Detachment of a normally located placenta is considered one of the most difficult conditions that occur during pregnancy. With this pathology, the danger is facing both the woman and her child. The most severe consequences occur with placental abruption in late pregnancy.

Causes of placental abruption

Without a placenta, a child simply could not exist in the womb for all nine months. It is the fetal place that guarantees the flow of oxygen, nutrients and vitamins to the baby. In the event that the placenta for some reason does not cope with its functions, they speak of its insufficiency. In more severe situations, the fetal site may even move away from the uterine wall and lead to fetal death.

Under normal conditions, the last is born immediately after the birth of the child. It happens that the placenta exfoliates much earlier than the due date. In the second half of pregnancy, the following factors lead to the occurrence of this pathology:

• severe gestosis;
• kidney disease
• exacerbation of chronic diseases of the heart and large vessels;
• disorders in the blood coagulation system (thrombophilic complications);
• significant shocks and stresses;
• multiple pregnancy.

Hormonal and infectious factors, which were given importance in the early stages, in the second half of pregnancy go by the wayside. After 20 weeks, the main reason for placental abruption is the pathology of hemostasis. Great importance is attached to diseases of the cardiovascular system, especially in women over 30 years old.

Symptoms of placental abruption in late pregnancy

The main sign by which it is possible to suspect the passage of the fetal place from the walls of the uterus is bleeding. The intensity of bleeding from the genital tract will depend on the size of the detachment. With a partial discharge of the placenta, the discharge will be moderate and even scarce. In the later stages of pregnancy, this phenomenon rarely occurs. Where more often there is a complete detachment of the placenta with massive bleeding. Such a development of events threatens the life of the woman and the fetus and requires the immediate assistance of specialists.

It happens that the placenta moves away from the uterine wall, but bleeding does not develop. An extensive hematoma forms between the fetal site and the uterus, from which blood gradually seeps into the muscle and serous layers of the organ. If more than 1/3 of the placenta is damaged, the fetus dies. The only sign of placental abruption in this situation will be the absence of fetal movements for a long time.

How to guess that something is wrong with the baby?   The woman feels the first movements at a period of 16-20 weeks. At first, these are timid, slightly noticeable tremors once every few days. The baby grows up, and fetal movements become more active. By the end of pregnancy, the baby kicks the mother’s tummy several times a day. Over time, each woman notes that the crumbs have their own periods of activity. It is noticed that some babies move more in the morning, while others prefer to stay awake at night.

For any deviations from the usual fetal movements, you should consult a doctor. A decrease or increase in the activity of the child does not always indicate placental abruption. This can be a sign of hypoxia, and thus the baby signals to his mother about his poor health. The absence of fetal movements during the day after 30 weeks is an alarming sign and can be regarded as a symptom of placental abruption.

Additional diagnostic methods

If suspected of detachment, all women must undergo an ultrasound scan. During the procedure, fetal heartbeats are counted. The thickness of the placenta, the presence of calcifications and other changes in it are also evaluated. If a hematoma is detected, its size is measured.

Cardiotocography (CTG) is performed after 34 weeks. This method allows you to determine the number of fetal heartbeats per minute, as well as evaluate their rhythm. At the same time, the state of the muscle layer of the uterus is monitored. The appearance of large waves of the Brexton-Hicks suggests that the uterus is in an increased tone and is ready at any time to get rid of the fetus.

What threatens placental abruption to a woman?

With partial detachment of the placenta, anemia develops. The level of red blood cells drops in the blood, which inevitably leads to a decrease in the amount of iron. All these processes threaten to lead to a lack of oxygen, which negatively affects the condition of the child. Anemia during pregnancy can be a direct cause of fetal hypoxia.

In the later stages of pregnancy, the passage of the fetal place ahead of time leads to the development of heavy bleeding. In severe cases, hemorrhagic shock develops. A woman loses consciousness, and only a team of experienced resuscitators can help her.

Against the background of severe blood loss, DIC syndrome often occurs. At this point, mechanisms that interfere with normal blood coagulation are triggered. Disseminated intravascular coagulation leads to the appearance of new episodes of bleeding, which will be difficult to stop.

What threatens with placental abruption of the fetus?

The placenta is an important organ that connects the baby with the mother's body. With partial detachment of the placenta, the flow of oxygen and nutrients to the baby is limited. Hypoxia of the fetus develops, which inevitably affects its development. The brain suffers primarily from a lack of oxygen, but the rest of the internal organs experience all the effects of hypoxia. Partial detachment of the placenta almost always leads to the development of placental insufficiency and the birth of a child with various developmental pathologies.

Departure of more than 1/3 of the fetal place leads to the death of the fetus. The baby's oxygen supply stops instantly, and the further existence of the baby in the womb is impossible. You can save the baby only by performing a cesarean section as soon as possible.

A child who was born after 22 weeks is given all the necessary resuscitation measures. Immediately after birth, the baby falls into the hands of neonatologists. A premature newborn is transferred to a specialized unit, where specially trained personnel will look after him. As soon as the child adapts to new conditions of existence, he will be discharged home.

Tactics for placental abruption in late pregnancy

Preserving therapy is carried out only with partial detachment of the placenta. If the fetal heart beats, doctors try to extend the pregnancy to at least 36 weeks. For this purpose, funds are prescribed that improve the utero-placental blood flow. Currently, Actovegin and its analogues are very popular. The drug is injected intravenously in a course of 5 to 10 days.

In late pregnancy, placental abruption is often associated with pathology of the blood coagulation system. That is why many expectant mothers are prescribed antiplatelet agents. Pentoxifylline and other similar drugs act on platelets, reducing their activity. Antiplatelet agents thin the blood, reduce spasm of blood vessels and improve microcirculation in tissues. The course of therapy lasts from 7 to 10 days.

With complete detachment of the placenta, an emergency cesarean section is performed. Pregnancy does not play a role here, it is about saving the life of a woman and a child. During the procedure, blood vessels are sutured and bleeding stops. After the operation, the woman is in the intensive care unit for several days. Premature babies are transferred to a specialized unit, while babies born after 36 weeks remain with their mother.

Placental abruption can occur not only during pregnancy, but also during childbirth. This often happens at the birth of the first twin child, as well as in the case of abnormal labor. In this situation, tactics will depend on how far the baby has progressed. If the baby is already at the exit, they help him to be born with the help of obstetric forceps. In all other cases, an emergency caesarean section is performed.

For prophylaxis   placental abruption in the later stages, experts recommend expectant mothers to monitor their health. Timely treatment of chronic diseases avoids severe pregnancy complications. When the first signs of detachment appear, consult a doctor immediately.

The placenta connects the mother's body with the embryo developing in it. Through it, the fetus receives the necessary nutrients and removes the final metabolic products. It synthesizes various biologically active substances. Detachment of an organ can lead to irreparable harm to a developing person.

Features of the fetoplacental system

Normally, the placenta attaches to the posterior wall of the uterus at the site of implantation of the ovum. Formation continues until the 15th week of pregnancy.

After complete germination of the placental vessels, an active metabolism begins with maternal blood flow.

Growth continues almost the entire pregnancy.
  Mature is considered after 36 weeks.

After ripening, it has the shape of a flattened disk 2-3 cm thick, weighing about 500 grams.

Anatomically distinguish 2 surfaces that differ in appearance:

• villous maternal, which is attached to the uterine wall,
• smooth fruit.

The placenta is a functionally significant formation during fetal development.

The main functions can be distinguished:

1. Gas transportation   - provides the flow of oxygen to the embryo, as well as the release of carbon dioxide into the maternal bloodstream.
2. Nutritious   - transports nutrients necessary for the timely and proper development of organs and systems. In addition to nutrients, alcohol, nicotine and other substances contained in tobacco, drugs, medications that adversely affect the child can penetrate the hematoplacental barrier from the mother’s body.
3. Excretory   - elimination of end products of metabolism.
4. Immune function   performed using two mechanisms. Firstly, the placental barrier does not pass immunocompetent cells into the fetal bloodstream to prevent conflict and rejection of a foreign organism. Baby cells contain a mixed genotype of mother and father. Secondly, it carries out the transport of antibodies to prevent infectious processes.
5. Secretory   - synthesizes biologically active substances: chorionic gonadotropin, prolactin, placental lactogen. They affect the normal course of pregnancy and lead to the necessary changes in the body of the mother and child.

The cycle of development and involution

Provides the development of the embryo until its birth. For 9 months she is undergoing significant.

1. At the 4th week of pregnancy, the laying of a future child's place in the form of a chorion begins.
2. Until 16 weeks, it grows into the uterine wall with the formation of hematoplacental blood flow, after which it becomes functionally active. From this moment it can be called the placenta.
3. Maturation occurs, consisting of 3 degrees of maturity, visible on ultrasound: 0 degree 16-30 weeks, 1 - 28-34, 2 - 32-38, 3 - from 36 until delivery

From the moment a child becomes viable, aging begins.

Most often, this coincides with the 3rd degree of maturity. At this stage, there is a decrease in blood flow, which leads to a decrease in the diffusion of nutrients and oxygen to the fetus.

If with an ultrasound the doctor discovers a more mature placenta than the term suggests, one should talk about premature aging. In this case, hospitalization and medical correction of the blood supply to the child's place are required.

After the birth of the fetus, the placenta is usually called the placenta.

What is premature placental abruption

The process of separating part of the placenta from its bed, occurs in 0.4-1.4% of all pregnant women. As a result, this leads between her and the uterine mucosa.

The resulting hematoma, as it increases, can aggravate the degree of separation until the uterus and fetal are completely separated.

There are detachments of three degrees of severity: mild, moderate and severe.

1. Easymay be asymptomatic and is most often detected with.
2. Averageaccompanied by the appearance of symptoms from the mother, a change.
3. Heavyis critical, accompanied by abnormalities in both organisms.

Causes

Almost all cases of anomalies are associated with one of the following factors.

1. Multiparous and age-related patients. They have a risk of developing pathological changes in the uterine mucosa. This leads to impaired implantation and the formation of the placental bed.
2. Bad habits. Alcohol and smoking impair blood circulation in the vessels, leading in addition to violations of the vascular wall. They also have a negative effect on a developing child.
3. Malnutrition.
4. Infection and inflammation of the membranes of the fetus.
5. Concomitant pathology:, diseases of the genitourinary system, metabolic syndrome affect the vessels of microcirculation.
6. Gestosis. If this occurs, a change in the capillaries of the placental bed may be observed. They lead to increased fragility of the vessels of the microvasculature. e and, as a result, the nutrition of the fetus.
7.   on the drugs used.
8. Injury   in the abdomen and polytrauma.
9. Fruitlessnesshistory of e.
10. Autoimmune diseases   due to the development of antibodies to the cells of your own body (antiphospholipid syndrome).

Symptoms

It is reasonable to highlight several symptoms that are leading:

1. Bleeding is the most common symptom of an onset of detachment. It can be external at the marginal compartment. When the spilled blood is detected in the form of brown discharge from the vagina of varying color intensity depending on the intensity of the bleeding. And internal with a central detachment with accumulation of blood between the uterine wall and the uterine surface of the placenta.
2. Change in tone towards its increase.
3. Dull, pulling pain when changing position and palpation, extending to the iliac region and thigh, to the pubic joint or back.

In severe cases, besides this, dyspeptic disorders, dizziness, and even loss of consciousness may appear.

With detachment of a quarter of the surface, oxygen starvation of the fetus begins. It manifests itself as a violation of his cardiac activity. It is detected using cardiotachography.

With the detachment of half, fetal death of the embryo is observed.

Diagnostics

The main diagnostic method is ultrasound. With its help, areas of incomplete diligence, blood flow disorders and blood accumulation are determined,.

Also, using repeated ultrasound examinations, one of three diagnoses can be made:

• partial progressive;
• non-progressive;
• total.

To determine the source of bleeding is carried out. This is necessary to exclude erosion on the neck, the presence of a tumor or other injuries.

Treatment

Patient management tactics depend on:

• gestational age
• degrees of separation
• blood loss
• functional state of the mother and fetus.

In the early stages and with a slight detachment, conservative management of a woman is possible without forced delivery.

In this case, the following drugs are prescribed:

• tone-reducing;
• antispasmodics (for example, no-shpa);
• hemostatic drugs (aminocaproic acid,);
• with massive blood loss - iron preparations, folic acid for the prevention of anemia;
• with decompensation of chronic pathology - correction of doses of drugs received earlier, or selection of new ones and replacement with more effective ones.

If during the treatment, the general condition of the woman worsens, or after stopping the bleeding, bloody discharge appears again, attempts to save the child should be abandoned.

We need to go to surgical treatment, as this indicates the progression of exfoliation and a threat to both lives.

Depending on the duration of pregnancy and the functional state of the organisms of the mother and the fetus, various surgical solutions are possible.

• the most common method for the likely viability of the fetus is surgery under the spinal or epidural. After a short preoperative preparation, a puncture of the subdural or subarachnoid space is performed. The introduction of a solution of local anesthetic. After the onset of anesthesia, layer-by-layer dissection of the soft tissues in the lower abdomen and removal of the child are performed. The wound is sutured in layers with a cosmetic skin suture. With this intervention, the presence, in addition to a team of anesthetists and obstetricians, neonatologists for the early start of intensive care of the child, is mandatory;
• the option of managing delivery through the natural birth canal is possible. But only under the condition of a stable state of the mother and the absence of deviations in the baby. After childbirth, a manual examination of the uterine cavity is performed. This will help to eliminate the incomplete separation of the placenta or the preservation of an additional fraction;
• in the early stages, medical curettage or abortion is performed under total intravenous or inhalation anesthesia.

The main and most serious complication is. Represents the uterine wall imbibition of blood that has expired from torn capillaries.

In this case, before the operation, the pregnant woman signs a consent to the removal of the uterus. A wall soaked with blood can become a source of blood clots, infection.

Pathology can initiate disseminated intravascular coagulation, followed by profuse internal bleeding.

Forecasts

With timely diagnosis in the first trimester or in the first half of the second and timely started treatment, prolongation of pregnancy is possible.

Such women require more careful monitoring and are hospitalized at the first change of state.

Compensation of the exfoliated area will occur due to increased growth of the remaining area of \u200b\u200bthe uterus and, consequently, an increase in the area of \u200b\u200bcontact.

Detection of detachment in the second half of the second trimester or in the third trimester of forecasts is not so favorable. The growth of the child's place has been completed and there is no way to compensate for the blood supply.

If the size of the separated area is insignificant, it is possible to inform the child at a later date. Provided a permanent stay in the hospital.

In all other situations it is carried out.

Prevention

Prevention is recommended for all pregnant women. Especially if she had such a condition during past pregnancies.

Includes general measures that are used as the prevention of other pathologies of the child's place.

• detection and treatment of chronic pathologies;
• refusal of alcohol, smoking, drugs;
• compliance with the correct mode of work and rest;
• sleep for at least 10-12 hours, preferably on the left side to prevent the pressure of the enlarged uterus on the aorta and vena cava;
• prevention of emotional and physical overload;
• sufficient outdoor recreation for 2 hours or more;
• prevention of infectious diseases and their early diagnosis;
• taking iron preparations and other medicines in the same regimen and dosage as prescribed by the doctor.

Risk of recurrence

Video: Premature maturation of the placenta

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

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

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

Why does placental abruption occur?

Medical science has not yet been able to unequivocally identify the factor causing the development of placental abruption. It is believed that this violation is multifactorial - that is, a combination of several predisposing factors often leads to its appearance.

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

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

What are the symptoms of premature placental abruption?

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

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

3. Severe   placental abruption is manifested by sudden strong bursting pain in the abdomen, dizziness, severe weakness, anxiety. Fainting may sometimes occur. There may be sweating, shortness of breath, increased heart rate, lower body temperature and blood pressure. There is also a pronounced pallor of the skin. The characteristic appearance of dark spotting from the genital tract in moderation. During the examination, the uterus is very tense and has an asymmetric shape: on the one hand, a protrusion is determined, which is very painful when felt. In some cases, for example, with existing scars or dystrophic changes in the uterine wall, it may rupture. Parts of the body of the fetus are not palpable, and his heartbeat is not heard.

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

Uterine bleeding

In four out of five cases, vaginal bleeding is observed with placental abruption. It can have a different degree of intensity: plentiful, insignificant, or completely absent. It depends on the place of placental abruption, the area of \u200b\u200bthe pathological process and the general condition of the blood coagulation system.

Sometimes blood accumulates in the uterus behind the separated part of the placenta, which means that no bleeding may be observed. This most often occurs with central placental abruption, and is considered the most dangerous form of this pathology. Bleeding from damaged vessels does not stop, but has the character of internal or latent. Blood is located between the uterus and the placenta - a retroplacental hematoma occurs. The placenta exfoliates in its central part, and its edges remain connected to the uterine wall. With a significant area of \u200b\u200bdetachment, extensive retro-placental hematoma and heavy bleeding, the outflowing blood permeates the uterine wall. This leads to a violation of her contractile abilities, up to their complete loss. In addition, it is associated with massive blood loss during childbirth. A similar condition was called kouveler uterus   by the name of the author who first described this picture. In such cases, we are talking about saving the woman’s life, so the dead fetus is usually urgently removed along with the uterus.

With marginal or partial detachment of the placenta, bleeding can be visible or external. External bleeding is most often secondary, and not so profuse. It is believed that its appearance can prevent the further development of placental abruption. This is due to the fact that if the area of \u200b\u200bthe placental abruption site is small, then after the occurrence of a retroplacental hematoma, thrombosis of the damaged uterine vessels occurs, leading to a stop of further detachment. Scarlet blood secreted from the vagina indicates a placental abruption that has just occurred. If the spotting is dark in color, and clots are noted in them, this means that some time has passed between the placental abruption and the onset of bleeding.

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

Abdominal pain and uterine tension

With premature detachment of the placenta, in the vast majority of cases, the presence of pain is noted. This pain is more often characterized as dull, often has a paroxysmal shape, and can be given to the thigh, perineum, or lumbar region. When feeling, the uterus is painful, while the pain can be strictly local, and can be spilled. Usually, pain will be more pronounced in the presence of internal bleeding. In connection with the formation of a retroplacental hematoma, a local swelling forms, stretching the uterine wall, and rapidly intensifying pain occurs, which gradually spreads to the remaining parts of the uterus. Also, when feeling, the tension of the uterus is determined, and its dense consistency is noted.

Violation of the heart in the fetus

This condition progresses in proportion to an increase in the area of \u200b\u200bplacental abruption and an increase in the volume of blood loss in the mother. Listening to this symptom indicates the development of fetal hypoxia. Its symptoms appear when more than a quarter of the total placental area is detached. If the pathological process captures a third of the total placental area, then the fetus experiences already threatening oxygen deficiency. And detachment of more than half of the placenta in most cases leads to fetal death.

Placental abruption at different stages of pregnancy

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

Premature detachment of the placenta in the early stages

Placental abruption in the first trimester is quite common, but with timely diagnosis and treatment, it can be prevented in most cases. Most often, a retroplacental hematoma is formed, which is clearly visible during ultrasound. In this case, the selection will be absent. Provided that the preserving pregnancy and hemostatic therapy are appointed in a timely manner, the pregnancy will continue to develop normally. The placenta, which continues to grow over time, is able to completely compensate for the lost area of \u200b\u200bcontact with the uterine wall, and the transferred complication will not affect the health of the unborn child.

Placental abruption in the second trimester

When placental abruption occurs between 12 and 27 weeks of gestation, tension and high uterine muscle tone are also added to the symptoms described above. If fetal hypoxia begins, then with a lack of oxygen, the child can activate his movements in the womb to accelerate blood flow, and hence the flow of fresh oxygen with blood. During this period, much depends on the specific gestational age, since the placenta is able to continue its growth until the middle of the second trimester, and due to this, it can compensate for the lost area of \u200b\u200bcontact with the uterus. At a later date, the question arises of emergency caesarean section, which is necessary to prevent fetal death from progressive hypoxia.

Late placenta detachment

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

Placental abruption in labor

With polyhydramnios or multiple pregnancy, placental abruption can occur directly during childbirth. In such cases, depending on the stage of childbirth, they are either stimulated (up to the use of forceps) or, if there is no labor, proceed to cesarean section. At the first stage of labor, premature detachment is most often manifested by bloody discharge with clots. In this case, with external bleeding during contractions, blood flow does not increase, but rather stops. Pathological tension of the uterus is observed, it does not completely relax between contractions. With vaginal examinations, the tension of the fetal bladder is also determined, and when it is opened, the flowing fetal water is stained with blood. There may be signs of fetal disruption: an increase or slowdown in heart rate, and in the amniotic fluid, in addition to blood, impurities of meconium, primary stool, may appear. Often, the appearance of precisely these symptoms is the only sign of the onset of premature placental abruption at the second stage of labor.

Remember that even a minimal detachment of the placenta serves as a reason for immediate hospitalization and the start of preserving therapy!

Urgently see a doctor, or even immediately go to the hospital, it is necessary when the following symptoms appear:

• vaginal bleeding or discharge;
• uterine pain, pain in the lower abdomen or in the back;
• very frequent or long-term contractions;
• lack of movement of the child in the womb.

Diagnosis of placental abruption

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

The doctor measures the fetal heart rate and performs an ultrasound scan. Using ultrasound, it is possible to unequivocally confirm the presence of placental abruption, to determine its area, as well as the volume and location of the retro-placental hematoma. A very small area of \u200b\u200bplacental abruption by ultrasound may not be diagnosed, but often this examination can determine the presence of blood clots behind the placenta. This helps to distinguish between placental abruption and its presentation, another common cause of bleeding.

Since the bleeding may not be uterine, the doctor examines the vagina and cervix in order to determine whether the infectious lesions, ruptures of the cervix, polyps (benign neoplasms) on it, or something else have caused the bleeding. The doctor also evaluates if there are cervical dilatations that can damage small blood vessels and cause bleeding.

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

2. With partial progressive   placental abruption, the process develops, the hematoma increases in size, and during pregnancy and subsequent childbirth become pathological. Detachment of one quarter of the total placenta is considered dangerous for the fetus. With an increase in the detachment area to one third, severe fetal hypoxia develops, and there is a threat of intrauterine death. With the detachment of half the area of \u200b\u200bcontact of the placenta with the uterine wall, this outcome becomes almost inevitable. Of course, in such conditions, a pregnant woman suffers greatly. Bleeding from damaged vessels of the exfoliated part of the placenta is constant, which means that a woman loses a lot of blood. The consequences of massive blood loss gradually increase until the development of hemorrhagic shock. Often it is possible to cope with the situation only by resorting to urgent delivery.

3.   In rare cases, observed complete or total detachment of the placenta   over the entire area of \u200b\u200bits contact with the wall of the uterus. In such situations, almost immediate death of the fetus occurs, since any gas exchange between the mother's body and the fetus is completely stopped.

What to do when placental abruption?

In the event that the expected date of birth is not far off, then it is necessary to give birth immediately, even if the detachment is insignificant. The process can begin to progress at any moment, and this can threaten the loss of the child. In most of these cases, delivery takes place using cesarean section. But if the bleeding is not very profuse and, according to the doctor and ultrasound, it is caused by a relatively small area of \u200b\u200bdetachment, and the child and you feel normal, you can be allowed to give birth in a natural way.

If the doctor diagnosed a small detachment of the placenta, but the baby is still premature, and there is no further bleeding, then the birth must be postponed. In this case, you and your doctor need to weigh the ratio of the risk of premature birth and the risk of progression of detachment. You need to stay in the hospital in order to be under the constant supervision of specialists. This will allow doctors to immediately begin the birth if the detachment intensifies, or the child or you feel the condition worsen.

Treatment of premature placental abruption

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

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

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

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

In this case, it is necessary to carefully monitor the condition of the placenta and the fetus. To this end, you need to regularly conduct an ultrasound examination, dopplerometry   and cardiotocography . It is also necessary to carefully monitor the condition of the coagulation system of a woman’s blood using laboratory tests. The patient is assigned bed rest.

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

• medicines relaxing the uterus (tocolytic therapy);
• antispasmodics (papaverine, no-spa, sulfate magnesia, metacin, etc.);
• hemostatic agents (ascorbic acid, vicasol, decinone);
• therapy aimed at combating anemia (iron preparations).

  The treatment of concomitant diseases and complications must be carried out without fail.

If in the hospital there are repeated, even the most insignificant, blood discharge, which indicates the progression of detachment, then expectant management should be abandoned even if the patient is in a satisfactory condition. In such cases, they usually resolve the issue in favor of the use of emergency caesarean section. The basis for surgical intervention are vital indications both from the fetus and from the mother. If the woman’s birth canal is already mature (the cervix is \u200b\u200bsoftened and shortened, and the cervical canal is passable), an artificial opening of the fetal bladder is performed, and it becomes possible to conduct birth through the natural birth canal. But in most of these situations, emergency delivery still goes through a caesarean section.

If the pregnancy is full-term, and the area of \u200b\u200bplacental abruption is small, then the question of natural delivery is immediately raised. The situation is facilitated by the presence of mature birth canal - at the first stage of labor an autopsy is performed. This causes a decrease in intrauterine pressure, which prevents further detachment of the placenta.

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

Along with delivery (by natural birth or cesarean section), the following activities are carried out:

• restoration of the volume of lost blood;
• the fight against manifestations of shock (maintaining the functions of the respiratory and cardiovascular systems, anesthesia, etc.);
• antianemic therapy;
• restoration of bleeding disorders by transfusion of fresh donated blood or its preparations (fibrinogen, freshly frozen plasma, platelet mass, etc.).

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

Pregnancy after placental abruption

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

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

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

Depending on the area of \u200b\u200bdetachment, the severity of blood loss and the severity of the process, this complication can both be resolved imperceptibly and carry a serious threat to the life of the fetus and mother.

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

• Monitor your blood pressure. If you have hypertension - try to conduct its most effective therapy. Your doctor will prescribe medications to lower your blood pressure, which will be safe for your child.
• Be sure to attend all routine examinations at the antenatal clinic. Periodically undergo an ultrasound examination.
• If you have a negative Rh factor, and your father has a positive one, and you had vaginal bleeding in the second or third trimester of pregnancy, then you need to introduce anti-D immunoglobulin to prevent the development of a Rhesus conflict.
• Do not smoke, do not use drugs and limit alcohol intake.
• Strictly observe all safety requirements, be sure to fasten your seat belt in the car. The cause of the onset of placental abruption may be the most insignificant at first glance injuries.
• In the event of complications or exacerbation of chronic diseases, it is necessary to proceed to their treatment as soon as possible. Special attention is paid to pregnant women with late toxicosis. At 36-38 weeks of pregnancy, patients with a similar complication should be hospitalized in the hospital without fail.

Prevention of placental abruption

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

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

Through the placenta, the baby draws oxygen and nutrients from the mother’s body. She surrounds the embryo all the time while it is in the womb, protects it from external stimuli, leaves during childbirth after the baby. The placenta for the fetus is a vital connection with the mother, the rupture of which threatens him with death. Therefore, placental abruption requires immediate medical attention.

What is the placenta? What is its importance?

The placenta is a thick cup-shaped membrane, tightly adjacent to the upper and back of the uterine mucosa, penetrated by blood vessels. The formation of this organ is completed by the 15th week of pregnancy, when the veins and arteries of the embryo are separated from the maternal circulatory system.

The placenta provides the fetus with all the elements for its normal growth and vital activity. Even its small deformations increase the risk of oxygen starvation and pathological changes in the embryo, and delay its development.

The placenta is a temporary organ whose sole function is to maintain contact between the organisms of the mother and the baby. Thanks to the placenta, the fetus:

• breathes, receives oxygen and removes carbon dioxide;
• gets rid of urea, toxins and other waste products;
• eats, absorbs vitamins, minerals;
• protects itself from the mother’s immune agents, perceiving it as a foreign body;
• provided by hormones for proper development, antibodies that protect it from adverse external influences.

The placenta presents the baby in the womb with everything that the mother eats and breathes. When a pregnant woman leads an immoral lifestyle, smokes nonchalantly, consumes alcoholic beverages and dubious drugs, nicotine, ethyl alcohol, narcotic particles and toxins get into the body of the embryo, destroying it before birth. Therefore, in order to endure a strong and healthy baby, it is so important to monitor your well-being, nutrition and behavior.

What is placental abruption?

Placental tissues are retained on the inner covers of the uterus due to the loose, elastic structure and pressure on the amniotic fluid. The placenta should not be separated from the mucous membrane of the uterus until the end of pregnancy. But it happens that blood clots accumulate under the placenta, forming a hematoma. The placenta begins to sag, gradually exfoliate from the uterine wall. The blood mass, growing, presses on the muscle tissue and nerve endings of the uterus, it can even break into the abdominal cavity and the water surrounding the fetus. A blood-soaked uterus, no longer able to function normally, erratically shrinks, and a pregnant woman feels severe pain and notices bloody discharge from the genital tract.

Placental abruption, depending on the degree of organ damage, can be partial marginal, partial progressive and complete, or total. With regional exfoliation, which manifests itself in a small area of \u200b\u200bthe placenta, an insignificant accumulation of blood thickens quickly, damaged vessels are clogged by blood clots. Pregnancy continues to flow at a normal rhythm.

Progressive detachment affects a large area of \u200b\u200bthe placenta, does not stop, the hematoma expands and penetrates into neighboring tissues. This pathological process ends, in some cases, with a total detachment of the placenta. The baby in the womb is completely blocked by the supply of oxygen and nutrients, he dies.

Causes of placental abruption

About 1% of pregnant women are diagnosed with premature placental abruption. The reasons for placental abruption are different, associated with both internal physiological problems and external adverse factors. Most often, placental abruption occurs for the following reasons:

1. bad habits, excessive use of alcohol, tobacco, drugs;
2. toxicosis, preeclampsia, deformities and malformations of the uterus, a born fetus;
3. impaired functioning of the cardiovascular system, anemia;
4. chronic kidney disease, insufficient metabolism, obesity, diabetes;
5. autoimmune manifestations, intensive exposure of the protective cells of the mother to the embryo;
6. allergy to certain medications;
7. infection in the uterus, infection of the embryo;
8. abdominal injuries, stress, jumps in blood pressure;
9. stretching of the uterine mucosa after numerous births;
10. if there was a period of infertility before pregnancy.

Symptoms of placental abruption

Detachment of the placenta is external and internal. It is easy to identify the external form of the disease: clotted blood clots are released from the genital tract, severe pain is felt in the lower abdomen. External exfoliation occurs when the edge of the placenta comes off from the uterine mucosa, blood flows into the peritoneum and amniotic fluid. But the internal form of the disease dispenses with bloody discharge, since the placenta is separated from the uterus by its central part. But the bouts of pain are tormented by the strongest, unbearable, usually pulling and shackling, giving to the legs and lower back. Blood that cannot be found accumulates under a damaged placenta. The abdomen is tight, tense to the touch, and touching it is painful.

The well-being of the child in the womb depends on how large a portion of the placenta has come off the uterus, how much blood the mother has lost. Already at a quarter of exfoliated placental tissues, the embryo experiences an acute shortage of oxygen, and its heart rhythm is disturbed.

The fetus dies when half the placenta exfoliates. But placental abruption is not a pregnancy sentence. It is possible to stop and prevent the pathological process by promptly seeking the help of a doctor.

Placental abruption during different periods of pregnancy

Detachment of the placenta in a pregnant woman can be accompanied by various symptoms, it all depends on in which trimester of pregnancy she happened.

Placental abruption in early pregnancy

Detachment of the placenta in the first trimester is a fairly common occurrence, but, as a rule, modern diagnostics and medical procedures allow it to be prevented in time. In most cases, the occurrence of retro-placental hematoma is diagnosed, which is diagnosed by a specialist through an ultrasound apparatus. In this case, it is not accompanied by any suspicious discharge. Timely therapy to preserve pregnancy and stop blood flow helps to safely convey the child to the end of the term without harming his health.

Due to its growth, the placenta can gradually restore the area of \u200b\u200bcontact with the uterine wall, so the transferred placental abruption will not affect the development of the future baby in the womb.

Placental abruption during the second trimester

If placental abruption occurs between 12 and 27 weeks of gestation, then tension in the uterus and increased uterine tone are added to the overall clinical picture. In the event of a lack of oxygen in the fetus, it can begin to move more actively in the womb in order to accelerate the blood flow, providing it with fresh oxygen through the blood. In this case, the specific period of pregnancy becomes the determining factor, because it is known that placenta growth is possible only until the middle of the second trimester, due to which it is possible at this time to restore the lost area that was in contact with the uterus earlier. The occurrence of detachment at a later date requires urgent cesarean section surgery in order to prevent fetal death as a result of developing hypoxia.

Placental abruption in late pregnancy

The highest risk is the placental abruption that occurred during the third trimester of pregnancy. At this point, the placenta loses its ability to grow, so it can no longer compensate for the area of \u200b\u200bcontact. This situation is an indication for emergency surgery. But there are cases when, with a non-developing partial detachment of the placenta without bleeding, it is possible to maintain pregnancy and give birth on time, being under the constant supervision of a doctor.

Placental abruption during childbirth

In the case of polyhydramnios or not a singleton pregnancy in a woman, placental abruption can occur directly during childbirth. If this happened at the last stage of childbirth, then urgent stimulation is done, and in the absence of labor, a cesarean section is performed on an emergency basis. The occurrence of detachment at the beginning of childbirth is accompanied by clot-like blood discharge. In this case, external bleeding during contractions does not increase, but disappears at this moment completely. The uterus of the pregnant woman is always in tension, not relaxing even after the end of the bout. Examination of the vagina determines the tension of the fetal bladder, and during its opening, the flowing water is mixed with blood. A fetal disruption may occur: its heart rate increases or, on the contrary, slows down, and the amniotic fluid can be filled not only with blood, but also with impurities of the first feces of the fetus (meconium). Most often, it is these signs that indicate premature detachment of the placenta during the second stage of labor.

You should know that even with minimal detachment of the placenta, it is necessary to immediately maintain pregnancy in a hospital!

Urgently seek help from a doctor, or go to the hospital, should the following symptoms occur:

• blood or its impurities in vaginal discharge;
• pain in the uterus, abdomen or in the lower back;
• frequent occurrence of contractions that do not stop;
• the calming of the baby in the womb and the absence of movements.

Placental abruption - Ultrasound:

Diagnostics

As a rule, the symptoms of placental abruption are pronounced, which allows the doctor to make an accurate diagnosis. If the signs of the disease are blurred, there is no pain or spotting, the pregnant woman is sent for an ultrasound scan. Ultrasound examination reliably shows what caused the malaise: detachment of the child's place or other reasons. On the ultrasound machine, you can clearly see the hematoma, determine the size of the detached portion of the placenta.

Complications during pregnancy and childbirth can lead to fatal consequences for the mother and fetus. These include the detachment of a normal or low located placenta from the wall of the uterus, with which it is connected by an extensive network of vessels.

The placenta (lat. Placenta) is a very important organ during pregnancy. It produces hormones, it is through it that oxygen and nutrients enter the child’s body. Premature detachment of the placenta is the detachment of the placenta ahead of time. That is, not after the baby is born, but during childbirth (during contractions or attempts) or even during gestation.

Placenta previa

The placenta begins to form in the very first weeks of pregnancy. But its exact location becomes clear closer to the second trimester of pregnancy. Normally, the placenta is located on the anterior or posterior wall of the uterus, or at its bottom (at the highest point). In addition, each type of arrangement has its own characteristics. So, premature detachment of the placenta as a result of a blow to the stomach, ending in premature birth, more often happened if it was located on the front wall of the uterus. For the same reason, it is more difficult for doctors to listen to the baby’s heartbeat with obstetric stethoscopes.

When the placenta is located in the bottom of the uterus, there are often problems with the regularity and intensity of uterine contractions during childbirth, labor is discoordinated.

But on the back wall of the uterus, the location is the most successful. But only if there is no scar after surgery (for example, after removal of uterine fibroids - myomectomy), myomatous node.

Early detachment of the placenta occurs most often with its low location or full presentation - this is when the placenta completely blocks the internal pharynx of the uterus (cervix). Complete presentation makes not only natural birth impossible for obvious reasons, but also provokes frequent detachment of the placenta. And this threatens with a large loss of mother’s blood and the death of an unborn child (with large detachment sizes) as a result of acute oxygen deficiency.

Normally, the placenta during pregnancy migrates upward along with the growth of the uterus. Moreover, this growth is faster if it is located on the front wall. However, the placenta located on the posterior wall of the uterus also rises.

When deciding on the method of giving birth, it will be a natural process or surgery, the doctor draws attention to how much the placenta is higher than the internal pharynx (at least 4 cm) and whether the baby’s head is above or below the placenta before delivery. For natural childbirth, it is precisely the low position of the baby's head that is needed. Otherwise, there is a risk of severe bleeding.

Placenta previa often occurs in women who have undergone curettage (cleaning) of the uterus, abortion, after numerous births. If there is a large uterine fibroid or in the past there was a severe inflammatory process in the uterus - endometritis. This pathology is more characteristic for women giving birth not for the first time.

Causes and symptoms of placental abruption

As for placenta previa, we have already listed the possible causes of this pathology. But not only the placenta located in the lower segment of the uterus, but also high enough from the internal pharynx, can exfoliate.

The possible causes of premature detachment of a normally located placenta are as follows.

1. Multiple pregnancy or large fetus.   Because of this, the tension of the walls of the uterus occurs.

2. Polyhydramnios.   As a result of acute polyhydramnios, the fetal bladder ruptures and the amniotic fluid leaves instantly, which also entails placental abruption.

3. Impact, fall, some kind of mechanical effect on the abdominal wall.

4. Violations of the uterine contractility during childbirth.   If the uterus is constantly tense, even between contractions.

5. The use of "Oxytocin" in large dosages to stimulate labor.

Risk factors for possible placental abruption include: nephropathy (preeclampsia), jumps in blood pressure (both sides), diseases of the heart and blood vessels, kidneys, incompatibility of blood groups and Rh factors of the mother and baby, anatomical features of the development of the uterus, postponed pregnancy .

The main symptom of detachment is spotting from the vagina. They can be plentiful and not very bright red blood and in the form of a so-called daub. It depends on where in the placenta, on the side or closer to the center, its detachment occurred. Dark blood means that after the detachment some time has already passed, the blood has managed to oxidize.

In the early stages, chorionic detachment is often generally asymptomatic and is accidentally detected by ultrasound.

Pain happens, but not always. Moreover, if the placenta is on the back wall, then there can be no strong tone of the uterus and a characteristic change in the shape of the uterus.

Diagnosis of premature detachment of a normally located placenta

During a gynecological examination, the doctor notes the presence of spotting directly from the cervix. To confirm the diagnosis, it is enough to do an ultrasound.

A woman feels hypertonicity of the uterus, she becomes painful, asymmetric. Nausea and vomiting appear. Sweating increases. The pulse quickens. The pressure drops.

If this happens during childbirth, the uterus is constantly in tension, labor is discoordinated.

Treatment and prevention of premature detachment of the placenta

If a woman has already been diagnosed with placenta previa, she needs to be especially careful and careful. Sexual rest, a minimum of physical exertion, stress are necessary. The doctor conducting her pregnancy should carefully monitor other possible pregnancy complications. The placenta begins to exfoliate during the period of rapid growth of the uterus. Usually after 20 weeks of pregnancy. The reason for the detachment can be even a strong cough. You need to take care of yourself.

If the detachment has already happened, then the woman is treated in stationary conditions. Anemia is prevented, hemostatic injections are made to relax the uterus (remove hypertonicity), the child’s heartbeat is monitored, and whether there is premature placental aging and violation of the uteroplacental blood flow. With improvement, they are discharged home. But if the detachment continues to progress, they deliver it regardless of the gestational age.

Many different complications during childbirth arise, including premature detachment of the placenta. In this case, the doctor acts depending on the situation. With a small detachment of a high located placenta and a mature cervix, labor can be conducted. True, their stimulation is prohibited. And if the detachment is large, then only an emergency cesarean.

Thus, it is impossible to somehow affect the placenta, raise it higher in the uterus or stop detachment. But the doctors have the power to do everything possible to stabilize the conditions of the mother and child and emergency delivery in the interests of both, if necessary.

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