Why does the placenta detach in a pregnant woman? Placental abruption in early pregnancy: causes, consequences, and is there a chance to save the baby. Disruption of the stages of aging

- early separation of the placenta from the walls of the uterus, occurring before the birth of the fetus. Classic manifestations of premature placental abruption are pain, bleeding, tension in the muscles of the uterus, and fetal disturbances. Premature placental abruption is diagnosed based on the pregnant woman’s complaints, vaginal examination data, and ultrasound. Treatment of premature placental abruption consists of tocolytic, antispasmodic, hemostatic, antianemic therapy; in some cases, the question of surgical delivery is raised.

General information

Premature placental abruption is serious complication, threatening the life of the mother and fetus and requiring urgent medical measures. In obstetrics and gynecology, a distinction is made between premature detachment of a normally located placenta when it is localized in the upper parts of the uterus, on the walls of the body or fundus, and detachment of the placenta previalocated in the area of the uterine pharynx. Premature placental abruption 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 under pressure, on the one hand, by the muscles of the uterus, on the other, by the fertilized egg and amniotic fluid. Normally, these forces are balanced by the significant elasticity of the placental tissue due to its spongy structure and the lesser ability to contract the area of the uterus to which the placenta is attached. These mechanisms normal pregnancy exclude the development of premature placental abruption.

Causes of premature placental abruption

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

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

There is a theory that the development of premature placental abruption is a consequence of chronic uteroplacental insufficiency, the causes of which lie in inflammatory, degenerative and other pathological processes of the uterus and placenta. Such changes occur in chronic endometritis, endocervicitis, uterine fibroids, anatomical abnormalities of the uterus, post-term pregnancy.

Risk factors for premature placental abruption also include abdominal trauma, multiple pregnancy, polyhydramnios, short umbilical cord, multiple births or terminations of pregnancy, delayed opening of the amniotic sac, anemia, bad habits, autoimmune diseases (SLE). In rare cases, premature placental abruption develops in response to the administration of any drugs (protein solutions, donor blood).

Options for premature placental abruption

Based on the area of the rejected area, partial and complete total premature placental abruption are distinguished. Total (complete) detachment is accompanied by the death of the child due to the cessation of gas exchange between the mother and fetus.

Partial placental abruption occurs in a limited area and can 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 disrupted. In the case of progressive detachment, the hematoma grows, the separation of the placenta continues, which leads to a pathological course of pregnancy and childbirth.

Based on the localization of the zone of separation of placental tissue, marginal (peripheral) and central premature placental abruption are distinguished. In case of premature detachment of the central part of the placenta, external bleeding may be absent; peeling of the marginal part is usually accompanied by leakage of blood from the genital tract. In the absence of external bleeding, blood permeates the thickness of the myometrium, which leads to damage to the neuromuscular apparatus of the uterus, loss of its excitability and contractility. In severe cases, blood may 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 cardiac abnormalities in the fetus. Bleeding during premature placental abruption can be external, internal and mixed (internal-external) with the release of scarlet or dark blood, depending on how long ago the detachment was. It is difficult to determine the amount of blood loss during internal or internal-external bleeding, so in practice they focus on the amount of external blood loss and the condition of the pregnant woman (pulse, pressure, Hb, etc.).

Tension of the uterus and abdominal pain with premature placental abruption are almost always present. The pain can be dull, paroxysmal, radiating to the womb, thigh or lower back, local or diffuse. Upon palpation, the gynecologist determines that the uterus is tense and has a dense consistency. The degree of intrauterine suffering of the fetus during premature placental abruption is determined by the area of the calved area of placental tissue. When more than 1/4 of the placenta is detached, the fetus begins to experience hypoxia; when 1/3 is detached, severe hypoxia occurs; when more than 1/3-1/2 of the surface of the placenta is rejected, intrauterine fetal death occurs.

Based on the severity of clinical manifestations, mild, moderate and severe forms of premature placental abruption are distinguished. Mild degree premature placental abruption may not present with clear symptoms and is often detected during routine ultrasound or when examining the placenta after birth. The moderate form of the pathology is characterized by abdominal pain and minor discharge of blood and clots from the genital tract. Palpation reveals a somewhat tense uterus and local moderate pain. When auscultating the fetus, cardiac abnormalities are heard, indicating varying degrees of hypoxia.

In severe cases of premature placental abruption, sudden intense bursting pain in the abdomen, severe weakness, dizziness, and sometimes fainting, pale skin, tachycardia, and hypotension are observed. A moderate amount of dark blood is released from the genital tract. There is a sharp tension and asymmetry of the uterus: a painful protrusion is palpated on one side. The fetal heartbeat is not detected by auscultation.

Diagnosis of premature placental abruption

With extensive manifestations of premature placental abruption, diagnosis is not difficult. This takes into account the presence of pain, bleeding, hemodynamic disorders, and hypoxic suffering of the fetus. A gynecological examination reveals uterine hypertonicity, its local or diffuse soreness, and asymmetry.

During the ultrasound process, the location of the placenta and the size of the area of detachment are determined. Dopplerography of the uteroplacental blood flow reveals disturbances in transplacental hemodynamics. The degree of fetal hypoxia is determined using fetal cardiotocography or phonocardiography. A mild degree of premature detachment can be detected when examining an already born placenta by the characteristic small depression on its surface filled with dark blood clots.

Treatment of premature placental abruption

Tactics for premature placental abruption depend 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 department of the hospital.

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 Doppler ultrasound. If there are indications of 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; labor can be managed vaginally with careful cardiac monitoring.

With moderate and severe premature placental abruption, the choice is made in favor of operative delivery. In severe cases of abruption, cesarean section is performed regardless of gestational age and fetal viability. After the fetus is removed and the placenta is separated, clots are removed, the walls of the uterus are examined, and the condition of the myometrium is clarified. If there are significant changes in the uterus, hysterectomy is indicated.

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

Forecast and prevention of premature placental abruption

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

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

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

Placental abruption: what is it?

The placenta, or baby's place, connects mother and baby, creating the most comfortable conditions for him, and therefore for intrauterine growth and development. Any rupture of 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 for a detachment to form, but in most cases nature can protect the child from external mechanical influences. However, the problem can arise internally: with some vascular diseases or pregnancy complications, conditions arise in which detachment occurs spontaneously. This is a high, chronic inflammation of the genital organs.

The most common causes leading to placental abruption:

trauma (car accident, falling on your stomach, 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 medications that change the tone of the uterus;
uterine tumors (fibroids, endometriosis);
hard physical labor;
severe stressful situation (unexpected severe fear).

What is placental abruption?

Small and not growing in size

With this option, the baby has every chance to calmly endure the inconveniences associated with a lack of nutrients and oxygen. And the placenta will be able to gradually restore its connection with the wall of the uterus. But a favorable outcome will only occur with proper and timely treatment in a hospital setting.

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 less substances necessary for life, which can cause significant suffering in the child.

Complete separation of the placenta

And with this option of detachment of a child’s place, the minutes count. A complete breakdown of the connection between mother and baby causes the rapid death of the fetus.

For the prognosis of fetal life, not only the degree of abruption is important, but also factors such as gestational age and the location of the placenta. Detachment with placenta previa is much more dangerous, and in a short pregnancy, even with urgent surgery, it is impossible to save a non-viable fetus.

How does detachment of a child's place manifest itself?

1. Pain

The first thing that occurs is pain in the abdomen above the womb. Even if they are not very pronounced, a woman should suspect something is wrong and consult a doctor. Especially if the pain does not stop or increases. Pain syndrome during abruption occurs due to increased tone of the uterus, and it is no less dangerous for the baby than tearing off part of the baby's place. With hypertonicity, the blood vessels are compressed, and the baby’s body immediately begins to experience oxygen starvation.

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, and not placental abruption. In any case, if there is bleeding, you must rush to the maternity 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 the baby is well. Moreover, if the fetus moves very actively, this does not mean that the child has enough of everything. Hyperactivity may indicate anxiety in the fetus, which feels a severe lack of oxygen. And a decrease in the number of movements can be a sign of serious problems with providing for the baby. In any case, if there are unexpected changes in fetal movements, it is better to consult a doctor.

Diagnosing abruption is not difficult: it is enough to do an ultrasound of the uterus to determine its exact location and size. And Doppler testing will show how seriously the blood flow in the affected area of the child’s place is disrupted, whether bleeding continues or a blood clot is already forming.

What to do if placental abruption occurs

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

The degree of detachment is of great importance for providing assistance:

with a small and non-progressive detachment, timely assistance to a baby suffering from a lack of oxygen will ensure the preservation of pregnancy and the carrying of the fetus to term;
with partial and increasing detachment, you need to get to the maternity hospital very quickly, because there is a real threat to the baby’s life and time is ticking;
If the baby's place is completely detached, the baby can be saved only if the pregnant woman is already in the maternity hospital, because without oxygen the fetus can live no more than 20 minutes.

The location of the baby's place and the duration of pregnancy are of great importance for preserving the life of the fetus. If the placenta is close to the exit of the uterus (placenta previa, low position), then the first manifestation of detachment will be heavy bleeding. If the pregnancy is less than 28 weeks, it will be very difficult for the fetus to survive due to severe immaturity.

Conservative treatment

With a small detachment under favorable conditions (minor bleeding, mild pain, the fetus does not suffer, the degree of detachment does not increase), timely assistance will allow you to maintain the pregnancy. In the hospital, the doctor will prescribe the following measures:

strict bed rest;
hormonal conservation therapy (utrogestan or duphaston);
reducing the tone of the uterus with the help of antispasmodics and sedatives;
impact on the vascular system to prevent thrombosis in small capillaries of the placenta;
the use of medications that improve blood flow in the placenta.

Surgical treatment

In the event of an unfavorable combination of circumstances (severe external bleeding, severe pain, increasing or complete detachment, threat to the life of the fetus), the question of urgent surgery will arise caesarean section, the main goal of which is to preserve the life of the baby.

What happens after detachment

If everything went well and the pregnancy was maintained, then the next step is to continue treatment. As a rule, even with partial suffering, the baby needs to be helped by providing Better conditions for growth and development. Optimal therapy will be carried out in the perinatal center. At the next stage, it will be necessary to continue treatment with a doctor at the antenatal clinic in order to prevent recurrence of detachment of the baby’s place. It is necessary to exclude the factors that caused the abruption (eliminate physical labor and stress, stop taking medications that affect the tone of the uterus). The doctor will prescribe maintenance medication.

After discharge from the hospital, constant monitoring of the child's condition is necessary. This will require an ultrasound as indicated and weekly. With the help of these studies, the doctor will promptly notice a developmental delay in the baby or the occurrence of a disturbance in blood flow between the mother and the fetus.

You wouldn’t wish this misfortune on your enemy, but if placental abruption occurs, then only quick help from professionals in a maternity hospital can save the baby. When the abruption can be dealt with as a result of treatment, careful attention to the doctor’s recommendations and prevention of pregnancy complications will allow the expectant mother to safely carry and give birth to a healthy child.

Placental abruption in early and later pregnancy is dangerous due to the development of complications, which pose a threat to the life of the child and the expectant mother.

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

Placental abruption in early and late pregnancy can occur prematurely, which indicates the occurrence of pathological processes in the body.

What is placental abruption during pregnancy?

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

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

supply of nutrients and oxygen through the blood;
removal of waste products;
production of hormones for fetal formation;
protective barrier - protects the baby from the influence of external harmful bacteria.

Detachment 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 hold the baby at the proper level. Emergence pathological process Before the onset of natural labor carries 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 impact are distinguished, and also risk factors become predisposing, but do not have a direct impact.

Causes of rejection in the first trimester:

hypertension, frequent and persistent increase in blood pressure;
gestosis, provokes fragility of blood vessels, which complicates blood flow;
bicornuate or sheer uterus;
toxicosis;
chronic severe diseases;
abnormal formation of the shell;
exceeding the gestation period;
multiple births with more than one fetus;
autoimmune pathologies;
allergy.

Threat of detachment on early stages is not a rare occurrence in medical practice, so timely contact with specialists will prevent the possibility of interrupting the pregnancy. A small detachment begins with the formation of an internal hematoma, which is determined after ultrasound examination.

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

Pain, heaviness in the lower abdomen, and often bleeding are the main signs by which a slight detachment can be suspected.

The percentage where the risk increases significantly occurs in women over 35 years of age. If you have a history of cesarean section or have undergone infertility therapy for a long time, the risk of pathology increases significantly.

Any injury or fall affecting the area of intrauterine development can provoke rejection. If you notice the first symptoms, you should immediately consult your doctor.

Consequences of placental abruption in early and late stages

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

External bleeding can be controlled with medication. The main source of this situation lies in the formation of a blood clot.
The consequences largely depend on the area affected by the disturbance. Hyposcia or lack of oxygen occurs with 25% damage, about 30% causes heart failure in the fetus. Rejection of more than half of the area leads to a frozen pregnancy.

Placental abruption in late pregnancy: symptoms, causes

At normal course intrauterine development, detachment should occur only after the birth of the child. Disorders that have different etiologies lead to premature departure. The causes of detachment in the later stages indicate the formation of pathology:

placental or uterine insufficiency leads to improper functioning of the embryonic internal organ;
increased tone uterus;
severe injuries;
late toxicosis and gestosis;
exacerbation of chronic diseases;
aging of the child's place;
smoking and alcohol abuse;
uncontrolled use of potent medications.

Just as during the initial diagnosis, the main provoking factor in the third trimester remains hypertension or sudden surges in pressure, which contributes to the loss of elasticity of the arteries.

Bleeding occurs due to rupture of the vessels that connect the uterus and the baby's place. In this case, pain occurs in the lower abdomen, radiating to the hip joint and lower limbs.

Additional symptoms include dizziness, toxicosis or nausea.

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

Complete rejection indicates the onset of immediate delivery. If the area of damage is partial, then, in a hospital setting and constant monitoring, drugs are used to preserve pregnancy until natural birth.

How to avoid placental abruption during pregnancy?

When making a diagnosis, a woman is faced with the question: “how to stop abruption during pregnancy?” In order to avoid negative consequences All risk factors should be excluded. Try to lead healthy image life, protect your body from stressful situations, maintain bed rest and rest. Protect your life as much as possible from traumatic situations.

Doctors prescribe drug therapy using antispasmodics, vitamin complexes, and drugs that affect blood flow and thrombus formation.

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

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

Classification

There are several classifications of premature placental abruption:

According to the time of occurrence of PONRP:

early stages of pregnancy;
late dates;
during childbirth.

By area of placental abruption:

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

According to the progression of detachment:

progressive;
non-progressive (stopped placental abruption).

Reasons for the development of PONRP

Placental abruption can occur both during pregnancy and during childbirth.

Causes of abruption during pregnancy:

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

Causes of placental abruption during childbirth:

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

Symptoms

The main symptoms of PORNP are:

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

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

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

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

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

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

Severity of placental abruption

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

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

Management of pregnancy and childbirth during PONRP

Pregnancy management depends on the following clinical symptoms:

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

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

There are several classifications that distinguish the degree of placental abruption and the possible risk of harm to the baby and pregnancy failure. This pathology mainly occurs in women giving birth for the first time.

By time

Complications may occur during:

pregnancy;
directly childbirth.

By area of detachment

Highlight:

partial detachment;
full PONRP.

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

By progression

There are 2 types of such complications: progressive (the area of detachment will increase over time) or non-progressive (refers to partial detachment) - the size of the detachment 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 of expectant mothers potentially susceptible to PONRP:

having abnormalities in the cardiovascular system;
with various congenital blood diseases;
having serious illnesses kidney, diabetes mellitus, tuberculosis, syphilis;
suffering from infectious diseases;
experiencing neuropsychic stress;
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. Tissue thromboplastin, which is a blood clotting factor, is released from damaged tissue. As a result, a hematoma occurs and thrombosis of the uterine vessels occurs, which leads to separation of the placenta. Salt deposits may form at the site of its former attachment to the uterus.

Signs and symptoms of pathology

Placental abruption has characteristic signs and symptoms, so it is impossible not to recognize it. This complication of any kind is accompanied by heavy blood loss, pain and tension in the uterus, and as a result, cardiac activity in the fetus is impaired. 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 quite difficult to determine the volume of blood lost during internal blood loss, so doctors often operate on data from external blood loss and the general condition of the patient.

Important! Pain during abruption is always present, be it characteristic cramps in the uterus or its compression. The gradation of pain level can be wide - from dull pulsating to sharp cutting. If you experience any pain, seek immediate medical attention. medical care!

Light form

There is a direct proportionality to the degree of placental abruption and the harm caused to the baby. If only one-fourth of the total area of this organ is exfoliated, 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 detected during or during a postpartum examination of the placenta.

Medium form

The average degree of detachment is characterized by separation by one third - the child experiences severe hypoxia. This degree is characterized by pain and blood loss (blood clots are released from the vagina). During the examination, the doctor determines by touch the characteristic tension in the uterus and the disturbance in the child’s heart rhythm.

Severe form

It is characterized by severe pain, uterine contractions, pushing and strong intrauterine pulsation. There is general weakness strong degree up to fainting, paleness of the skin. Heavy bleeding from the uterus and its asymmetrical bulge are also symptoms of this degree. If half of the placenta detaches, the fetus dies. This pathology is a very dangerous disease that directly affects the life and health of your child. Therefore, it is very important to monitor the progress of pregnancy and be sure to undergo routine examinations.

Features of the course at different stages of pregnancy

This pathology is mainly observed in early stage, therefore, timely detection, correct diagnosis and 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 on ultrasound due to the formation of a hematoma, which is clearly visible during examination. Pregnancy can be saved and its normal course can be ensured if hemostatic therapy is prescribed at this stage. This will ensure further growth and enlargement of 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 detachment in the period up to 26 weeks, painful sensations and compression of the uterus are observed. When the baby becomes hypoxic, he intensifies his movements, trying to speed up the flow of oxygen. All this is accompanied by characteristic tremors. At this period of time, everything depends on the specific stage of pregnancy - the placenta still continues to grow, and theoretically it can still compensate for the lost area of contact with the uterus. At a later stage of pregnancy, doctors may make an urgent decision, since the placenta will no longer be able to have sufficient area for the normal development of the fetus. To save the baby and relieve him of hypoxia, an emergency measure is taken - surgical intervention.

In the third trimester

Placental abruption in late pregnancy is the most dangerous period. If pathology is detected, call premature birth. In very rare cases, if the abruption is not severe, an attempt to maintain the pregnancy is possible with careful 24-hour medical supervision. In addition, pathology can also occur during childbirth, especially in the presence of a multilayer pregnancy or. Depending on the nature of the birth (at what point this happened), either stimulation of contractions is carried out, or a caesarean section is performed. Detachment at this stage is also accompanied by bleeding, the uterus does not relax in between contractions. Sometimes there is an abnormal fetal heart rate, in amniotic fluid In addition to blood, stool particles may be present. The presence of such symptoms is the main and most significant reason for causing premature birth.

How is the diagnosis carried out?

Fortunately, the signs of placental separation are quite clear in terms of symptoms, and the pathology is easy to distinguish. Diagnosis will primarily be aimed at examining the vagina to identify bloody ones. A special place in establishing a diagnosis is occupied by the patient’s well-being, her complaints, the presence of pain in the abdomen and the level of uterine contraction. The doctor must carry out ultrasonography and listens to the baby's heartbeat. Even the smallest detachment can be detected using ultrasound, so treatment can begin at an early stage. Also, the specialist will definitely examine the vagina and uterus.

Treatment of detachment

Pathology that arose in the last trimester is more than a dangerous phenomenon. This threatens surgical intervention. There is no need for treatment as such - you will have to give birth urgently. The exception is isolated cases in which doctors place the patient in hospital to continue pregnancy - provided that the period is less than 36 weeks, the area of detachment is small and there is no hypoxia in the mother and child. In other cases, therapy will be carried out. The doctor will prescribe medications that relax the tone of the uterus, various antispasmodics and hemostatic agents. Please note - treatment of placental abruption folk ways does not exist! Only high-quality traditional medical care is necessary; only in this case will it be possible to get rid of the complication.

If the doctor has decided to continue the pregnancy, and the patient is undergoing an inpatient examination, this does not exclude a possible recurrence of hemorrhage and detachment. In this case, a decision is usually made in favor of an urgent cesarean section, without inducing labor naturally.

In some cases, blood transfusions are performed to improve blood clotting in the pregnant woman's body. Remember: treatment of placental abruption is carried out only under the supervision of a specialist!

Is there a possibility of a complication during the next pregnancy?

The risk of recurrent pathology during subsequent conceptions remains high - up to 15%. Modern medicine has not yet developed methods to reduce or completely eliminate the risk of detachment during a subsequent pregnancy. However, you can take some measures to maximally prepare and protect the body of mother and baby from complications:

Constant monitoring of blood pressure - it should not be high. In the presence of high blood pressure the doctor will prescribe the appropriate medications.
Timely attendance of all scheduled examinations with a doctor.
If there is a conflict of Rh factors, internal administration of immunogloblin will be required.
Avoid drinking alcohol, tobacco and drugs, introduce more fresh vegetables and fruits into your diet.
Protect yourself as much as possible from injury - the cause of detachment can be the slightest blow.

When the first signs of pathology appear, immediately seek medical help. If pathology is detected late, hospitalization may be required.

Prevention

Preventive actions mostly overlap with measures that need to be taken when there is a threat of relapse of the disease. This is a timely examination by a doctor, careful tracking general condition of the body and pressure, preventing reactions and avoiding injuries of any kind. Buckle up in the car, avoid crowded areas where you might be harassed, provide a constant flow of fresh air, and eat only high-quality, healthy food rich in vitamins.