- early separation of the placenta from the walls of the uterus, which occurred before the birth of the fetus. The classic manifestations of premature placental abruption are pain, bleeding, tension in the muscles of the uterus, and disorders of the fetus. Premature detachment of the placenta is diagnosed based on the complaints of the pregnant woman, data from a vaginal examination, ultrasound. Treatment of premature placental abruption consists of tocolytic, antispasmodic, hemostatic, antianemic therapy; in some cases, the question is raised of operative delivery.

General information

Premature detachment of the placenta is a serious complication that threatens the life of the mother and fetus and requires urgent medical measures. In obstetrics and gynecology, premature detachment of a normally located placenta is distinguished when it is localized in the upper parts of the uterus, on the walls of the body or the bottom, and detachment of the placenta located in the uterine throat. Premature detachment of the placenta can develop, both during pregnancy and during childbirth. The frequency of this pathology occurs in 0.4-1.4% of all pregnancies.

During pregnancy, the placenta is pressured, on the one hand, by the muscles of the uterus, and on the other, by the ovum and amniotic fluid. Normally, these forces are balanced by the significant elasticity of the placental tissue due to its spongy structure and less ability to contract the area of \u200b\u200bthe uterus to which the placenta is attached. These mechanisms during normal pregnancy exclude the development of premature placental abruption.

Causes of premature placental abruption

Modern views on the etiology of premature placental abruption as a leading factor highlight the development of vasculopathy - vascular changes that violate the uteroplacental circulation. Vascular disorders can occur if a pregnant woman has somatic diseases (pyelonephritis, hypertension, obesity, diabetes mellitus), toxicosis (gestosis), etc.

Vasculopathies are characterized by increased permeability, fragility and fragility of capillaries, multiple heart attacks and thrombosis in the placental tissue. Violation of the contact between the placenta and the uterine wall is accompanied by an accumulation of blood between the uterine wall and the placenta with the formation of a retroplacental (post-placental) hematoma, which further aggravates placental abruption.

There is a theory that the development of premature placental abruption is the result of chronically occurring utero-placental insufficiency, the causes of which lie in the inflammatory, degenerative and other pathological processes of the uterus and placenta. Such changes are found in chronic endometritis, endocervicitis, uterine fibroids, anatomical abnormalities of the uterus, pregnancy.

Other risk factors for premature placental abruption include abdominal trauma, multiple pregnancy, polyhydramnios, short umbilical cord, multiple births or abortions, delayed opening of the fetal bladder, anemia, bad habits, and autoimmune diseases (SLE). In rare cases, premature placental abruption develops in response to the introduction of any drugs (protein solutions, donated blood).

Options for premature placental abruption

Partial and total total premature detachment of the placenta is distinguished by the area of \u200b\u200bthe rejected area. Total (complete) detachment is accompanied by the death of the child due to the cessation of gas exchange between the organisms of the mother and the fetus.

Partial detachment of the placenta occurs in a limited area and may have a progressive or non-progressive course. With the non-progressive nature of premature placental abruption, thrombosis of the uterine vessels occurs and further separation of the placenta is suspended. The subsequent course of pregnancy and childbirth is not violated. In the case of progressive detachment, the hematoma increases, the separation of the placenta continues, which leads to the pathological course of pregnancy and childbirth.

According to the localization of the placental tissue separation zone, marginal (peripheral) and central premature detachment of the placenta are distinguished. In the case of premature detachment of the central part of the placenta, external bleeding may be absent; exfoliation of the marginal part is usually accompanied by leakage of blood from the genital tract. In the absence of external bleeding, the blood impregnates the myometrium, which leads to damage to the neuromuscular apparatus of the uterus, loss of its excitability and contractility. In severe cases, blood can enter the amniotic fluid and abdominal cavity.

Symptoms of premature placental abruption

Signs of premature placental abruption include bleeding, pain and tension in the uterus, hypoxia, and impaired cardiac function from the fetus. Bleeding with premature detachment of the placenta can be external, internal and mixed (internal-external) with the release of red or dark blood, depending on the duration of exfoliation. The amount of blood loss in case of internal or external bleeding is difficult to determine, therefore, in practice they are guided by the volume of external blood loss and the state of the pregnant woman (pulse, pressure, Hb, etc.).

Uterine tension and abdominal pain with premature placental abruption are almost always present. The pain can be dull, paroxysmal, with radiation to the fold, thigh or lower back, local or diffuse. On palpation, the gynecologist determines that the uterus is tense and has a dense consistency. The degree of intrauterine suffering of the fetus with premature detachment of the placenta is due to the area of \u200b\u200bthe calving area of \u200b\u200bthe placental tissue. With an detachment of more than 1/4 of the placenta, the fetus begins to experience hypoxia, with an detachment of 1/3 - severe hypoxia; with rejection of more than 1 / 3-1 / 2 of the surface of the placenta, fetal death occurs.

The severity of clinical manifestations distinguish between mild, moderate and severe forms of premature placental abruption. A mild degree of premature detachment of the placenta may not manifest distinct symptoms and is often found during a planned ultrasound scan or examination of the placenta after childbirth. The moderate form of the pathology is characterized by abdominal pain and slight discharge of blood and clots from the genital tract. Palpation is determined somewhat tense uterus, local moderate soreness. During auscultation of the fetus, cardiac abnormalities are heard, indicating varying degrees of hypoxia.

In severe forms of premature placental abruption, sudden intense bursting pains in the abdomen, severe weakness, dizziness, sometimes fainting, pale skin, tachycardia, hypotension are observed. A moderate amount of dark blood is secreted from the genital tract. A sharp tension and asymmetry of the uterus is noted: on one side of it, a painful protrusion is palpated. The fetal heart rate is not auscultatory determined.

Diagnosis of premature placental abruption

With the developed manifestations of premature placental abruption, the diagnosis is not difficult. In this case, the presence of pain, bleeding, hemodynamic disorders, and hypoxic suffering of the fetus is taken into account. Gynecological examination reveals uterine hypertonicity, its local or diffuse soreness, asymmetry.

In the process of ultrasound, the localization of the placenta is established, the size of the detachment site. Dopplerography of the uteroplacental blood flow reveals violations of transplacental hemodynamics. The degree of fetal hypoxia is established using fetal cardiotocography or phonocardiography. A mild degree of premature detachment can be detected by examining an already born placenta by a characteristic small impression on its surface filled with dark blood clots.

Treatment of premature placental abruption

Tactics for premature placental abruption depends on the time of development of the pathology (pregnancy, childbirth), the severity of bleeding, the condition of the pregnant woman and the fetus. Pregnant women with signs of premature placental abruption are hospitalized in the obstetric ward.

With partial non-progressive detachment for up to 36 weeks. bed rest, antispasmodic, tocolytic, hemostatic, antianemic therapy are prescribed. Treatment is carried out under the control of a coagulogram, dynamic ultrasound and dopplerography. With indications of the progression of premature placental abruption, there is a need for early delivery. When the birth canal is ready (shortening, softening of the cervix, patency of the cervical canal), an amniotomy is performed; childbirth can be carried out naturally with careful cardiomonitoring.

With moderate and severe premature placental abruption, the choice is made in favor of surgical delivery. In severe cases of cesarean section, detachment is performed regardless of gestational age and fetal viability. After removing the fetus and separating the placenta, clots are removed, the walls of the uterus are examined, and the state of the myometrium is specified. With pronounced changes in the uterus, a hysterectomy is indicated.

Regardless of the method of delivery, the restoration of blood loss, anti-shock therapy, correction of anemia and blood clotting disorders using infusion and transfusion therapy are carried out. Uterotonic drugs (oxytocin, prostaglandins, methylergometrine) are prescribed to prevent postpartum hemorrhage.

Prognosis and prevention of premature placental abruption

The mild form of non-progressive premature placental abruption is prognostically the most favorable. With a more severe course, there is a danger to the pregnant woman and the fetus. In severe cases, fetal death may occur. The main threat to a woman is the development of hemorrhagic shock with DIC.

Prevention of premature placental abruption is the timely treatment of somatic and gynecological pathology of women planning a pregnancy; treatment of late toxicosis, dynamic monitoring of uteroplacental blood flow at all stages

There is nothing worse for a pregnant woman than losing a baby. This is the worst thing that can happen. And one of the reasons for this may be placental abruption. How to identify her in time, and what is needed to save the baby.

Placental abruption: what is it

The placenta, or child's place, connects the mother and baby, creating the most convenient conditions for him, and therefore for intrauterine growth and development. Any break in this connection, even a small area or edge of the placenta, can harm the baby. Sometimes a minor injury in the form of a fall or a push in the stomach is enough to form a detachment, but nevertheless, in most cases, nature can protect the child from external mechanical influences. However, a problem may arise internally: in some vascular diseases or in pregnancy complications, conditions arise in which detachment occurs spontaneously. This is a high, chronic inflammation of the genitals.

The most common causes of placental abruption:

• injury (car accident, a fall on the stomach, a blow to the stomach);
• short umbilical cord in the fetus;
• excessive stretching of the uterus (twins, excess amniotic fluid);
• diagnostic and therapeutic procedures during pregnancy;
• improper use of drugs that change the tone of the uterus;
• uterine tumors (myoma, endometriosis);
• heavy physical labor;
• severe stressful situation (unexpected strong fright).

What happens placental abruption

1. Small and not increasing in size

With this option, the baby has every chance to calmly transfer the inconvenience associated with a lack of nutrients and oxygen. And the placenta can gradually restore communication with the uterine wall. But a favorable outcome will only be with proper and timely treatment in a hospital setting.

2. Partial and gradually increasing in size

In this case, the risk to the fetus is very high. An increase in the degree of detachment leads to the fact that the baby receives fewer substances necessary for life, which can cause severe suffering in the child.

3. Complete separation of the placenta

And with this option, detachment of a child’s place is counted for minutes. A complete break in the connection between the mother and the baby becomes the cause of the rapid death of the fetus.

To predict the life of the fetus, not only the degree of detachment is important, but also factors such as gestational age and the location of the placenta. Detachment with placenta previa is much more dangerous, and with a short gestation, even with urgent surgery, it is impossible to save an unviable fetus.

How will detachment of a child's place

1. Pain

The first thing that arises is abdominal pain over the womb. Even if they are not very pronounced, a woman should suspect something was wrong and consult a doctor. Especially if the pain does not stop or increase. Pain during detachment occurs due to an increase in the tone of the uterus, and it is no less dangerous for the baby than the separation of a part of the child’s place. With hypertension, blood vessels are compressed, and the crumb body immediately begins to experience oxygen hunger.

2. Bleeding

Any blood that appears from the vagina is a sign of a threatening condition. We need to be in the hospital soon. Even if it is a threat of premature termination of pregnancy, rather than placental abruption. In any case, if there is bleeding, you must hurry to the hospital. Blood loss is also dangerous for the expectant mother.

3. Change in fetal movements

By the movements of the fetus, a woman can always find out whether a baby is good. Moreover, if the fetus moves very actively, then this does not mean that the child has enough. Hyperactivity may indicate anxiety of the fetus, which feels a pronounced lack of oxygen. And a decrease in the number of movements can be a sign of serious problems with providing the baby. In any case, with unexpected changes in fetal movements, it is better to consult a doctor.

Diagnosis of detachment is not difficult: it is enough to do an ultrasound of the uterus to determine its exact location and size. And dopplerometry will show how seriously the blood flow in the affected area of \u200b\u200bthe child's place is disturbed, whether bleeding continues or a blood clot is already forming.

What to do when placental abruption

No matter how scary it seemed, it is impossible to stay inactive when symptoms of placental abruption occur: the woman has little time to save the baby. And in no case should you hesitate. With minimal manifestations, if you can’t get to the doctor the next day, you need to go to the hospital yourself. In the case of a decrease in fetal movements or when blood appears from the vagina, you must call an ambulance and go to the hospital. With placental abruption, all possible help can only be obtained in an obstetric hospital.

Of great importance for helping is the degree of detachment:

• with a small and non-progressive exfoliation, timely assistance to a baby suffering from a lack of oxygen will ensure the preservation of pregnancy and the fetal termination;
• with partial and increasing detachment, you need to get into the hospital very quickly, because there is a real threat to the baby’s life and time is running out for hours;
• with the complete detachment of the child’s place, you can save the baby only if the pregnant woman is already in the hospital, because without oxygen the fetus can live no more than 20 minutes.

Of great importance for preserving the life of the fetus is the location of the child's place and gestational age. If the placenta is close to the exit from the uterus (placenta previa, low location), then the first manifestation of exfoliation will be heavy bleeding. With a period of less than 28 weeks, due to severe immaturity, the fetus will be very difficult to survive.

Conservative treatment

With a small detachment in favorable conditions (minor bleeding, unexpressed pain, the fetus does not suffer, the degree of exfoliation does not increase) timely assistance will help to maintain pregnancy. In the hospital, the doctor will prescribe the following activities:

• the strictest bed rest;
• hormone preserving therapy (utrozhestan or duphaston);
• decrease in uterine tone with antispasmodics and sedatives;
• exposure to the vascular system to prevent thrombosis in small capillaries of the placenta;
• the use of drugs that improve blood flow in the placenta.

Surgical treatment

In unfavorable circumstances (severe external bleeding, severe pain, increasing or complete detachment, threatening the life of the fetus), the question will arise about the urgent operation of a cesarean section, the main purpose of which is to preserve the baby's life.

What will happen after detachment

If everything turned out well, and managed to maintain a pregnancy, then the next step is to continue treatment. As a rule, even with partial suffering, the baby needs help, providing the best conditions for growth and development. Optimal therapy will be performed at the perinatal center. At the next stage, it will be necessary to continue treatment with the doctor of the antenatal clinic to prevent a repetition of the detachment of the child's place. It is necessary to exclude the factors that caused the detachment (exclude physical labor and stress, stop taking drugs that affect the tone of the uterus). The doctor will prescribe preserving medication.

After discharge from the hospital, constant monitoring of the condition of the child is needed. This will require an ultrasound testimony and weekly. With the help of these studies, the doctor will notice in time the developmental delay in the baby or the occurrence of a blood flow disorder between the mother and the fetus.

You will not wish this trouble and the enemy, but if there was a detachment of the placenta, then only the quick help of professionals in the hospital can save the baby. When it is possible to cope with the detachment as a result of treatment, careful attention to the doctor’s recommendations and prevention of pregnancy complications will allow the future mother to calmly inform and give birth to a healthy child.

Detachment of the placenta in early and late pregnancy is dangerous for the development of complications, which poses a threat to the life of the child and the expectant mother.

A child's place begins to form immediately after conception. Throughout the entire nine-month period, the embryonic organ grows and develops with the baby.

Detachment of the placenta in the early and late stages of pregnancy can occur prematurely, which indicates the occurrence of pathological processes in the body.

What is placental abruption during pregnancy?

The placenta plays an important role in the development of the baby. In the second week, the membrane for the ovum begins to form, at the beginning of the second trimester this process ends and only growth continues.

During intrauterine development, the embryonic membrane, which contains many arteries, remains the main connecting link between the mother and the child, and also has many tasks:

• the flow of nutrients and oxygen through the blood;
• conclusion of vital products;
• the production of hormones to form the fetus;
• protective barrier - protects the baby from the influence of external harmful bacteria.

   Exfoliation can occur, either partially or completely. This means that the embryonic organ gradually moves away from the walls of the uterus, the fixation becomes too weak to keep the baby at the proper level. The occurrence of the pathological process before the onset of natural labor brings with it a danger to the child.

Placental abruption in early pregnancy: causes, treatment

   Pathology can be caused by a combination of multiple factors. Among them, those that have a direct influence are distinguished, and also risk factors become predisposing, but do not have a direct effect.

Reasons for rejection in the first trimester:

1. hypertension, frequent and persistent increase in blood pressure;
2. preeclampsia, provokes fragility of blood vessels, which complicates the patency of the blood;
3. bicornism or sadness of the uterus;
4. toxicosis;
5. chronic severe illness;
6. abnormal shell formation;
7. exceeding the gestation period;
8. multiple births with more than one fetus;
9. autoimmune pathologies;
10. allergy.

   The threat of detachment in the early stages is not a rare occurrence in medical practice, so timely contact with specialists will prevent the possibility of interruption of the bearing of the child. A small detachment begins with the formation of an internal hematoma, which is determined after an ultrasound examination.

Treatment of placental abruption involves therapy with hemostatic drugs and medications that help preserve the baby's life.

Pain syndrome, heaviness in the lower abdomen, often blood discharge, are the main signs by which a slight exfoliation can be suspected.

The percentage when the risk increases significantly occurs in women older than 35 years. If a history of cesarean section or a long time therapy was performed to eliminate infertility, the risk of pathology increases significantly.

Any injury or fall that affects the area of \u200b\u200bfetal development can provoke rejection. When observing the first symptoms in yourself, you should immediately contact your doctor.

The consequences of placental detachment in the early and late stages

   Bleeding is distinguished between vaginal and uterine. With internal uterine bleeding, the fetus most often dies. Therefore, doctors are faced with the question of maintaining the health of the mother.

External bleeding can be stopped with the help of drug therapy. The main source of the occurrence of such a situation lies in the formation of a blood clot.
   The consequences are more dependent on how much area is affected. Hyposcia or lack of oxygen occurs with 25% damage, about 30% - cause heart failure in the fetus. The rejection of more than half the area leads to a dead pregnancy.

Placental abruption in late pregnancy: symptoms, causes

   In the normal course of intrauterine development, exfoliation should occur only after the birth of a child. Violations that have a different etiology lead to premature discharge. The causes of detachment in the later stages indicate the formation of pathology:

1. placental or uterine insufficiency leads to malfunctioning of the embryonic internal organ;
2. increased tone of the uterus;
3. severe injuries;
4. late toxicosis and gestosis;
5. exacerbation of chronic diseases;
6. aging of a child's place;
7. smoking and alcohol abuse;
8. uncontrolled intake of potent drugs.

   As in the initial diagnosis, the main provoking factor in the third trimester is hypertension or sudden pressure surges, which contributes to the loss of arterial elasticity.

Bleeding is formed due to rupture of blood vessels that connect the uterus and the child's place. In this case, pain occurs in the lower abdomen, extending to the hip joint and lower limbs.

Additional symptoms are dizziness, toxicosis, or a feeling of nausea.

Not infrequently, placental abruption is detected only by ultrasound. The compensatory capabilities of the internal organ are almost exhausted, and it is very difficult to restore functionality in the third trimester.

Complete rejection indicates the onset of immediate delivery. If, however, the damage area is partial, then, in a hospital and constant monitoring, use drugs that retain gestation until the time of natural birth.

How to avoid placental abruption during pregnancy?

   When making a diagnosis, the woman raises the question: "how to stop the detachment during pregnancy?" In order to avoid negative consequences, all risk factors should be excluded. Try to lead a healthy lifestyle, protect your body from stressful situations, observe bed rest and rest. Protect your life from traumatic situations as much as possible.

Doctors prescribe drug therapy with the use of antispasmodic drugs, vitamin complexes, drugs that affect blood flow and thrombosis are used.

If the membrane has left after 34 weeks, then a planned or emergency caesarean section is prescribed to save the life of the newborn and his mother. Prolonged and heavy bleeding indicates the need for a blood transfusion.

Premature detachment of a normally located placenta (abbreviated as PNRP)   - This is her premature separation before the birth of the child: during pregnancy or childbirth.

Classification

There are several classifications of premature placental abruption:

According to the time of occurrence:

• early pregnancy;
• late dates;
• during childbirth.

By area of \u200b\u200bplacental abruption:

• complete (detachment of the entire area of \u200b\u200bthe placenta);
• partial (only part of the placenta exfoliates). Partial detachment can be marginal (the edge of the placenta is separated) and central (respectively, the central part exfoliates).

On the progression of detachment:

• progressive;
• non-progressive (stopped placental abruption).

Reasons for the development of PONRP

Placental abruption can occur both during pregnancy and during childbirth.

Causes of Detachment During Pregnancy:

1. Diseases of the cardiovascular system (arterial hypertension).
2. Diseases of the urinary system (glomerulonephritis).
3. Diseases of the endocrine system (diabetes mellitus).
4. Late gestosis.
5. Allergic reactions.
6. Violations of the hemostatic system (tendency to thrombosis).
7. Falls, abdominal injuries.

Causes of placental abruption during childbirth:

1. Delayed rupture of the fetal bladder (the bladder remains intact with the full opening of the cervix).
2. Amniotic fluid outflow with polyhydramnios.
3. Hyperstimulation of the uterus during childbirth (oxytocin).
4. Short umbilical cord.
5. Birth of the first fetus with multiple pregnancy.

Symptoms

The main symptoms of POARP are:

1. Sharp abdominal pain.
2. Uterine bleeding.
3. Acute hypoxia of the fetus.

Additionally   The severity of symptoms can be different and depends on the size and location of the placental abruption.

Bleeding may be external (blood is secreted from the genital tract) and internal   (blood builds up in the uterus, forming a hematoma). With marginal detachment, blood quickly flows out of the vagina and, as a rule, has a bright scarlet color. With a central detachment of the placenta, the blood does not go outside, but impregnates the walls of the uterus, forming a retroplacental hematoma.

Abdominal pain, most often, expressed with internal bleeding and is associated with impregnation of the uterus, irritation and distension of the peritoneum.

Uterine hypertonicity   It is also more common with internal bleeding and is caused by overstretching of the uterus, which is constantly in contraction and does not relax.

Acute hypoxia of the fetus   with placental abruption caused by a sharp violation of the uteroplacental blood flow. With the detachment of more than one third of the fetus can die, with complete detachment, intrauterine death of the fetus occurs instantly.

Severity of placental abruption

According to the clinical picture, they are distinguished three severity of placental abruption:

1. Light form. The general condition of the woman is not broken. A small detachment of the placenta occurs, discharge from the genital tract is insignificant. With internal bleeding using ultrasound, you can detect a small hematoma.
2. Medium grade. Detachment of one third of the placenta occurs. With external bleeding, discharge from the genital tract is quite plentiful with large clots. With internal bleeding, there is abdominal pain, increased uterine tone. Acute hypoxia of the fetus develops; in the absence of treatment, the fetus dies.
3. Severe degree. The placenta exfoliates half of the entire size and more. The condition of the woman is sharply worsened. Suddenly there is severe pain in the abdomen, profuse bleeding. In most cases, the fetus dies quickly.

Management of pregnancy and childbirth with PNRP

Pregnancy management tactics depend on the following clinical symptoms:

1. Bleeding volume.
2. Gestational age.
3. General condition of women and children.
4. The condition of the hemostatic system   (a set of mechanisms that support the liquid state of the blood).

With a gestational age of less than 34 weeks, if the condition of the woman and the fetus remains satisfactory, there are no severe symptoms (bleeding, anemia), further pregnancy is possible. A woman should only be in a hospital under the constant supervision of a doctor (daily

  There are several classifications that distinguish the degree of detachment of the placenta, the possible risk of harm to the baby and pregnancy failure. Such a pathology mainly occurs in women giving birth for the first time.

By time

Complications may occur during:

• pregnancy
• directly childbirth.

By area of \u200b\u200bdetachment

Allocate:

• partial detachment;
• full PNRP.

  There is also a lateral (marginal) compartment (accompanied by external blood loss) and central (with the appearance of hematomas).

On progression

There is 2 type of such complication: progressive (the area of \u200b\u200bexfoliation will increase with time) or non-progressive (refers to partial detachment) - the size of the exfoliation remains unchanged.

Did you know? During pregnancy, the uterus increases in size up to 500 times, and 2 months after birth it returns to its normal state.

Causes of Detachment

In modern medicine, there are quite a few reasons that can lead to such a complication. There is a certain risk group for expectant mothers who are potentially vulnerable to ECD:

• having abnormalities in the cardiovascular system;
• with various congenital ailments of the blood;
• having severe kidney disease, diabetes, tuberculosis, syphilis;
• suffering from infectious diseases;
• surviving neuropsychic overstrain;
• terminated a previous pregnancy;
• in some cases, the presence of a short umbilical cord or its injury.

The main cause of placental abruption can be considered a violation of blood formation due to rupture of blood vessels. From the damaged tissue comes tissue thromboplastin, which is a factor in blood coagulation. As a result, a hematoma occurs and thrombosis of the uterine vessels occurs, which leads to the separation of the placenta. In place of its former attachment to the uterus, salt deposits may form.

Signs and symptoms of pathology

Detachment of the placenta has characteristic signs and symptoms, so it is impossible not to recognize. This complication of any kind is accompanied by profuse blood loss, pain and tension in the uterus, as a result - there is a violation of the cardiac activity in the fetus. It is noteworthy that bleeding can be of 3 types: internal, external and mixed (both inside and outside the uterus). There is a discharge of bright scarlet or dark blood, which depends on how long ago the separation occurred. It is difficult enough to determine the amount of blood lost during internal blood loss, therefore, doctors often operate with data on external blood loss and the general condition of the patient.

Important! Pain with detachment is always present, be it characteristic cramps in the uterus or its compression. The gradation of the level of pain can be wide - from a dull throbbing to a sharp cutting. For any manifestations of pain immediately seek medical attention!

Light form

There is a direct proportion to the degree of detachment of the placenta and the harm caused to the baby. If only one fourth of the total area of \u200b\u200bthis organ exfoliates, the child experiences hypoxia (oxygen starvation). A mild degree may sometimes not be expressed by pronounced pain or blood loss. Often, such a pathology can be found on or on a postpartum examination of the placenta.

Middle form

The average degree of exfoliation is characterized by one-third separation - the child has severe hypoxia. This degree is characterized by painful manifestations and blood loss (blood clots from the vagina are secreted). Upon examination, the doctor by touch determines the characteristic tension in the uterus and the violation of the heart rhythm of the child.

severe form

It is characterized by severe pain, uterine contractions, pushing and strong intrauterine pulsation. There is general weakness of a severe degree, up to a swoon, blanching of the skin. Heavy bleeding from the uterus and its asymmetric bulge are also symptoms of this degree. If the delamination of half of the placenta occurs, then the death of the fetus occurs. This pathology is a very dangerous ailment that directly affects your life and health. Therefore, it is very important to monitor the course of pregnancy and be sure to undergo scheduled examinations.

Features of the course at different stages of pregnancy

Basically, this pathology is observed at an early stage, so timely detection, proper diagnosis and the optimal course of treatment can prevent complications and save the life of the fetus.

In the early stages

Often, placental abruption in early pregnancy is detected by ultrasound due to the formation of a hematoma, which can be clearly seen during the study. Pregnancy can be maintained and its normal course ensured if hemostatic therapy is prescribed at this stage. This will ensure further growth and increase in the placenta, which with its growing area will cover the previous lost area, thus preventing the occurrence of pathologies and complications in the fetus.

In the second trimester

As already described above, with exfoliation in the period up to 26 weeks, painful sensations and compression of the uterus are observed. With the onset of baby hypoxia, he activates his movements, trying to accelerate the flow of oxygen. All this is accompanied by characteristic jolts. At this time, it all depends on the specific gestational age - the placenta is still growing, and theoretically it can still compensate for the lost area of \u200b\u200bcontact with the uterus. At a later stage of pregnancy, doctors can decide on an urgent one, since the placenta is no longer able to have enough area for normal development of the fetus. To save the baby and save him about hypoxia, an emergency measure is taken - surgical intervention.

In the third trimester

Detachment of the placenta in late pregnancy is the most dangerous period. If pathology is detected, premature birth is caused. In very rare cases, if the detachment is not severe, an attempt to maintain pregnancy with careful round-the-clock medical supervision is possible. In addition, pathology can occur during childbirth, especially in the presence of a multilayer pregnancy or. Depending on the nature of the course of childbirth (at what point did this happen), either contractions are stimulated or a cesarean section is performed. Exfoliation at this stage is also accompanied by bleeding, the uterus does not relax in between contractions. Sometimes an abnormality of the fetal heart rate is observed; in the amniotic fluid, in addition to blood, fecal particles may be present. The presence of such symptoms is the main and most significant reason for causing premature birth.

How is the diagnosis

Fortunately, the signs of placenta separation are fairly unequivocal in symptomatology, and the pathology is easy to distinguish. Diagnosis will primarily be directed to a review of the vagina for the detection of bloody. A special place in the diagnosis is taken by the patient's well-being, her complaints, the presence of pain in the abdomen and the level of uterine contraction. The doctor must conduct an ultrasound scan and listen to the baby's heartbeat. Even the smallest exfoliation can be detected thanks to ultrasound, so treatment can begin at an early stage. Also, a specialist will necessarily hold the vagina and uterus.

Detachment Treatment

The pathology that arose in the last trimester is more than a dangerous phenomenon. This threatens with surgical intervention. Treatment as such will not be needed - you will have to give birth urgently. An exception is single cases in which doctors put the patient in the hospital for the continued maintenance of pregnancy - provided that the term is less than 36 weeks, the area of \u200b\u200bexfoliation is small and there is no hypoxia in the mother and child. In other cases, therapy will be carried out. The doctor will prescribe drugs that relax the tone of the uterus, various antispasmodics and hemostatic agents. Please note - there is no cure for placental abruption in alternative ways! Only high-quality traditional medical care is needed, only in this case it will be possible to get rid of the complication.

  If the doctor has decided to continue the pregnancy, and the patient is in a stationary examination, this does not exclude a possible relapse of blood formation and exfoliation. In this case, a decision is usually made in favor of an urgent cesarean section without causing a natural birth.

In some cases, a blood transfusion is performed to improve its coagulability in the pregnant body. Remember: the treatment of placental abruption is carried out only under the supervision of a specialist!

Is complication possible during the next pregnancy?

The risk of repeated pathology during subsequent conception remains high - up to 15%. In modern medicine, methods have not yet been developed to reduce or completely eliminate the risk of detachment during subsequent pregnancy. However, you can take some measures to maximize prepare and protect the body of mother and baby from complications:

• Constant monitoring of blood pressure - it should not be high. If there is high blood pressure, the doctor will prescribe the appropriate drugs.
• Timely visit to all scheduled examinations by a doctor.
• In case of a Rh factor conflict, internal immunoglobin administration will be required.
• Do not consume alcohol, tobacco and narcotic drugs, introduce more fresh vegetables and fruits into your diet.
• Protect yourself from injury as much as possible - the cause of detachment can be the most minor blow.

  When the first signs of pathology appear, immediately seek medical help. With a late detection of pathology, hospitalization may be required.

Prevention

For the most part, preventive actions intersect with measures that need to be taken when there is a threat of a relapse of the disease. This is a timely examination by a doctor, careful monitoring of the general condition of the body and pressure, prevention of reactions and avoidance of injuries of any kind. Fasten your seat belt in a car, avoid crowds where you can be oppressed, provide a constant flow of fresh air, eat only high-quality wholesome food rich in vitamins.