasound scan is required. This method allows you to learn a lot about the condition of the fetus, uterus and placenta. Several signs are assessed during the procedure. Fetal heartbeats are counted. The thickness of the placenta is measured and the presence of changes in its structure is assessed. If there is a hematoma, a dangerous symptom of placental abruption in the later stages, its size is measured.

After 34 weeks, all pregnant women undergo cardiotocography (CTG). It also allows you to measure the fetal heart rate and rhythm. In addition, the condition of the muscular layer of the uterus is assessed. Its increase means readiness for premature birth.

Treatment of placental abruption

If there are several weeks left before the birth, it is better to speed up the birth than to wait for the unpleasant consequences of placental abruption. In the later stages, early birth is not so scary.

But in favorable cases expectant mother may be admitted to hospital. In this case, strict bed rest is observed. The patient is under day and night observation by doctors. The child's condition is regularly monitored using Dopplerography and cardiotocography. Any abnormalities may be an indication for an emergency caesarean section.

Women who had placental abruption in a previous pregnancy are sent to the hospital from 36 weeks, even if no dangerous symptoms are observed.

Experiences of real people

What do women who experience placental abruption in the later stages write? Reviews about this pathology are very different. Unfortunately, a significant number of pregnant women have lost their babies. Such women lament that the pathology was discovered too late or not detected at all. Placental abruption also threatens the life of the mother - severe bleeding during childbirth is very likely. However, modern medicine allows almost all women to survive. So don't focus on the negative. Positive emotions, even if a pathology is detected, can help to safely carry the baby.

Always remember that many babies have been saved by caesarean section. Moreover, pregnancy with placental abruption in the late stages and cesarean section are not a death sentence. Many women with this pathology became pregnant again and gave birth to healthy children without complications. There are also cases when birth with placental abruption occurred at term. So you should never lose faith in the best. By paying close attention to your condition, you can avoid many things. dangerous consequences. And if you consult a doctor in time and undergo regular examinations for pregnant women, you can reduce the risk of pathology to a minimum.

Premature abruption of the normally located placenta (abbreviated as PONRP)- this is its premature separation before the birth of the child: during pregnancy or childbirth.

Classification

There are several classifications of premature placental abruption:

According to the time of occurrence of PONRP:

early stages of pregnancy;
late dates;
during childbirth.

By area of placental abruption:

complete (detachment of the entire area of the placenta);
partial (only part of the placenta is exfoliated). Partial detachment can be marginal (the edge of the placenta is separated) and central (accordingly, the central part is exfoliated).

According to the progression of detachment:

progressive;
non-progressive (stopped placental abruption).

Reasons for the development of PONRP

Placental abruption can occur both during pregnancy and during childbirth.

Causes of abruption during pregnancy:

Diseases of the cardiovascular system (arterial hypertension).
Diseases of the urinary system (glomerulonephritis).
Diseases of the endocrine system (diabetes mellitus).
Late gestosis.
Allergic reactions.
Disorders of the hemostasis system (tendency to thrombosis).
Falls, abdominal injuries.

Causes of placental abruption during childbirth:

Delayed rupture of the membranes (the bladder remains intact when the cervix is fully dilated).
Rush of amniotic fluid with polyhydramnios.
Hyperstimulation of the uterus during labor (oxytocin).
Short umbilical cord.
Birth of the first fetus during multiple pregnancy.

Symptoms

The main symptoms of PORNP are:

Sharp pain in the abdomen.
Uterine bleeding.
Acute fetal hypoxia.

Additionally The severity of symptoms may vary and depend on the size and location of the placental abruption.

Bleeding may be external(blood is released from the genital tract) and internal(blood accumulates in the uterus, forming a hematoma). With marginal detachment, blood quickly flows out of the vagina and, as a rule, has a bright scarlet color. With central placental abruption, the blood does not come out, but permeates the walls of the uterus, forming a retroplacental hematoma.

Abdominal pain, most often expressed in internal bleeding and is associated with saturation of the uterus, irritation and stretching of the peritoneum.

Hypertonicity of the uterus also more common with internal bleeding and is caused by overstretching of the uterus, which is constantly contracting and does not relax.

Acute fetal hypoxia with placental abruption it is caused by a sharp disruption of uteroplacental blood flow. With detachment of more than one third, the fetus may die; with complete detachment, intrauterine fetal death occurs instantly.

Severity of placental abruption

According to the clinical picture there are three degrees of severity of placental abruption:

Light form. The general condition of the woman is not impaired. There is a slight placental abruption, and the discharge from the genital tract is insignificant. With internal bleeding, ultrasound can detect a small hematoma.
Average degree. Detachment of one third of the placenta occurs. With external bleeding, the discharge from the genital tract is quite profuse with large clots. Internal bleeding causes abdominal pain, increased tone uterus. Acute fetal hypoxia develops; if left untreated, the fetus dies.
Severe degree. The placenta peels off by half its entire size or more. The woman's condition has deteriorated sharply. Suddenly there is severe abdominal pain and heavy bleeding. In most cases, the fetus dies quickly.

Management of pregnancy and childbirth during PONRP

Pregnancy management depends on the following clinical symptoms:

Amount of bleeding.
Gestational age.
General condition of the woman and child.
State of the hemostasis system(a set of mechanisms that maintain the liquid state of blood).

If the pregnancy is less than 34 weeks, if the condition of the woman and the fetus remains satisfactory, there are no pronounced symptoms (bleeding, anemia), further continuation of pregnancy is possible. A woman should only stay in a hospital setting under constant medical supervision (daily

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

What is the placenta and what is it for?

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

respiratory - blood circulates through the uteroplacental vessels, carrying oxygen with it; having given it away, they capture carbon dioxide released during breathing and remove it into the mother’s lungs;
trophic - the circulatory system also transports nutrients necessary for the growth and development of the embryo; it removes metabolites formed during the breakdown of nutritional polymers - if this process is disrupted, the fetus may be poisoned by metabolic products;
endocrine - the placenta transmits maternal hormones to the fetus and synthesizes its own, which affect the growth and development of the child;
protective - the “placental barrier” filters all substances transmitted to the fetus, if possible protecting it from potentially dangerous ones;
immune - protects the organisms of the mother and child from conflicts (for example, by blood type or Rh factor), preventing the penetration of antigens from the mother’s body to the child’s body; protects the fetus from infections coming from outside with the help of maternal antibodies.

Placenta is translated from Latin as “cake”; it is named so because of its appearance.

In its normal location, this “cake” is attached to the upper parts of the uterus, usually on its back wall, less often on the front. Since the posterior wall of the uterus is less susceptible to deformation, the location of the placenta on it is considered normal. Attachment of the placenta to the anterior wall of the uterus is more dangerous, because the anterior wall has the ability to stretch, which can cause premature placental abruption - since the placenta itself does not have this property. But in itself, this location of the placenta is not critical, but only indicates the possibility of pathologies occurring and the need for a more attentive attitude to pregnancy from both the woman herself and doctors.
The norm is that the placenta is attached back wall, anteriorly - pathology

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

At the first screening, done at 12 weeks, I was diagnosed with “low placentation” - there was about 5 centimeters from the lower edge of the placenta to the internal os. As the doctor told me, this is a fairly common phenomenon and does not pose any particular danger - if precautions are taken and in the absence of problems that contribute to the descent of the placenta, it will most likely gradually rise upward, since the uterus grows with the fetus. As a preventive measure for even greater descent, sexual rest was recommended, with the exception of physical activity, avoidance of overheating (sauna, hot bath), refusal to fly and public transport. In general, I tried to follow the doctors’ orders, but it didn’t always work out - for example, in the second trimester I had a vacation, during which I flew to the sea, sunbathed, and moved around a lot. The second ultrasound, at 19 weeks, showed that the situation had improved somewhat - the placenta had actually risen a little. As a result, by the time of birth, the attachment of the placenta was still low, but did not turn into presentation, and I gave birth on my own without any problems.

Partial presentation can be lateral (most of the internal os is covered) or marginal (about a third of the passage is covered). At full presentation placenta, the internal os of the uterus is completely closed, natural childbirth is impossible.
The placenta may have marginal presentation, sideways or completely block the internal pharynx

Life cycle of a child's place

When ovum is implanted into the uterus, the cells of the future placenta actively divide and form a membrane around the embryo, permeated with blood vessels, integrating the fetus into the mother’s circulatory system. At 8–9 weeks, the formation of the placenta as a separate organ ends. By 12 weeks, the placenta already looks familiar to us - in the form of a “cake” with an umbilical cord extending from it. By 15–16 weeks, its formation is complete, and the final transition to the placental blood supply occurs.

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

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

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

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

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

Disruption of the stages of aging

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

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

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

Consequences of early aging of the placenta:

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

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

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

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

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

What is placental abruption?

At normal development events, the rejection of the placenta from the walls of the uterus begins to occur at the moment of birth, when the child (or children - in case of multiple pregnancy) has already been born. But it happens that, as a result of some reason, the child’s place begins to peel off earlier. This dangerous pathology, since with a sufficiently large area of detachment, intrauterine fetal death occurs.

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

Experts distinguish 3 degrees of placental abruption:

mild degree - usually goes unnoticed by a woman, visible only on ultrasound; there is usually no threat to the fetus;
medium - an extensive hematoma occurs, the uterus is in good shape, pain is felt on palpation; when listening to the fetus, disturbances in the heart rhythm are noticeable - acceleration or, conversely, deceleration;
severe - arise sharp pains, your health worsens - dizziness appears, sweat appears, blood pressure drops; The uterus takes on an asymmetrical shape and is tense when palpated.

When placental abruption occurs, bleeding occurs and a hematoma forms.

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

central - when the edges of the placenta remain attached to the uterus, and the separation of the baby’s place from the walls begins in the main part of the placenta; in these cases, bleeding remains hidden; this type of abruption is more dangerous, since the accumulating blood puts pressure on the placenta, aggravating the situation and causing the abruption to progress; in addition, the absence of bleeding from the genital tract may complicate early diagnosis, while treatment is usually required immediately;
marginal - in this case, the edge of the placenta extends from the walls of the uterus, and blood has the opportunity to freely exit into the uterus and, if the internal os is slightly open, out.

At 6 weeks of pregnancy, I was diagnosed with an ultrasound. The doctor said that the size of the hematoma is small, the detachment is partial and does not progress, so there is no danger. They prescribed Duphaston to raise progesterone levels, and Papaverine suppositories to relieve spasms in the uterus. After taking the pills and suppositories, nothing happened, there was no pain, no tension in the uterus, or any discharge. At 9 weeks there was a repeat ultrasound for control, and the hematoma was no longer visible. Subsequently, the pregnancy proceeded without deviations, and the birth was successful.

Causes

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

attachment to the anterior wall of the uterus - due to its ability to stretch;
low placenta attachment or placenta previa;
disorders in the vascular system - the uteroplacental vessels become thinner and become fragile and brittle;
problems with blood pressure in the mother - hypotension, sudden fluctuations, compression of the inferior vena cava by the uterus;
frequent and/or multiple births, especially during previous pregnancies, a caesarean section was performed;
toxicosis and its pathological forms (preeclampsia, gestosis);
abnormalities in the structure of the uterus;
bad habits - alcohol, smoking, drugs;
post-term pregnancy - the placenta is physiologically ready for rejection;
allergy to drug therapy;
pathologies during childbirth - rapid labor, short umbilical cord, late rupture of amniotic fluid;
age of the pregnant woman - the risk increases as it increases;
various hereditary and chronic diseases, inflammatory and tumor processes, problems with the endocrine system and other health pathologies;
autoimmune processes - conflict over Rh or blood group creates a false idea in the mother’s body about the fetus as a foreign object, and it is rejected by the uterus;
abdominal injury from a fall or blow;
Once placental abruption occurs, it increases the risk of this pathology occurring in subsequent pregnancies.

Symptoms of abruption at different stages of pregnancy

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

bleeding;
pain in the lower abdomen;
fetal heartbeat disorder.

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

When the abruption begins, the placenta is tense; when palpating it, there is painful sensations- the larger the area of detachment, the stronger the pain. It can be either constant or paroxysmal, radiating to the lower back, thigh and perineum.

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

If any of these symptoms appear, you should immediately consult a gynecologist. Timely medical care can stop the onset of placental abruption and correct its consequences.

Detachment in the first trimester

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

Detachment in the second trimester

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

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

Detachment in the third trimester

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

Detachment during childbirth

Typically, during childbirth, premature placental abruption occurs in the case of multiple or polyhydramnios pregnancy. Depending on the stage of labor, the doctor prescribes either a cesarean section (if the baby has not yet descended into the birth canal or labor is absent for some reason), or stimulation up to the application of pinches. Symptoms of abruption during childbirth:

tension in the uterus does not disappear even between contractions;
the fetal heartbeat is disrupted (increases or slows down);
V amniotic fluid blood or meconium is present.

Diagnostics

Diagnosis of placental abruption is carried out either on the basis of symptoms (the classic triad of signs of abruption - bleeding, pain in the lower abdomen, cardiac dysfunction in the child, or any others that suggest any pathology), or during routine examinations or screenings.

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

In addition to the ultrasound, the doctor also performs a gynecological examination to rule out other possibilities of bleeding.

The doctor will also listen to the fetal heartbeat to find out if hypoxia has begun.

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

Forecast

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

partial non-progressive - gives the maximum chance of positive resolution; the detachment is small and does not increase, the vessels are usually capable of self-clogging and stopping bleeding, as a result, the passage of the placenta from the uterine walls is suspended; often goes asymptomatically, pregnancy in the future can proceed as usual and without consequences;
partial progressive - an increase in the hematoma provokes an increase in detachment, the fetus suffers from hypoxia, the pregnant woman suffers from blood loss; urgent medical intervention is required until immediate delivery;
complete detachment - in this case, immediate death of the fetus occurs; its extraction is required to save the life of the mother.

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

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

Treatment

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

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

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

pregnancy period is less than 7 months;
there are no signs of hypoxia in the fetus;
the condition of the expectant mother and child does not cause concern;
the amount of blood lost is small.

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

The pregnancy period does not go smoothly for every woman, and no one can be immune from various pathologies. One of the most dangerous complications is placental abruption in early pregnancy. Fortunately, this pathology is not very common; according to statistics, no more than 1.7% of pregnant women are affected by it. About the nature of this disease, causes and symptoms, as well as preventive measures ah let's talk below.

The placenta is organ that connects the lining of the uterus and the fetus. It is formed in the second week () of pregnancy, when the fertilized egg is fixed in the uterus. The placenta reaches maturity only at , and until this moment it grows and forms.

The placenta has a complex structure, which is a plexus of the circulatory systems of the mother and fetus, between which there is a protective barrier. This kind of membrane protects the child from harmful substances , which can enter the mother’s body, and ensures the removal of waste products from the fetus.

Functions of the placenta:

Nourishing, excretory. Through the placenta, all substances necessary for development are supplied to the baby and waste products are removed.
Respiratory. The placenta allows oxygen to enter the baby's blood and then removes the resulting carbon dioxide from it.
Immune. The placenta allows antibodies from the mother's body to pass through to the fetus, which provides it with immunological protection.
Hormonal. The placenta produces hormones responsible for the development of a woman’s mammary glands and preparing them for milk production, the growth of the mucous membranes of the uterus, preventing the release of new eggs and a number of other functions.

What is premature placental abruption

Placental abruption- the process of separating it from the mucous membrane of the uterus. Can be partial or complete. During abruption, blood collects between the fetus and the walls of the uterus, pushing the placenta away from the walls.

This process is completely natural and occurs during the third stage of pregnancy. But it happens that under the influence of various unfavorable factors, placental abruption occurs ahead of time. We will talk about what the consequences of such a pathology may be below.

Placental abruption in different trimesters of pregnancy

Depending on the stage of pregnancy, the process of separation of the placenta proceeds differently and leads to different consequences.

First trimester. At this stage, it is important to quickly diagnose the pathology. Surgical treatment will help to completely avoid the consequences, and the subsequent growth of the placenta will compensate for the insufficient area of contact with the walls of the uterus. In this case, the complication will not have any harmful effects on the development of the child or the course of pregnancy.
Second trimester. During this period, the actions of doctors will depend on the specific stage of pregnancy. This is due to the fact that the placenta grows until the middle of the second trimester, and an increase in the area of the organ itself compensates for the abruption. If the pathology began to develop at the end of this period, then the only way to save the child - caesarean section.
Third trimester. Separation of the placenta in late pregnancy is considered the most dangerous, and with serious consequences, since the placenta loses its ability to grow and can be serious. Therefore, emergency delivery is usually performed. However, in some cases, with a small detachment, doctors can place the pregnant woman in a hospital, where, under constant supervision, she will be able to carry the child to term.

Causes of placental abruption during pregnancy

The reasons that cause abruption of a normally located placenta include:

gestosis and;
hypertension (high blood pressure);
increased capillary fragility;
chronic diseases of the genitourinary system;
abnormalities in the structure of the uterus itself;
post-term pregnancy;
previous multiple births;
placental abruption may be an allergic reaction to medications;
age of the woman in labor - than older woman, the higher the likelihood of pathology;
abdominal injuries (fall, blow);
chronic, hereditary and infectious diseases (for example, pyelonephritis).

There is also a number of factors, which can (but not always) cause pathology. Among them:

bad habits (drug addiction, smoking, alcoholism);
damage to the uterus due to past physical trauma;
formation of fibroids (benign tumor) in the area where the placenta is attached;
the presence of postoperative scars in the space of contact between the uterus and placenta.

Symptoms and diagnosis of placental abruption

Signs of placental abruption:

. This is usually the first symptom of pathology. The discharge may be copious or not very abundant, has a rich color, usually without clots. IN in rare cases detachment can begin without bleeding.
Dull pain in the lumbar region and... May have a paroxysmal form. When feeling the uterus, the woman feels pain.
Contractions that don't stop.
The activity of the fetus decreases, its heartbeat is disturbed.
Convulsions may occur.
A pregnant woman experiences severe weakness and may faint. Her skin turns pale and her sweating increases.

Primary diagnosis carried out based on the presence of the symptoms described above. To confirm the diagnosis or insufficient symptoms (no bleeding or pain) use. The images clearly show the area of detachment and the size of the resulting hematoma.

In any case, even if not all symptoms of the pathology appear, it is necessary seek medical help immediately. The sooner placental abruption is diagnosed, the higher the chance of saving the child.

Treatment of placental abruption not prescribed by a doctor in all cases. Great importance at the same time, it depends on the gestational age, the amount of bleeding and the health indicators of the woman and her baby. If time permits and the mother’s condition worsens, doctors prefer to perform a quick delivery. If placental abruption occurs in early pregnancy, drug treatment is performed.

But in cases where the area of detachment is small and the woman’s health is not in danger, it is prescribed treatment that includes:

mandatory bed rest;
medications that relax the uterus;
hemostatic drugs;
agents that have an antispasmodic effect;
drugs for anemia.

In addition, patients are constantly monitored for their condition, ultrasound examinations are performed (monitoring the fetal heartbeat and monitoring the tone of the uterus), Doppler measurements (measuring the speed of blood flow in the vessels of the uterus).

If treatment doesn't help and the condition of the expectant mother worsens, doctors usually perform an emergency caesarean section.

Many women, knowing about the possibility of premature placental abruption, think about how to avoid this. This issue is especially troubling for those who have already suffered this pathology in previous pregnancies.

Unfortunately, relapse of the disease in subsequent pregnancies is very high. After the first pregnancy with placental abruption, 17% of women experience a recurrence of the complication. And after two similar pregnancies– in 25%.

At the moment, there is no therapy that could completely protect a woman from this pathology. However, there is a number of preventive measures which will help reduce the risk of disease. Among them:

systematic visits to a gynecologist;
blood pressure tracking;
absence of mechanical injuries (falls, blows);
regular ultrasound examinations;
rejection of bad habits;
absence of allergic reactions;
timely treatment of diseases that arise during pregnancy;
absence of stressful situations.

What should a woman do if she has placental abruption? If the term is already long and there is not much time left before the birth, it is better to agree to a quick delivery. The fact is that the detachment may begin to progress, and this will threaten the child’s death.

If the end of the term is still far away, the condition of the mother and child does not cause serious concern, and the process of detachment is static, then it is better to postpone delivery. Here you need to proceed from the ratio of degrees of risk premature birth and possible progression of detachment. In this case, you can consult a doctor so that he can determine the degree of danger for the child and mother when choosing one or another solution.

Video about placental abruption in a pregnant woman

In the presented video you can learn more about what is placenta, what it consists of, what it looks like, what functions it performs. And also what changes occur in the placenta throughout the entire period of gestation.

You can talk a lot about the danger of placental abruption, the symptoms and ways to avoid this pathology, but these are just words. The most valuable thing in such situations is experience. Therefore, if among those reading this article there are women who have just encountered this situation or have already experienced it, share with us please!