Placental abruption at 34 weeks gestation. Serious complications during pregnancy: placental abruption

Premature placental abruption - too early, before the birth of the fetus, separation of the placenta from the uterine wall. This serious complication requires urgent medical attention.

Normally, the placenta is located on the wall of the uterus in upper divisions her body - at the bottom, back and front walls. Premature separation of the placenta in these cases is called premature detachment of the normally located placenta. Placental abruption can occur both during childbirth and during pregnancy. This complication threatens the life of the fetus, as well as the health and life of the mother due to bleeding.

The placenta is constantly under pressure from the muscles of the uterus on the one hand and the fetal egg with amniotic fluid on the other. The balancing of these two opposing forces, as well as the significant elasticity of the placental tissue due to its spongy structure, as well as the fact that the area of the uterine wall corresponding to the attachment of the placenta is reduced less, prevent premature detachment of the placenta.

Placental abruption is a serious diagnosis that complicates the course of pregnancy and directly threatens its favorable outcome. Is it possible to prevent this condition and what to do if detachment does occur?

The placenta is not in vain called the "children's place", because it is formed and functions solely in the interests of the unborn child. This unique organ appears in the body of a pregnant woman shortly after conception, and throughout pregnancy is the link between the mother and her unborn baby. The main tasks of the placenta include:

Providing the fetus with nutrition and oxygen. In fact, the placenta consists of a huge number of vessels intertwined with each other, through which the blood of the mother and the fetus she carries is constantly moving. It's from the mother's blood future child receives all the nutrition and oxygen it needs.
Removal of fetal waste products, which also occurs due to the close interaction of the blood vessels of the mother and child in the placenta.
Production of hormones. The placenta produces and releases a huge amount of hormones into the mother's blood, which help maintain pregnancy and prepare a woman for childbirth and breastfeeding.
Protecting the fetus from unwanted environmental influences. As the placenta forms, a hematoplacental barrier forms in it - a kind of filter, thanks to which many unnecessary and even harmful substances from the mother's blood do not enter the child's blood.

Important: Despite the presence of a hematoplacental barrier, the placenta is not able to protect the baby from the harmful effects of nicotine, alcohol-containing and narcotic substances, certain drugs and viruses .

What is placental abruption

Nature provides that the placenta should perform its functions of life support for the child until it is born. And only after the baby was born, the placenta spontaneously separates from the walls of the uterus and is born after it.

For a number of reasons, sometimes this algorithm fails, and the placenta separates from the walls of the uterus even before the birth of the child - in this case, we are talking about placental abruption.

Important: Untimely or premature placental abruption is diagnosed in approximately 1% of cases.

This pathology can overtake a future mother at any gestation period. But on later dates Premature abruption of the placenta is most dangerous during pregnancy, since the placenta at this time no longer grows and develops, which means compensating for the state of abruption naturally will not work. Doctors have to save the child's life with an emergency caesarean section. Otherwise, the consequences can become unpredictable, even fatal.

Important: Placental abruption is the main cause of intrauterine death, as it leads to the rapid development of acute oxygen starvation in the fetus.

Why does placental abruption occur?

Scientists have not yet identified a single factor that would unequivocally lead to the occurrence of placental abruption in late pregnancy. But numerous studies have confirmed that the risk of developing this pathology increases in the following cases:

high blood pressure in the expectant mother for a long time;
injury to the abdomen of a pregnant woman (as a result of an accident, accident);
diagnosed placental abruption in the past increases the likelihood of the same pathology up to 25%;
uterine abnormalities (eg, saddle shape);
anomalies of the placenta (previa, the presence of additional lobules);
pathology of blood clotting in a pregnant woman;
caesarean section in the past;
multiple pregnancy;
delayed pregnancy;
polyhydramnios;
a large number of births;
rapid childbirth;
the age of the pregnant woman is more than 34 years;
early and late toxicosis;
autoimmune and chronic endocrine diseases (lupus, diabetes mellitus).

Important: With a combination of 2 or more factors, the risk of developing placental abruption increases many times. Such women should be especially attentive to the state of their health during pregnancy.

Detachment symptoms

Depending on where the detachment occurred and how extensive it is, the symptoms can be of varying severity. But the main signs of placental abruption in a pregnant woman in any case are:

Uterine bleeding. It always occurs, since detachment is a break in the connection between the placenta and the wall of the uterus, which is accompanied by bloody discharge. Bleeding is external in most cases, and a pregnant woman can detect it almost immediately.

Important: If any bloody discharge from the vagina is detected, a pregnant woman should immediately consult a doctor.

In 20% of cases of placental abruption, there is no bleeding, since blood accumulates in the form of a hematoma between the placenta and the uterine wall. This is a very dangerous condition, since a growing hematoma puts pressure on the placenta and thereby exacerbates its detachment. In this case, the main symptoms of the pathology will be

Pain in the abdomen, its palpable tension. With internal bleeding, a hematoma occurs, which gradually increases in size and begins to put pressure on the wall of the uterus and peritoneum, irritating them and causing pain. If, at the same time, a pregnant woman also has a general malaise in the form of nausea, increasing weakness and dizziness, this is an alarming sign of possible internal bleeding. Contacting a doctor should be immediate!

On the part of the fetus, a symptom of placental abruption is a state of acute hypoxia or oxygen starvation. With a slight degree of hypoxia, the fetus begins to actively move. Thus, he, as it were, “massages” the placenta in order to increase the flow of oxygen and nutrients. As the degree of oxygen starvation increases, the child's movements become more and more rare, his cardiac activity is disturbed.

Important: If placental abruption is suspected, it is imperative to conduct a cardiotocographic study to assess the health of the fetus.

Detachment of the third part from the entire area of the placenta can lead to the death of the baby. With complete detachment of the placenta, intrauterine death of the fetus occurs almost instantly.

Diagnosis of placental abruption

This diagnosis rarely causes difficulties for doctors, since most often there are spotting from the genital tract of a pregnant woman, abdominal pain and increased tone uterus, signs of oxygen starvation in the fetus.

Ultrasound diagnostics is necessary in order to classify placental abruption on the following grounds:

Basis for classification	Types of placental abruption	Forecast
Time of occurrence	Early (up to 20 weeks)	Favorable, 80% deliver on time
	Late term (after 20 weeks)	Unfavorable, term delivery in 20%
	During childbirth	Adverse
Progression	progressive	Adverse
	Non-progressive (detachment has stopped)	Favorable
Area	Partial	Favorable when the detachment area is less than 25%
	Complete	Adverse
Localization	Marginal - the placenta is separated along the edge, pronounced uterine bleeding	Favorable with a small area of detachment
	Central - the placenta separates in the central part, uterine bleeding may be absent	Adverse
Severity	Mild - the symptoms are insignificant, there is no hypoxia on the part of the fetus	Favorable for the fetus
	Moderate to moderate maternal and fetal symptoms	Favorable
	Severe - the condition of the mother is severe, intrauterine death of the fetus	Adverse

Any spotting, abdominal pain, pronounced uterine tone, a significant deterioration in the well-being of a pregnant woman and a change in fetal activity should alert the expectant mother. If any of these symptoms appear, you should immediately seek medical attention. Self-medication during pregnancy can be simply criminal, since it is not only about the health of the woman herself, but also about the life of her unborn child.

In late pregnancy, especially if there are only a few weeks left before the birth, the onset of placental abruption is a direct indication for emergency delivery. In this case, this is the optimal outcome for the mother and child in order to avoid irreversible consequences for their health.

If placental abruption is minor and non-progressive, then doctors will try to create all the conditions for a pregnant woman to deliver her baby. In this case, only inpatient treatment is necessary under day and night supervision of physicians in compliance with strict bed rest. Monitoring the child's condition is carried out using dopplerometry and cardiotocography. Any negative changes in the condition of the mother or fetus may be an indication for an emergency caesarean section.

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

Placenta and its detachment

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

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

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

There are three degrees of placental abruption:

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

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

Symptoms:

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

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

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

Causes of premature placental abruption

Until now, experts still cannot name what are the causes of placental abruption. Previously, there was an opinion that a woman’s wrong lifestyle leads to this: for example, if she smokes, drinks or uses drugs, and also if her diet is not varied and future mom does not receive any vitamins, minerals and trace elements. But there is no scientific evidence that this is actually the case. However, scientists have good reason to believe that vascular problems, for example, late preeclampsia or arterial hypertension, lead to this defect. Often, placental abruption is a consequence of a stroke, for example, when a woman receives an abdominal injury. Sometimes there is placental abruption with polyhydramnios and with multiple pregnancy- immediately before childbirth or in childbirth. Doctors say that in this case, the cause of detachment is a sharp decrease in intrauterine pressure. By the way, not only their pathology can lead to the transformation of blood vessels, but also various ailments, such as hypovitaminosis or nephritis.

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

Treatment and prognosis

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

The placenta is the tissue surrounding the fetus, designed to exchange nutrients between mother and fetus. The condition when the placenta before childbirth exfoliates from the inner wall of the uterus, partially or completely, is commonly called premature detachment of the placenta. Placental abruption can cause hypoxia of the child (oxygen starvation) and cause heavy bleeding in a pregnant woman.

If you do not provide emergency medical care to a pregnant woman, then there is a real threat to life.

Symptoms

Most often, placental abruption occurs during the last 12 weeks before delivery. The classic symptoms of this condition are as follows:

Profuse bleeding;

Abdominal pain;

Backache;

Frequent spasms of the uterus (more than one spasm in 3 minutes).

Pain in the abdomen and back begins suddenly. Then the bleeding starts. The more the placenta is exfoliated, the more bleeding will be.

In some cases, the placenta may exfoliate slowly.

If you have at least one symptom, you urgently need to contact your doctor.

Causes of placental abruption

Very often, the cause of placental abruption cannot be established. I can only list the most common factors that increase the risk of developing this condition:

a history of placental abruption (if you had a placental abruption during a previous pregnancy);

High blood pressure (hypertension disease or the development of late toxicosis during pregnancy);

Abdominal injury (one of the most common causes);

Smoking and drug use;

Premature rupture of the fetal (amniotic) membrane;

Decreased blood clotting in a pregnant woman;

The age of pregnancy is over 40 years.

Complications

Placental abruption can cause life-threatening problems for both mother and baby.

A pregnant woman may have the following complications:

Shock due to blood loss;

Violation of blood clotting;

excessive blood loss;

Failure of the kidneys or other organs.

For a child, placental abruption can lead to the following consequences:

hypoxia;

Nutrient deficiencies;

premature birth;

Stillbirth.

What to do in case of placental abruption

Placental abruption requires urgent medical attention, so you are unlikely to be able to prepare for this problem in advance. However, try to follow these guidelines:

Keep track of any symptoms you experience and be sure to tell your doctor if there are any changes in your condition;

Tell your doctor about intolerance to any pharmacological drugs, if any;

If you smoked during pregnancy or used drugs, be sure to tell your doctor;

Ask the father of the child or someone close to you at this moment.

It is also advisable to ask the doctor some questions, the answers to which can calm you down:

What diagnostic procedures do I need to undergo?

Is there a real threat to me and my child?

What are the treatment options?

Do I need to be on bed rest?

What are the possible complications for me and my child?

Do I need a blood transfusion?

If you have any other questions for the doctor, feel free to ask.

Diagnostics

If there is a suspicion of premature detachment of the placenta, the doctor first of all conducts a gynecological examination. Ultrasonography (ultrasound) and laboratory blood tests may be required to determine the exact cause of bleeding.

Treatment

Treatment options will depend on the following circumstances:

- Pregnancy up to 34 weeks. If placental abruption is partial, hospitalization may be required. In some severe cases, doctors have to induce premature birth.

- Pregnancy over 34 weeks. Hospitalization is possible. If the detachment progresses, as a rule, a caesarean section is performed.

Prevention

Unfortunately, there is no specific prevention of placental abruption. However, you can reduce your risk of developing this condition by:

Do not smoke or use drugs during pregnancy;

If you have high blood pressure, take the medication prescribed by your doctor;

If you had a placental abruption during a previous pregnancy, be sure to tell your doctor about it so that he can monitor your condition more carefully.

Thanks

The site provides reference information for informational purposes only. Diagnosis and treatment of diseases should be carried out under the supervision of a specialist. All drugs have contraindications. Expert advice is required!

Premature detachment of a normally located placenta is a condition, the main symptom of which is the untimely separation of the placenta from the uterine wall. This occurs during pregnancy, or during childbirth, and not after the birth of the fetus, as it should be normal. Detachment in a general sense can be described as separation of the placenta from the uterine mucosa, which is accompanied by damage to the blood vessels of the uterus and placenta, and, consequently, bleeding of varying severity. This pathology occurs, according to various sources, in 0.5% -1.5% of all pregnancies.

Normally, the placenta separates from the uterus only in the third stage of labor. With premature separation of the placenta from the uterine wall, which occurs not after the birth of the child, but even during pregnancy or at the very beginning of childbirth, the uteroplacental vessels are almost always seriously damaged. This process leads to the fact that the child is deprived of access to oxygen and nutrients - a condition called fetal hypoxia develops. In addition, placental abruption may be accompanied by massive bleeding, which threatens the life of both the fetus and the mother. Placental abruption also increases the risk of abnormalities. physical development fetus, premature birth and death of the child in the womb. Unfortunately, according to statistics, placental abruption is one of the most common causes of stillbirths and neonatal deaths.

Why does placental abruption occur?

So far, medical science has not been able to unambiguously identify the factor causing the development of placental abruption. It is believed that this disorder is multifactorial - that is, a combination of several predisposing factors often leads to its appearance.

At the moment, there are a number of causes of premature placental abruption during pregnancy or childbirth:

High blood pressure (hypertension) in the mother is considered one of the most significant factors.
Sudden fluctuations in blood pressure that occur during neuropsychic influences or stress can lead to placental abruption. In addition, blood pressure may change when the inferior vena cava is compressed by the pregnant uterus. This condition can occur when you lie on your back for a long time.
The risk of placental abruption increases if the same pathology was observed during previous pregnancies.
Frequent or multiple births - premature detachment of the placenta is significantly more common in women who have given birth many times. This is associated with degenerative changes in the mucous membranes of the uterus.
One of the predisposing factors for placental abruption is post-term pregnancy.
The age of the pregnant woman - with its increase, the risk of placental abruption also increases. In addition, in women over the age of 34, the formation of an additional placental lobule is often observed. During childbirth, this additional lobule often comes off, which can lead to the development of detachment of the entire placenta.
The chance of placental abruption increases if the pregnant woman has already had at least one child by caesarean section in the past.
The risk of placental abruption increases if conception was preceded by a period of infertility.
Preeclampsia, gestosis and toxicosis, especially in the first trimester of pregnancy, are one of the important factors. This is explained by the fact that gestosis is manifested by an increase in blood pressure, edema, and the appearance of protein in the urine. In addition, with gestosis, especially in their severe forms, it is the vessels that suffer first of all: they become brittle and fragile.
Anomalies in the structure of the uterus (bicornuate or saddle uterus) can lead to placental abruption. In addition, an anomaly of the vessels located deep in the muscular layer of the uterus, changes in the vascular walls, an increase in their permeability, an increase in the fragility and fragility of the capillaries caused by the loss of their elasticity, as well as a violation of their patency for blood, are an important factor.
Anomalies in the location and maturation of the placenta itself during pregnancy can also lead to its rejection.
A possible cause of placental abruption may be disorders of the blood coagulation system, often accompanying various pathologies of pregnancy.
Placental abruption can also cause pathologies of labor. For example, a rapid drop in pressure in the uterus. More often this happens with polyhydramnios at the time of opening of the birth bladder, and the rapid outflow of water. Sometimes it can be caused by the birth of the first fetus in multiple pregnancy. Also, this pathology can occur with rapid childbirth. If the umbilical cord is shorter than usual, or the fetal bladder opened late, the placenta is pulled down by unruptured fetal membranes or a short umbilical cord, which leads to its detachment.
Blunt external trauma to the abdomen, such as a blow, a fall on the stomach, or a car accident, can lead to an acute condition and the occurrence of placental abruption.
In the development of this pathology, factors such as smoking, the use of a large number alcoholic beverages and also cocaine. The situation is even more complicated with the development of anemic conditions: anemia, a decrease in the number of red blood cells, a decrease in hemoglobin.
Placental abruption may be the result of an allergic reaction to drug therapy, to the transfusion of protein drugs or blood components. Occasionally, an autoimmune form of detachment occurs. In this case, the woman's body produces antibodies to its own tissues, and rejects them. This happens more often with extensive systemic diseases, such as rheumatism or systemic lupus erythematosus.
Diabetes mellitus and other hereditary and chronic diseases, infectious inflammations (for example, pyelonephritis), tumor processes, obesity, thyroid diseases, pathologies of the blood and hematopoietic system, etc. can lead to placental abruption. This is explained by the fact that the course of all these diseases can be considerably complicated and aggravated during pregnancy, which in itself is a serious test for the female body.

What are the symptoms of placental abruption?

Pathological changes that are associated with placental abruption are primarily in the appearance of bleeding that occurs due to damage to the uteroplacental vessels. Due to the fact that the placenta begins to separate, blood accumulates between the wall of the uterus and the placenta, and a hematoma is formed. Gradually increasing, the hematoma enhances the detachment of the placental tissue from the uterine wall, and as a result, this leads to compression and cessation of the functioning of the placenta, which is adjacent to this area.

Specialists distinguish mild, moderate and severe form of premature detachment of the placenta:
1. Lightweight often not associated with any distinct symptoms, and placental abruption is detected only by ultrasound, or after childbirth, when a small depression filled with dark blood clots is found on the maternal surface of the placenta.
2. Pathology of moderate severity manifested by abdominal pain and minor bloody discharge from the genital tract. Sometimes external bleeding may be completely absent. It depends on the size of the hematoma and the location of the violation. When palpating, a somewhat tense uterus is revealed, sometimes moderate local pain is noted. When listening, cardiac disorders in the fetus can be determined, which indicate its hypoxia.

3. Severe form placental abruption is manifested by sudden severe arching pains in the abdomen, dizziness, severe weakness, anxiety. Sometimes fainting may occur. Sweating, shortness of breath, increased heart rate, lower body temperature and blood pressure may occur. There is also pronounced pallor skin. The characteristic appearance of dark bloody discharge from the genital tract in moderate amounts. During the examination, the uterus is very tense and has an asymmetric shape: on the one hand, a protrusion is determined, which is very painful when palpated. In some cases, for example, with existing scars or dystrophic changes wall of the uterus, it may rupture. Parts of the body of the fetus are not palpable, and its heartbeat is not heard.

The classic clinical triad of signs of premature placental abruption is bleeding from the genital tract, pain and tension of the uterus, and disturbances in the activity of the heart in the fetus.

Uterine bleeding

In four out of five cases, vaginal bleeding is observed with placental abruption. It can have a different degree of intensity: abundant, insignificant, or completely absent. It depends on the placental abruption, the area of the pathological process and the general condition of the blood coagulation system.

Sometimes blood accumulates in the uterus behind the separated part of the placenta, which means that no bleeding may be observed. This most often occurs with central placental abruption, and is considered the most dangerous form of this pathology. Bleeding from damaged vessels does not stop, but has the character of internal or hidden. Blood is located between the uterus and the placenta - a retroplacental hematoma occurs. The placenta exfoliates in its central part, and its edges remain connected to the uterine wall. With a large area of detachment, extensive retroplacental hematoma and heavy bleeding, the outflowing blood impregnates the wall of the uterus. This leads to a violation of its contractile abilities, up to their complete loss. In addition, it is associated with massive blood loss during childbirth. Such a state is called couveler's uterus by the name of the author who first described this picture. In such cases, we are already talking about saving the life of a woman, so the dead fetus is usually urgently removed along with the uterus.

With marginal or partial abruption of the placenta, bleeding may be visible or external. External bleeding is most often secondary, and not as profuse. It is believed that its appearance can prevent the further development of placental abruption. This is due to the fact that if the area of the site of placental abruption is small, then after the occurrence of a retroplacental hematoma, thrombosis of damaged uterine vessels occurs, leading to a stop of further detachment. The scarlet blood that stands out from the vagina indicates a placental abruption that has just occurred. If the spotting is dark in color, and the presence of clots is noted in them, this means that some time has passed between placental abruption and the onset of bleeding.

Mixed (internal-external) bleeding can also be observed. In this case, there is both latent and visible bleeding. With premature detachment of a normally located placenta, it is almost impossible to accurately determine the amount of blood lost. The amount of external bleeding is usually estimated, and clinically doctors are guided by the general condition of the woman and the reaction of her body to blood loss: changes in pulse, pressure, etc. It must be remembered that the absence of bleeding during placental abruption cannot be regarded as the absence of symptoms, since it can be completely hidden.

Abdominal pain and uterine tension

With premature detachment of the placenta, in the vast majority of cases, the presence of pain is noted. This pain is often characterized as dull, often paroxysmal, and may radiate to the thigh, perineum, or lumbar region. When palpated, the uterus is painful, while the pain can be strictly local, or it can be diffuse. Usually, the pain will be more pronounced in the presence of internal bleeding. In connection with the formation of a retroplacental hematoma, a local swelling is formed that stretches the uterine wall, and there is a rapidly increasing pain, which gradually spreads to the rest of the uterus. Also, when feeling, the tension of the uterus is determined, and its dense consistency is noted.

Violation of the activity of the heart in the fetus

This condition progresses in proportion to the increase in the area of placental abruption and the increase in the volume of blood loss in the mother. Listening to this symptom indicates the development of fetal hypoxia. Its signs appear with detachment of more than a quarter of the total area of the placenta. If the pathological process captures a third of the total area of the placenta, then the fetus experiences an already threatening oxygen deficiency. And detachment of more than half of the area of the placenta in most cases leads to intrauterine death of the fetus.

Placental abruption at different stages of pregnancy

Placental abruption has different clinical manifestations depending on the gestational age at which it occurred.

Premature abruption of the placenta in the early stages

Placental abruption in the first trimester is quite common, but with timely diagnosis and treatment, it can be prevented in most cases. Most often, a retroplacental hematoma is formed, which is clearly visible during ultrasound. In this case, there will be no selections. Provided that preserving pregnancy and hemostatic therapy are prescribed in a timely manner, the pregnancy will continue to develop normally. The placenta that continues to grow over time is able to fully compensate for the lost area of contact with the uterine wall, and the transferred complication will not affect the health of the unborn child in any way.

Placental abruption in the second trimester

With placental abruption in the period from 12 to 27 weeks of pregnancy, tension and high muscle tone of the uterus are also added to the symptoms described above. If fetal hypoxia begins, then with a lack of oxygen, the child can activate its movements in the womb to accelerate blood flow, and hence the supply of fresh oxygen with the blood. During this period, much depends on the specific gestational age, since the placenta is able to continue its growth until the middle of the second trimester, and due to this, it can compensate for the lost area of contact with the uterus. At a later date, the question of an emergency caesarean section is raised, which is necessary to prevent fetal death from progressive hypoxia.

Detachment of the placenta in the later stages

Placental abruption is most dangerous in the third trimester of pregnancy. The placenta no longer has the ability to grow, which means that all its compensatory possibilities have already been exhausted. In such a situation, immediate delivery is indicated for health reasons. But it should be noted that a non-progressive partial placental abruption in the absence of bleeding sometimes allows you to carry a pregnancy in a hospital and under close medical supervision.

Placental abruption during childbirth

With polyhydramnios or multiple pregnancy, placental abruption can occur directly during childbirth. In such cases, depending on the stage of labor, either they are stimulated (up to the use of forceps), or, if there is no labor activity, they proceed to delivery by caesarean section. At the first stage of labor, premature detachment is most often manifested by bloody discharge with clots. At the same time, with external bleeding during contractions, the release of blood does not increase, but, on the contrary, stops. There is a pathological tension of the uterus, it does not relax completely between contractions. During vaginal examinations, the tension of the fetal bladder is also determined, and when it is opened, the outflowing fetal waters are stained with blood. There may be signs of fetal dysfunction: increased or slowed heart rate, and in amniotic fluid in addition to blood, impurities of meconium, the primary feces, may appear. Often, the appearance of these symptoms is the only sign of the onset of premature placental abruption in the second stage of labor.

Remember that even minimal placental abruption is a reason for immediate hospitalization and the start of conservation therapy!

It is necessary to immediately consult a doctor, or even immediately go to the hospital, if the following symptoms appear:

vaginal bleeding or discharge;
uterine pain, pain in the lower abdomen or in the back;
very frequent or long-lasting contractions;
no movement of the baby in the womb.

Diagnosis of placental abruption

Diagnosis of this pathology is usually not difficult. Its clinical manifestations are most often extremely unambiguous, and in difficult cases resort to the use of ultrasound. Diagnosis is based primarily on the detection of bloody discharge from the genital tract during childbirth or during pregnancy. This is usually accompanied by an increase in tone and a change in the shape of the uterus, as well as abdominal pain in combination with signs of progressive fetal oxygen deficiency. When diagnosing, the patient's complaints, her medical history, as well as the results of objective, instrumental and laboratory examinations are taken into account.

The doctor measures the fetal heart rate and performs ultrasound procedure. With the help of ultrasound, it is possible to unambiguously confirm the presence of placental abruption, determine its area, as well as the volume and location of the retroplacental hematoma. A very small placental abruption on ultrasound may not be diagnosed, but often this examination can determine the presence of blood clots behind the placenta. This helps to distinguish between placental abruption and placenta previa, another common cause of bleeding.

Since the bleeding may not be uterine, the doctor examines the vagina and cervix to determine if infections, cervical tears, polyps (benign growths) on the cervix, or anything else caused the bleeding. The doctor also evaluates for dilatation of the cervix, which can damage small blood vessels and cause bleeding.

From the point of view of diagnosis, there are 3 types of placental abruption:
1. Partial non-progressive premature detachment of the placenta begins in a small area after the formation of a hematoma. In such cases, blockage of damaged blood vessels often occurs, bleeding stops and the progression of detachment stops. Pregnancy and childbirth can be completely normal. Minor and non-progressive placental abruption may not manifest itself clinically at all, and it is recognized only after delivery. In the process of examining the maternal surface of the placenta, after its birth, a small blood clot of a dark red color or a slight depression is found.

2. With partial progressive placental abruption, the process develops, the hematoma increases in size, and the course of pregnancy and subsequent childbirth become pathological. Dangerous for the fetus is the detachment of one quarter of the total area of the placenta. With an increase in the area of detachment to one third, severe hypoxia of the fetus develops, and there is a threat of its intrauterine death. With detachment of half the area of contact of the placenta with the uterine wall, this outcome becomes almost inevitable. Of course, in such conditions, a pregnant woman also suffers greatly. Bleeding from damaged vessels of the exfoliated part of the placenta is constant, which means that a woman loses a lot of blood. The consequences of massive blood loss gradually increase up to the development of hemorrhagic shock. Often it is possible to cope with the situation only by resorting to urgent delivery.

3. In rare cases, there is complete or total abruption of the placenta over the entire area of contact with the wall of the uterus. IN similar situations there is an almost immediate death of the fetus, since any gas exchange between the mother's body and the fetus is completely stopped.

What to do with placental abruption?

If the expected date of delivery is not far off, then it is necessary to give birth immediately, even if the detachment is insignificant. The process can begin to progress at any time, and this may threaten the loss of the child. In most of these cases, delivery is by caesarean section. But if the bleeding is not very heavy and, according to the doctor and ultrasound data, it is caused by a detachment of a small enough area, and the baby and you feel fine, you may be allowed to give birth naturally.

If the doctor has diagnosed a small detachment of the placenta, but the baby is still premature, and there is no further bleeding, then the birth should be postponed. In this case, you and your doctor need to weigh the ratio of the risk of preterm birth and the risk of progression of detachment. You need to stay in the hospital to be under the constant supervision of specialists. This will allow doctors to go into labor right away if the detachment gets worse or the baby or you feel worse.

Treatment of premature placental abruption

Therapy for premature detachment of a normally located placenta is based on the choice of the method of the most rapid and gentle delivery. In addition, it is necessary to simultaneously carry out activities aimed at combating blood loss, shock, as well as replenishing factors that increase blood clotting.

Obstetric tactics when choosing a method of delivery will be determined by three parameters:
1. The time of detachment - whether it occurred during pregnancy, or already in childbirth.
2. The severity of bleeding and the amount of blood loss.
3. General condition of mother and fetus.

Prolongation of pregnancy in a hospital setting is possible, but only if the following conditions are met:

placental abruption is partial, small in area and does not progress;
pregnancy is less than 36 weeks;
both the pregnant woman and the fetus feel well, and there are no signs of oxygen starvation of the fetus;
the total amount of bleeding is small.

In this case, it is necessary to carefully monitor the condition of the placenta and fetus. To this end, it is necessary to conduct regular ultrasound examinations, dopplerometry And cardiotocography . It is also necessary to carefully monitor the condition of the woman's blood coagulation system using laboratory tests. The patient is placed on bed rest.

In addition, the following drugs are used in the treatment of placental abruption:

medicines that relax the uterus (tocolytic therapy);
antispasmodics (papaverine, no-shpa, magnesium sulfate, metacin, etc.);
hemostatic agents (ascorbic acid, vikasol, decynon);
therapy aimed at combating anemia (iron preparations).

Comorbidities and complications should be treated without fail.

If repeated, even the most insignificant blood discharges appear in the hospital, which indicate the progression of detachment, then expectant tactics should be abandoned even if the patient is in a satisfactory condition. In such cases, the issue is usually resolved in favor of the use of an emergency caesarean section. The basis for surgical intervention are vital indications from both the fetus and the mother. If the woman's birth canal is already mature (the cervix is softened and shortened, and the cervical canal is passable), then an artificial opening of the fetal bladder is performed, and it becomes possible to give birth through the natural birth canal. But in most of these situations, emergency delivery still takes place by caesarean section.

If the pregnancy is full-term, and the placental abruption area is small, then the question of natural delivery is raised immediately. The situation is facilitated by the presence of a mature birth canal - at the first stage of childbirth, the fetal bladder is opened. This causes a decrease in intrauterine pressure, which prevents further placental abruption.

In any case, childbirth should be carried out under close supervision of the cardiac activity of the fetus, as well as the contractile activity of the uterus. In case of increased bleeding, deterioration of the fetus, increased uterine tone in the intervals between contractions, or deterioration of the mother's condition, they urgently proceed to a caesarean section. If the birth took place naturally, then immediately after the birth of the child, it is necessary to conduct a manual examination of the uterine cavity. In the afterbirth and early postpartum periods, bleeding prevention is used using drugs that increase uterine contractions (oxytocin, prostaglandins, methylergometrine).

Simultaneously with delivery (by natural childbirth or caesarean section) carry out the following activities:

restoration of the volume of lost blood;
combating the manifestations of shock (maintaining the functions of the respiratory and cardiovascular systems, anesthesia, etc.);
antianemic therapy;
restoration of blood clotting disorders by transfusion of fresh donor blood or its preparations (fibrinogen, fresh frozen plasma, platelet mass, etc.).

If premature placental abruption progresses, has a severe course, and it is impossible to perform an urgent delivery through the natural birth canal, then it is necessary to proceed immediately to an emergency caesarean section without hesitation. When performing this operation, it is necessary to free the uterine cavity from blood and clots immediately after the extraction of the fetus and placenta. Next, the doctor must carefully examine all the uterine walls in order to assess the condition of the muscle layer. If the muscles of the uterus are already saturated with blood, then the uterus is removed, as it will become a source of further bleeding.

Pregnancy after placental abruption

Many women who have had a placental abruption during a previous pregnancy are wondering: how to avoid the recurrence of this complication in the next pregnancy?

The percentage of recurrence of placental abruption in subsequent pregnancies is very high. The frequency of such cases ranges from 5 to 17%. In a situation where a woman had placental abruption during two previous pregnancies, the possibility of her recurrence is about 25%. Unfortunately, at the moment, a therapy regimen has not yet been developed that would prevent placental abruption during the next pregnancy, or at least be able to reduce the percentage of relapses.

What threatens placental abruption, and is it possible to somehow prevent it?

Depending on the area of detachment, the severity of blood loss and the severity of the course of the process, this complication can either resolve imperceptibly or pose a serious threat to the life of the fetus and mother.

The best method for preventing this pathology will be to identify all possible risk factors at the very early stages of pregnancy, and take all available measures to eliminate them.

Control your blood pressure. If you have hypertension, try to treat it as effectively as possible. Your healthcare provider will prescribe blood pressure medicines that are safe for your baby.
Be sure to attend all scheduled examinations in the antenatal clinic. Periodically undergo an ultrasound examination.
If you are Rh negative and the baby's father is positive and you experience vaginal bleeding during the second or third trimester of your pregnancy, you will need to inject anti-D immunoglobulin to prevent Rh incompatibility.
Do not smoke, do not use drugs, and limit your alcohol intake.
Strictly observe all safety requirements, be sure to buckle up in the car. The cause of the onset of placental abruption can be the most minor injuries at first glance.
If complications or exacerbations of chronic diseases occur, it is necessary to start their treatment as soon as possible. Specialists pay special attention to pregnant women with late toxicosis. At 36-38 weeks of pregnancy, patients with a similar complication must be hospitalized in the maternity hospital without fail.

Prevention of placental abruption

Among the most significant preventive measures, which are aimed at preventing premature placental abruption, the following can be distinguished:

thorough professional examination, diagnosis and therapy of inflammatory, degenerative and any other pathological processes in the uterus and pelvic area with mandatory monitoring of the effectiveness of treatment;