Among the questions frequently asked by pregnant women, in particular, on the website www.site, those related to placental abruption - a normally located and pre-existing fetus - a significant amount. Apparently, for everyone who does not even know the terminology, the phrase is associated with an emergency, difficult situation. And this is true.
  Placental abruption is a complication of pregnancy that occurs both in the process of it and in childbirth. In the general case, placental abruption is a premature separation of the placenta from the uterine mucosa, proceeding with damage to the uteroplacental vessels and bleeding of one or another localization and severity. The detachment is marginal - along the edge of the placenta - in this case, blood is poured out and all this does not go unnoticed. The blood that has just separated will be scarlet, coagulated - dark. A small detachment does not affect the condition of the fetus, it continues to receive the necessary oxygen and nutrients from the mother's body. Significantly more dangerous due to the difficult diagnosis, the detachment that happened in the center of the placenta, when the spilled blood accumulates between the uterus and the placenta without finding a way out, is called a retroplacental hematoma. It contributes to further detachment, blood permeates the layers of the uterus through and sometimes even pours out into the abdominal cavity. You can detect the process when you feel the uterus, an ultrasound scan, in addition, any detachment of the placenta is accompanied by pain, sometimes significant, and any bleeding - by paleness, weakness, acceleration of the pulse - by tachycardia. With the onset of suffering, the fetus also changes the frequency of its heartbeats. Detachment of one quarter of the placenta is considered dangerous for the fetus. With an increase in area to one third, we can talk about intrauterine death of the fetus, with detachment of half this becomes inevitable. Of course, the mother suffers greatly, since the vessels of the exfoliated part of the placenta gap, the woman loses a lot of blood with all the ensuing consequences, up to hemorrhagic shock. It is clear that such bleeding can be stopped only by urgent delivery.
Why is there a formidable complication? Often this happens “like a bolt from the blue” and it seems that nothing portended trouble. This also happens, although there are some "harbingers" of the disaster, they only need to be seen.
  It contributes to the detachment of the placenta of gestosis, especially their severe forms - after all, it is the vessels that suffer, they become fragile and brittle. Possible coagulation disorders of the blood, also accompanying the pathology of pregnancy.
  Of course, a direct injury to the abdomen during a fall, injury, accident can lead to an acute condition. There is a sudden severe stress. It is useless for the mother's vessels to smoke, excess alcohol and medications, more often in combination with anemia and other factors. Placental abruption can be an allergic reaction to transfusion of protein preparations, blood components, which pregnant women sometimes have to do. Rarely, an autoimmune form is found - the production of antibodies to own tissues, for example, with rheumatism or lupus erythematosus. In addition, a small pathology of labor can also cause placental abruption - a rapid outflow of water when the fetal bladder is opened and a subsequent pressure drop, rapid delivery with a short umbilical cord, sudden jumps in arterial or venous pressure - “lower vena cava syndrome”.
  Diagnosis of placental abruption usually does not present difficulties, its clinic is unambiguous and visible, in complicated cases they use ultrasound.
  From the point of view of treatment - it all depends on the period of delivery and the degree of detachment of the placenta. Sometimes small clots on the placenta are found only after childbirth. Sometimes massive bleeding requires the involvement of resuscitators, several surgical interventions with organ amputation and has the most serious consequences for the health of the mother and the life of the child - you need to know this in order to navigate in terms and not refuse the most obscure, undesirable measures offered by doctors in the event of a vascular catastrophe .

The organ that occurs during pregnancy in the uterine cavity and binds the organisms of the mother and the fetus is very important. The placenta is responsible for the biological processes of the child, so that he has the opportunity to develop normally in the tummy. The health and life of the baby depends on this organ, so placental abruption in the early or late gestation is considered a dangerous phenomenon, the diagnosis and treatment of which is best done as soon as possible.

What is placental abruption

The condition, the main symptom of which is untimely rejection of the child's place from the uterine membrane, is called premature detachment of the placenta. Pathology can develop both during pregnancy and in the process of labor. Normally, the placenta is separated only after the birth of the baby. Premature detachment is accompanied by damage to blood vessels, which causes uterine bleeding of varying severity. A dangerous complication occurs in 0.5-1.5% of cases of pregnancy and, according to statistics, develops more often in primiparous women.

Pathology, as a rule, develops in premature birth and always requires urgent medical intervention. The condition of the child's place determines the development of the fetus or its death. Normally, the organ is located on the uterine wall in the upper part of the uterus (at the front and back walls or at the bottom), otherwise placenta previa is diagnosed - its incorrect location. On the one hand, the uterine muscles press on the latter, on the other, the fetus and amniotic fluid. Normally, the pressure balance prevents premature organ detachment.

Symptoms

The pathological process is accompanied by bleeding due to damage to the uterine and placental vessels. As a result, the placenta begins to separate, blood between it and the uterine wall accumulates and a hematoma forms. Gradually, it increases in size and causes the progression of detachment, which entails compression and organ dysfunction. Doctors distinguish three degrees of severity of premature placental abruption, each of which is characterized by certain symptoms:

1. The mild form, as a rule, does not have distinct signs, therefore pathology can be diagnosed only during a planned ultrasound scan or after childbirth, when a slight deformation (depression) filled with blood clots is found on the surface of the bladder.
2. Signs of placental abruption of moderate severity are characterized by abdominal pain and small spotting from the genital tract. In some cases, external bleeding is generally absent, which depends on the size of the hematoma and the localization of the site of the violation. Palpation reveals a slightly tense uterus, sometimes there is moderate soreness.
3. The severe form of detachment is characterized by sudden intense pain in the peritoneum, severe weakness, dizziness, and a sense of anxiety. Sometimes women experience fainting, possibly increased sweating, decreased body temperature and blood pressure, increased heart rate. In addition, as a rule, pale skin and the appearance of dark spotting from the vagina are noted. During the examination, the uterus is tense and has an asymmetric shape (there is a protrusion on either side, pressing this area causes pain). Parts of the fetal body are not palpable, and the heartbeat is not heard.

Causes of placental abruption

It is extremely difficult to determine which factor caused the partial or total detachment of the child's place. It is believed that this pathology occurs due to the presence of several negative aspects and predisposing factors. To date, doctors identify the following possible causes of detachment of the placenta during pregnancy and childbirth:

• hypertension in the mother, strong fluctuations in blood pressure during stress and neuropsychic influences (sometimes pressure changes occur due to compression of the inferior vena cava, which occurs with prolonged lying on the back);
• pathology has already been observed in a previous pregnancy (while the risk of premature rejection of the placental bladder increases);
• multiple or frequent births (detachment is observed in women who have given birth several times, which is associated with changes in the uterine mucosa);
• post-term pregnancy;
• pregnant age (the older the woman, the higher the risk of pathology);
• period of infertility before conception;
• toxicosis, gestoch, preeclampsia, especially in the first trimester of the term;
• anomalies in the structure of the uterus;
• vascular diseases located deep in the muscle layer of the uterus, changes in the walls of blood vessels, increased permeability, impaired blood patency;
• abnormalities of maturation and location of the placenta;
• bleeding disorder;
• pathology of labor activity (a rapid decrease in pressure in the uterus, which, as a rule, occurs when the labor bubble opens or a rapid outflow of water);
• quick birth;
• late opening of the fetal bladder;
• short umbilical cord;
• blunt external trauma to the abdomen (due to a fall, shock, etc.);
• bad habits, addiction (drinking, smoking, taking drugs);
• anemia, a decrease in hemoglobin levels, the number of red blood cells;
• an allergic reaction to medications, transfusion of blood components or protein preparations;
• autoimmune factors (occasionally the female body produces antibodies to tissues, after which their rejection begins; as a rule, this occurs in the presence of systemic diseases such as rheumatism or lupus);
• diabetes mellitus, other hereditary, infectious or chronic diseases;
• obesity, the presence of tumors, etc.

Manifestation at different stages of pregnancy

Detachment of the placental sac is the process of its separation from the uterine wall, while a complete and partial detachment is isolated. In the course of the pathological process between the fetus and the walls of the uterus, blood accumulates, which repels the afterbirth. This process is natural and occurs in the last trimester of pregnancy, however, under the influence of various negative factors, detachment can occur ahead of time.

Detachment of the placenta in the early stages

In the first trimester, the pathological process is diagnosed relatively often, but with timely detection and treatment, negative consequences can be prevented. As a rule, the cause of placental abruption is a retroplacental hematoma, which is visible during ultrasound examination. Detachment of the placenta in early pregnancy is not accompanied by discharge. With adequate and timely therapy, there is no threat to mom or baby. The continued growth of the placenta gradually compensates for the lost area and the complication does not affect the health of the child.

In the second trimester

Placental abruption from 13 to 26 weeks of gestation is characterized by tension and high tone of the uterine muscles. At the onset of fetal hypoxia, the baby can begin to move more actively in the fetal bladder, which stimulates the acceleration of blood flow and, as a result, the supply of fresh oxygen. At this time, the positive outcome of the pathology depends on the gestational age, since the placenta can continue to grow until the middle of the second trimester, thereby compensating for the area of \u200b\u200bcontact with the uterus. In the later stages, the question arises of emergency caesarean section.

Placental abruption in late pregnancy

The most dangerous is the premature detachment of a normally located placenta in the third trimester of the term. This is due to the fact that the body no longer grows, therefore its compensatory capabilities are absent. In this case, patients are shown operative delivery according to vital indicators. Nevertheless, progressive partial placental detachment with minor bleeding or their complete absence sometimes allows you to deliver the fetus in a hospital and under the supervision of a doctor.

At birth

Pregnancy complications such as polyhydramnios or multiple births increase the risk of detachment of the child's place during labor. In this case, depending on the stage of childbirth, the doctor decides to stimulate them (up to the use of forceps) or, if there is no labor at all, do a cesarean section. At the first stage, premature exfoliation is manifested, as a rule, by bloody discharge with clots. With external bleeding during contractions, blood loss does not increase, but stops.

In women with placental abruption during labor, uterine tension is observed, which does not weaken between contractions. When examining the vagina, the doctor determines the tension of the fetal bladder, at the opening of which the stained fetal water is detected. In addition, there may be signs of impaired fetal functioning, for example, a slowdown or increased heart rate. In the amniotic fluid, an admixture of meconium (primary feces) is sometimes found. Such symptoms are evidence of premature placental abruption in the second stage of labor.

Diagnosis of placental abruption

If there are symptoms of marginal or central detachment, an examination is carried out to confirm the diagnosis. The main method is ultrasound, due to which it is possible to establish the area of \u200b\u200bthe part of the placenta that has departed from the uterine wall and the size of the retroplacental hematoma. In addition, a blood test and gynecological examination are performed. It is important in the process of diagnosis to establish the condition of the fetus, whether he is alive. During the examination, the doctor can establish one of 3 possible diagnoses:

• partial progressive (the uterine vessels burst, the size of the hematoma gradually increases, as a result of which the woman loses a lot of blood, which can lead to hemorrhagic shock; in this case, urgent delivery is indicated);
• non-progressive partial (minor marginal detachments are often accompanied by blockage of blood vessels, as a result of which bleeding stops, as does the further passage of the child's place from the uterine wall; while pregnancy can proceed normally, and the baby is born healthy);
• total detachment (the forecast is disappointing - the fetus dies almost immediately, since gas exchange between him and the mother stops).

How to treat detachment

If premature placental rejection is detected, the doctor is faced with the task of choosing the appropriate treatment method aimed at increasing blood coagulation, combating blood loss, and shock. Therapy of placental detachment in the early and later stages of pregnancy depends on such factors:

• pathology development time;
• volume of blood loss, intensity of bleeding;
• general health of the baby and mother.

The doctor may refuse the option of surgical delivery if:

• a small portion of the placenta exfoliated and this condition does not progress;
• the term is not more than 36 weeks;
• no signs of hypoxia in the child;
• the discharge has stopped, the amount of blood loss is negligible;
• the woman feels well and is under the supervision of doctors in a hospital.

The patient with the detachment of the placenta must observe bed rest, while the state of her health is subject to constant medical supervision. Ultrasound, dopplerometry, cardiotocography, and blood coagulation, which is determined by laboratory tests, should be regularly performed. With placental detachment, such drugs can be prescribed:

• hemostatic agents;
• antispasmodics;
• medicines relaxing the uterus;
• hormones;
• remedies for the treatment of anemia.

Consequences for the child

Premature placental abruption is a common cause of stillbirth in the last weeks of pregnancy. About 15% of children die from this pathology. The cause of death is the serious violations that the fetus faces as a result of the separation of the placenta. These include hypoxia (oxygen deficiency) and other problems caused by prematurity in case of premature labor. The consequence of the pathology often becomes neurological disorders and a lag in the development of the child.

Preventative measures

There are no methods that are guaranteed to help the normal attachment of the placenta at conception. The causes of placental abruption are difficult to determine, so you can only try to reduce the risk of pathology using the following measures:

• when planning pregnancy, a woman is recommended to undergo a full examination, in which her fertility, the presence of any diseases and infections in the body that are treated before pregnancy begins;
• during gestation, you need to regularly undergo examinations, visit a doctor;
• any medication is allowed to be taken only with the consent of the doctor;
• a pregnant woman needs to avoid injuries, abandon bad habits, monitor her own health;
• a woman is recommended to regularly walk in the fresh air, eat right, and avoid stress.

Video

A placenta is a very important organ that initially develops from the same cells as the baby himself. Until 11-16 weeks, it is called the chorion, the villous shell of the embryo: its villi penetrate the thickness of the uterine wall, oxygen and food are delivered to the baby through it, and its waste products and carbon dioxide are removed. After this period, a full-fledged placenta is formed, which also has many villi, but, in addition to nutrition, it also produces hormones (in particular, progesterone) that help maintain pregnancy (until the formation of the placenta, this function performs

The placenta does not have a contractile function, but attaches to the uterus - a strong and large muscle, which even before the onset of labor periodically briefly “trains”, which is expressed in the reduction of its individual sections for a short period of time. Usually, the placenta adjusts to these movements, and nothing happens to it, but sometimes a situation arises when its larger or smaller portion exfoliates from the uterine wall. Then the fetus suffers, as its nutrition is disturbed. In addition, this condition can lead to the death of the mother and fetus, so the symptoms of placental abruption should be brought to the attention of both pregnant women and their families.

What is placental abruption?

Normally, the placenta should attach closer to the top, that is, the bottom of the uterus, usually along its posterior wall, but sometimes it is located closer to the exit - the cervical canal. This is called It can be full or central when the child's place is on both sides of the exit from the uterus, blocking the exit from it. It may also be that the placenta is just a little lower than necessary. Such placentation is predisposing to detachment.

Thus, a normally located or pre-existing placenta can exfoliate. The symptoms of placental abruption depend on how it is located.

Also, manifestations will depend on such factors:

Detachment continues or she was able to stop;

Where did it separate from the uterine wall - in the center or on the edge;

In what periods of pregnancy or even childbirth such a condition developed: placental abruption in the early stages, if a very small portion of it has departed from the uterine wall, has a mild course and a favorable prognosis, since subsequently the child's place will still grow and develop, and it is likely that the defect will close and “outgrow”.

The main are three signs:

1) Bleeding from the vagina of varying intensity.

2) Pain in the abdomen, its lower sections.

3) Signs of fetal suffering: a change in heart rate, an increase or decrease in its motor activity.

Symptoms depending on the clinical situation are as follows:

I. If there is an abruption of the placental placenta from the edge, there is mainly only bleeding, pain almost does not occur. If such a small area exfoliates, the fetus does not suffer.

II. If the placenta, wherever it is located, exfoliates in the central area, and the bleeding stops (that is, non-progressive detachment), then there may be no symptoms. A woman will find out about this case on an ultrasound scan or, after the fact, a little brown blood is released after the fact.

III. If the detachment of a normally located placenta in the marginal segment exfoliates, two of three symptoms may be present: bleeding and pain. If bleeding does not stop, then the fetus begins to suffer, contractions and (or miscarriage, if it is a placental abruption in the first trimester) can begin.

IV. When the detachment of the central part of the placenta occurred, blood accumulates behind the placenta. This is called a retroplacental hematoma. It by itself, even if the bleeding has stopped, is able to exfoliate the placenta further. As a result, a significant area, and even a whole placenta, can exfoliate. Blood with such a partial detachment does not always stand out. Then the symptoms of placental abruption are: weakness, pallor, palpitations of a woman, she feels pain in the abdomen, tension of the uterus, the baby first moves more often, then it can calm down altogether. With further impregnation of the walls of the uterus with blood from the hematoma, the pain intensifies, the uterus does not relax. If the blood finds a way out, it pours out of the vagina.

V. The placenta can exfoliate during childbirth. Then bleeding also occurs, clots may be released. The uterus does not relax well beyond contractions; if the fetus suffers, then its dark cal - meconium is secreted. These signs should be noted by obstetrician-gynecologists

What if you think your placenta has exfoliated?

With any discharge, even if it is a brown "daub", you must take a horizontal position and inform your gynecologist who is watching you. If scarlet blood is secreted, you must lie down immediately, do not even get in the toilet, be sure to call an ambulance and ensure maximum peace. If the child (by ultrasound) developed normally, you do not have severe gestosis or chronic pathology, there is a high probability that you will stop bleeding with the strictest bed rest, and then the help will come in time. in case of placental abruption does not mean that you can get up, you have to go to the toilet even on the vessel for several days.

Detachment of the placenta (abbreviated OP) is one of the most serious and dangerous complications that can be encountered during pregnancy. At the first symptoms of detachment, the expectant mother should immediately seek medical help, otherwise the consequences can be the most unpredictable and sad.

In the next article, we will try to answer all the basic questions related to this pathological condition of pregnant women.

  The placenta and its role in pregnancy

The placenta can be called a unique organ consisting of connective tissue, which appears in the body of a woman only during pregnancy. She connects the mother and her unborn baby, and is also responsible for all the biological processes necessary for his vitality and further development.

More precisely, the placenta performs the following functions:

• Nutritious. All the nutrients necessary for normal growth, the baby receives it through the placenta.
• Gas exchange. Despite the fact that the child’s lungs develop only towards the end of the second trimester, he urgently needs oxygen, which also enters his body through the placenta. In addition, with the help of this organ, carbon dioxide is transferred from the child to the mother - all these vital processes for the baby are called gas exchange.
• Hormonal. For the normal course of pregnancy, the mother should maintain a normal level of certain hormones (hCG, prolactin progesterone, placental lactogen, etc.), for which the placenta is responsible.
• Protective. The body provides the so-called placental barrier that protects the baby from various infections and diseases.

Based on the foregoing, we can conclude that

without the normal functioning of the placenta, the development and even the life of the baby in the mother’s womb is simply impossible.

  What is detachment of the placenta and what is its danger?

Normally, the placenta is attached to the uterine wall in its upper part (at the bottom, back and front walls), and is separated from the mucous membrane in the third birth period, that is, about half an hour after the baby is born.

However, there are situations when, for one reason or another, this organ begins to separate much earlier, which is called placental abruption. This is due to a violation of the integrity of the vessels at the junction of the uterus and the placenta - there is a hematoma, blood begins to accumulate, because of which the adjacent portion of the placenta is compressed and ceases to function.

The main danger of this pathology is that it disrupts the normal functioning of the organ, because of which the child is in serious danger.

Fortunately, this is an unpleasant and dangerous phenomenon found in about one out of 120 pregnant women, but there is also a sad moment - every sixth child in this situation dies.

Classification of placental abruption

Depending on the complexity of the pathology, three degrees of placental exfoliation are distinguished:

• I degree.  The placenta exfoliates no more than one third, which is accompanied by a slight excitability of the uterus, and a woman and a child usually do not suffer at all.
• II degree.  Detachment occurs approximately by half, the uterus begins to contract, and the expectant mother has an increased heart rate. The second degree of this pathology can threaten the child with death from hypoxia.
• III degree.  The most severe degree in which the baby almost always dies. In such cases, the placenta exfoliates completely (totally), and a woman develops hypotension, severe uterine hypertonicity and other unpleasant and dangerous symptoms.

In addition, the detachment may not be progressive or progressive. In the first case, the placenta exfoliates from the mucous membrane in a small area, after which the damaged vessels are clogged, and further delamination does not occur.

In the second, detachment occurs in a significant area, and the size of the hematoma (accumulation of blood between the wall of the uterus and the placenta) is gradually increasing, because of which both the child and the expectant mother suffer.

  Causes of placental abruption

The exact causes of placental abruption are still unknown, but there are factors that, according to doctors, can contribute to the occurrence of this pathology. These include:

• Some diseases and pathologies in the mother: it can be hypertension, endocrine disorders, diseases of the heart, kidneys, liver, etc .;
•   pregnant
• Pathological and inflammatory processes in the placenta and uterus;
• The period of infertility preceding pregnancy or vice versa, a large number of births;
• Improper mother's lifestyle: smoking, alcohol abuse, malnutrition;
• History of pregnancy complicated by placental abruption;
• Allergic reactions to medications;
• Strong physical activity or trauma in the abdomen.

  Symptoms and diagnosis of placental abruption

The list of symptoms of placental abruption includes:

• Spotting or bleeding  from the genital tract. The main symptom that accompanies this phenomenon is most often observed in approximately 80% of patients. Depending on the degree of exfoliation, it can be a small spotting or full uterine bleeding. It should be noted that situations where the detachment is accompanied not by external but by internal bleeding are considered especially dangerous. The placenta begins to exfoliate in the central part, the blood fills the free space and impregnates the wall of the uterus, because of which it loses its contractile properties. Forecasts in this case are often quite disappointing: since it is about saving the life of the mother, the fetus has to be removed along with the uterus.
• Lower abdominal pain. Another common symptom that occurs due to uterine hypertonicity. Typically, patients attribute the pain as singing and dull, extending to the thigh or perineum. Especially severe pain is expressed with internal bleeding.
• General malaise. Nausea, vomiting, dizziness, increased anxiety, heart rhythm disturbance, and other similar phenomena are considered secondary symptoms, but they also often accompany placental abruption.

The main way to diagnose this pathology is ultrasound - this study allows you to determine the area of \u200b\u200bthe exfoliated part of the organ, as well as the size of the hematoma formed.

In addition, the patient is done (a blood coagulation test), as well as to assess the condition of the child.

  Treatment of placental abruption

The tactics of treating patients with placental abruption depends on the degree of complexity of the pathology, as well as on the duration of pregnancy.

For example, with a slight non-progressive exfoliation of the pregnant woman, bed rest is indicated, antispasmodics that help relax the uterus muscles, as well as hemostatic and iron-containing drugs. With a full-term pregnancy and a small detachment, doctors usually stimulate childbirth, which takes place in a natural way.

But in the case of extensive, serious damage, the question usually arises of the premature delivery of a woman by cesarean section. Further actions depend on the condition of the baby and the woman in childbirth.

Detachment of the placenta in the early stages

It is important to note that detachment of the placenta in early pregnancy (until about the 20th week) is considered a less threatening condition than a similar pathology at a later date.

This is due to the fact that as it grows, which occurs in the first and partially in the second trimester, the organ can still compensate for part of its lost surface.

That is, with a timely diagnosis and adequate treatment, a woman has all chances to normally endure and give birth to a healthy baby.

Moreover, in some cases, the pregnant woman does not even notice that there have been changes in her condition, and the pathology is detected only with a planned ultrasound.

With detachment of the placenta in the early stages, further prognoses are usually favorable: the fetus can be preserved, and further pregnancy and childbirth proceed without complications.

Late placenta detachment

The detachment of the placenta in the third trimester is most dangerous for the child, when its growth is already impossible, and disruption of work can lead to serious violations of the fetus.

Depending on the complexity of the pathology, the patient may be recommended immediate delivery or treatment in a hospital.

  The course of labor with detachment of the placenta

The birth process with this pathology can be complicated by severe bleeding, so it must proceed under the supervision and control of specialists.

If a woman gives birth herself, the obstetrician opens the fetal bladder (usually this stops the exfoliation), and also uses forceps to quickly empty the uterus.

In addition, the placenta in such cases is removed manually, and the uterine cavity is examined carefully. If, after childbirth, bleeding cannot be stopped even despite hemostatic therapy and blood transfusion, doctors may decide to remove the organ.

  Prevention of placental abruption

Unfortunately, not a single woman can insure against this pathology, however, it is possible to minimize the risk of her future mother's occurrence.

To do this, she must exclude all factors that can provoke placental abruption (in particular, quit smoking and alcohol), eat properly and lead a healthy lifestyle.

It is very important, even at the stage of pregnancy planning, to undergo a medical examination and cure all existing diseases, and after conception, register in a antenatal clinic in a timely manner, regularly visit a gynecologist and take all tests.

In addition, after placental abruption, women are advised to become pregnant again not earlier than a year later - it is during this time that the body will be able to fully recover from the complication and will be completely ready for the birth of a new life.

The placenta (fetal place) is an important organ that connects the baby with the mother's body. It is through the placenta that the fetus is supplied with oxygen and nutrients. It happens that the fetal place exfoliates from the wall of the uterus earlier than the time set by nature. Why does this situation arise?

Why is a placenta needed?

Without a placenta, the existence of a baby in the mother's body would have been simply impossible. It is through this organ that oxygen enters the fetus and carbon dioxide is removed. The placenta ensures the intake of all the necessary nutrients, vitamins and minerals to the baby. Also, the hormone progesterone, which ensures the normal course of pregnancy, produces a fetal place.

The placenta is formed on a period of 14-16 weeks. Until this time, its function is performed by the chorion - one of the membranes of the fetal egg. This organ not only provides the embryo with all the necessary nutrients. Like the placenta, the chorion performs a barrier function, preventing the penetration of drugs, bacteria and other dangerous agents to the fetus.

The placenta is a round flat disc, consisting of many intertwined blood vessels. By the end of pregnancy, its size is from 14 to 18 cm, and weight reaches 500-600 g. Any deviations from the norm are considered as a manifestation of placental insufficiency - a condition in which the fetal place can not perform its functions in full.

What is placental abruption?

Normally, the fetal place leaves in the second stage of labor. 10-20 minutes after the birth of the baby, the placenta is separated from the uterine wall and is born. The doctor carefully examines the placenta, evaluates its external condition and the number of lobules. If at least one of the lobules is not enough, a manual examination of the uterus is performed. Not a single particle of the placenta should remain in the body of a woman, otherwise endometritis (inflammation of the uterus) and even sepsis will occur.

Premature detachment of a normally located placenta is a condition in which the fetal place departs from the uterine wall ahead of schedule. In the early stages of pregnancy, we are talking about the detachment of the chorion, and only after 16 weeks they talk about the detachment of the placenta. Fertile place can go away and in childbirth, even before the birth of the child. This condition is accompanied by severe bleeding and can lead to fetal death.

Causes of placental abruption

There are many factors that can lead to premature detachment of the placenta during pregnancy:

• cardiovascular diseases (hypertension and others);
• endocrine pathologies (diabetes mellitus);
• autoimmune diseases (antiphospholipid syndrome, systemic lupus erythematosus);
• blood coagulation diseases;
• severe gestosis;
• allergic vasculitis;
• reaction to blood transfusion (blood transfusion).

During childbirth, placental abruption occurs in the following situations:

• amniotic fluid outflow with polyhydramnios;
• the birth of the first fetus during multiple pregnancy;
• short umbilical cord;
• belated rupture of the fetal bladder;
• uterine hyperstimulation using oxytocin;
• damage to the placenta during obstetric procedures.

When exposed to any of these factors, a rupture of the vessels of the placenta occurs. A hematoma is formed, which in turn violates the integrity of all layers of the fetal site. The placenta exfoliates from the muscle layer of the uterus. There are two possible scenarios. Partial detachment implies that the fetal space has moved away from the uterine wall in only one part. The hematoma can spread further, gradually capturing the entire surface of the placenta, or stop growing. In the latter case, the fetal site may continue to function, and the fetus will not die.

With progressive detachment of the placenta, the blood gradually fills all layers of the organ, and then penetrates the uterus. The walls of the uterus, soaked in blood, are stretched. In severe cases, deep cracks may appear in the muscle and serous (outer) layer of the organ. Complete soaking of the uterus with blood leaves no chance for a favorable outcome of the pathology.

Symptoms of placental abruption

With partial detachment of the placenta from the genital tract of a woman spotting appears. This can happen at any time during pregnancy. Allocations can be moderate or very plentiful. In the initial stages, scarlet blood will come out of the genital tract of the pregnant woman. As the hematoma forms, the discharge becomes brown-brown, and then completely stops.

Many women with partial detachment of the placenta complain of drawing pains in the lower abdomen. Unpleasant sensations are given in the groin, sacrum and lower back. The general condition of the expectant mother with a partial detachment of the placenta is usually not broken.

Complete detachment is characterized by massive bleeding from the genital tract. Blood comes out bright scarlet, which indicates the departure of a large area of \u200b\u200bthe fetal place. There are pains in the lower abdomen caused by an increase in the tone of the uterus. Significant pain syndrome occurs with the formation of retro-placental hematoma. In this case, the blood does not go outside, but remains inside, between the placenta and the uterine wall. Impregnation with blood leads to irritation of the peritoneum, which becomes the cause of severe pain in the lower abdomen. If the hematoma is located on the back of the uterus, the pain will be localized mainly in the lumbar region.

There are three degrees of severity of placental abruption:

• lung (separation of less than 1/4 of the placenta with the formation of a hematoma);
• average (discharge 1/4 -1/3 of the placenta);
• severe (detachment of more than 1/3 of the placenta).

The consequences of placental abruption

Premature passage of the fetal space from the wall of the uterus threatens great troubles for both a woman and a child. With a mild severity of detachment, a hematoma is formed, which can subsequently completely disappear. In this situation, a woman safely carries a child before the due date. Since part of the placenta is shut down, placental insufficiency develops. The fetus throughout the pregnancy receives less nutrients and oxygen, which leads to hypoxia and a delay in the development of the baby. The consequences of this condition can affect the health of the baby after birth.

With the detachment of the third part placenta, fetal death is possible. The baby can be saved only in case of emergency caesarean section. If this situation occurs before 36 weeks, the baby is born prematurely. Such a newborn needs special help in a specialized unit.

Premature detachment? part of the placenta leads to instant death of the fetus. In this case, the child cannot be helped. In the case of retro-placental hematoma, when the blood does not go outside, fetal death may be the only sign of placental abruption.

For a woman, passing a fetal place is also a dangerous condition. Massive bleeding that develops with this pathology can lead to a sharp deterioration in the condition, anemia and the development of DIC. Placental abruption is one of the most significant causes of death during pregnancy and childbirth.

Dangerous for a pregnant woman is not only profuse bleeding from the genital tract. The formation of an extensive hematoma behind the placenta leads to soaking of the uterus with blood. This condition is called the uterus of the Kuveler. In severe cases, doctors have to remove the uterus in order to save the patient's life. It is logical that after such an operation, a woman will never be able to have children again.

Diagnostics

Premature detachment of the placenta can be suspected already with the appearance of bloody discharge from the genital tract. In the later stages, the cessation of fetal movements can indicate a discharge of the placenta.

An ultrasound scan for suspected premature placental abruption should be performed as soon as possible. Be sure to determine the heartbeat of the fetus. During the procedure, the doctor assesses the condition of the fetal site, and also measures the size of the hematoma. The absence of a hematoma indicates that all the blood goes out. With a slight detachment, the specialist may not notice any changes during ultrasound examination.

Treatment of placental abruption

The treatment regimen will depend on the severity of placental abruption. With partial detachment (less than? Parts) and the presence of a fetal heartbeat (by ultrasound), maintenance therapy is performed. To this end prescribed drugs that reduce the tone of the uterus: ginipral or magnesium sulfate. Medicines are administered intravenously. When the condition improves, the pregnant woman is transferred to tablet forms of ginipral until the signs of uterine hypertonicity are completely eliminated.

In the early stages, when it comes to chorionic detachment, apply antispasmodic drugs. In most cases, drotaverine is prescribed one tablet three times a day. Alternatively, you can use papaverine suppositories. This drug is injected into the rectum once at night.

If there is a threat of chorionic detachment in the early stages, a supportive hormone therapy. Synthetic analogues of progesterone, the main hormone of pregnancy, gained wide popularity. The drug "Duphaston" is used internally, and its analogue "Utrozhestan" is inserted into the vagina. Hormonal drugs are prescribed up to 16 weeks of pregnancy.

With the development of anemia in the background of bleeding are prescribed iron preparations. In pregnant women at any time you can use "Sorbifer", "Ferrum-Lek" and other means. Some of them cause constipation and an unpleasant metallic taste in the mouth. An allergic reaction to the components of the drug is not excluded.

With the development of fetal hypoxia utero-placental blood flow improving drugs. For this purpose, Actovegin, pentoxifylline and other effective agents are used. If abnormalities in the blood coagulation system are detected, specific therapy is performed. A hemostasiologist is engaged in the selection of funds after a complete examination of the patient.

With a significant detachment of the placenta, emergency cesarean section  at any stage of pregnancy. After birth, the baby is passed into the hands of neonatologists, and gynecologists carefully examine the uterus. If the main female organ is filled with blood, an additional ligation of the internal iliac arteries is performed. With continued bleeding, doctors remove the uterus.

Management of labor with placental abruption

It happens that the detachment of the fetal place occurs already in the process of childbirth. The baby has not yet been born, and the placenta is already trying to move away from the uterine wall. With a slight detachment, a satisfactory condition of the woman and the fetus, childbirth continues to lead through the natural birth canal according to plan. Constant control is established for the contractile activity of the uterus and the baby's heartbeat. Epidural anesthesia for pain relief is indicated.

With the progression of detachment, tactics will depend on the location of the fetus. If the baby’s head is in the wide part of the pelvis, an emergency cesarean section is performed. With the head located in the narrow part of the pelvis, at the very exit, obstetric forceps are superimposed. Without this, the baby simply will not have time to go out on its own and may die in the process of childbirth.

Specific prevention of premature placental abruption has not been developed. Doctors recommend consciously planning a pregnancy and treating all chronic diseases on time. With the development of preeclampsia and other pregnancy complications, one should not refuse the help of a doctor. Timely treatment of these conditions will avoid placental abruption and all its complications.