Detachment along the anterior wall for a short time. Causes and treatment of placental abruption in early pregnancy

The modern rhythm of life and an abundance of stress often cause placental abruption in early pregnancy. With such a pathology, many women lie in conservation. During the first trimester, any negative impact on the physical or moral state of the mother can be fatal. But if you notice the deviation in time, there is every chance to avoid the loss of the child.

What is placenta

The placenta is a unique organ, it is formed in female body and is only needed during pregnancy. She has round shape, flattened on the sides, which is why it has such a name. From the Latin "placenta" is translated as "flat cake". The umbilical cord emerges from the middle of the organ.

The second name of the placenta is "children's place." It begins to form from the third week of pregnancy, and ends by 12-13 weeks, but the placenta continues to develop until the end of pregnancy, successively going through several stages.

The placenta should depart after the birth of the child. If it separates from the walls of the uterus in the first trimester, the diagnosis is "placental abruption in the early stages." Treatment in this situation should begin immediately.

The placenta has four degrees of maturity:

• Zero - up to 27-30 weeks. The use of tobacco and alcohol can contribute to the fact that the first degree of maturity will come ahead of time.
• The first - from 30 to 34 weeks. During this period, it stops growing, and begins to thicken.
• The second - from 34 to 37 weeks. This is the most stable stage.
• The third - from 37 weeks. From this moment on, the process of natural aging starts in the placental tissue. If it starts earlier, the child will not receive the necessary substances and oxygen to the fullest. This can lead to the development of fetal pathologies and even death.

Excessive diets and lack of weight also cause premature aging of the “children's place”. Pregnancy is not the time to diet.

The placenta consists of two circulatory systems that do not mix, they are separated by a membrane called placental barrier. The child's blood circulates through special villi that permeate the entire "children's place". Maternal blood washes them from the outside, but transfers oxygen and nutrients through the vessels. The embryo pumps carbon dioxide and metabolic products back to the mother. Being in the womb, the child does not breathe easy.

The placental barrier serves as a filter for substances coming from the mother's body. It lets in useful ones, but blocks those that can harm the child. Interesting feature consists in the fact that toxins from the baby are transmitted to the woman, and in the opposite direction - practically none.

One of the main functions of the placenta is to produce hormones. The sex hormone begins to appear when the placenta is fully formed, it is necessary to maintain pregnancy. With its appearance, the threat of losing a child drops significantly, doctors no longer need to administer hormonal drugs to a woman.

At first, the placenta grows faster than the baby. By the end of the first trimester (14th week), the embryo weighs about 25 grams, and the “baby place” is several times larger. By the end of pregnancy, the placenta can reach a mass of 500-600 grams, and its circumference is up to 18 cm.

Severity

If the affected area is large, placental abruption can lead to fetal death. Due to tissue separation, blood circulation between mother and child is disturbed. Detachment has several degrees of severity:

• Mild - a small detachment of the placenta in the early stages. There may be no pronounced symptoms, it is possible to notice it only upon examination.
• Medium - accompanied painful sensations in the abdomen, the uterus becomes stony, bleeding is observed.
• Severe placental abruption in early pregnancy. Symptoms of a critical situation are also manifested by blood discharge of varying intensity. Additionally, nausea, vomiting, loss of consciousness, palpitations, asymmetric position of the uterus can be observed. Rejection of the placenta by 1/3-1/2 leads to fetal death. There is also a serious risk for the mother.

Types of delamination

Tissue rejection can be different: a small detachment of the placenta (in the early stages of pregnancy it occurs quite often) and a complete detachment of the "children's place". With a total lesion, the death of the fetus occurs.

Partial withdrawal of the placenta from the wall of the uterus is observed in a separate part of the organ. It can increase in area or remain the same size throughout pregnancy with thrombosis of the uterine vessels.

The marginal separation of the placental tissue and the central one are also distinguished. In the latter form, there is no external bleeding.

It should be noted that during the first six weeks of pregnancy, the placenta as such is not yet. In the very early stages, it is called the chorion and is located around the entire fetal egg. As a rule, detachment of the chorion leads to spontaneous miscarriage.

Causes

There are a lot of reasons for placental abruption in early pregnancy, sometimes they act in combination.

1. Pathological changes in the vessels that disrupt the blood exchange between the uterus and the placenta. These disorders occur in pregnant women due to obesity, diabetes mellitus, infectious diseases of the kidneys, hypertension. With pathology, the capillaries become brittle and fragile, heart attacks and thrombosis of the placental tissue occur. As a result of poor contact between the two circulatory systems, blood accumulates between the wall of the uterus and the placenta with the formation of a hematoma. The accumulation of blood exacerbates the current critical situation.
2. Inflammatory and pathological processes in the uterus, as well as fibroids, an anomaly in the anatomy of the structure of the reproductive organ.
3. The cause of placental abruption in early pregnancy can be an unhealthy lifestyle - smoking, alcohol, unbalanced diet.
4. The detachment of the "children's place" can be affected by injuries of the abdomen, falls, bruises, immoderate physical exercise.
5. Multiple births.
6. Complicating factors such as multiple pregnancies, polyhydramnios, short umbilical cord, old age of the mother, many abortions before this pregnancy.
7. Disorders of the immune system.
8. Postponed pregnancy.
9. In rare cases, placental abruption is possible in the early stages due to allergic reaction for the administration of medicines or donated blood.
10. Rh-conflict of mother and fetus.

Symptoms of pathology

In the early stages, the symptoms of mild placental abruption often do not manifest themselves. A woman may feel a pulling pain in the lower abdomen, but do not attach any importance to this, considering it to be the norm.

The average degree is characterized by pain in the lower abdomen (as a rule, they have a pulling character), slight bleeding. On palpation, the doctor detects uterine hypertonicity.

Severe pathology manifests itself in the form of symptoms:

1. Severe abdominal pain, they may have different character: from dull and aching to sharp. Sensations are given to the inguinal or hip region.
2. Increased tone uterus and its asymmetric arrangement.
3. Bleeding can be internal and external, as well as mixed. The color of the discharge is from scarlet to dark red, which depends on the prescription of the pathology.
4. Critical condition of a woman - lowering blood pressure, increased pulse and heart rate, pallor skin, dizziness, fainting.
5. in the fetus, as evidenced by a violation of its cardiac activity. With a severe degree of placental abruption in the early stages, the loss of a child can become a consequence of hypoxia.

If at least one symptom is detected, an immediate medical examination is required.

Diagnostics

As already mentioned, to determine the rejection of placental tissues in mild form difficult visually, it can be seen only during a routine examination or after the birth of a child and a “children's place”.

With an average and severe form of pathology, it is easier to make a diagnosis. The doctor takes into account the general symptoms and condition of the pregnant woman. For reliability, gynecological examination with palpation.

Regardless of the cause of placental abruption in early pregnancy, the observing gynecologist should determine the size of the site of rejection, as well as its localization. For this, it is assigned ultrasonography.

Dopplerography will determine whether there are violations of the movement of blood through the vessels between the fetus and the mother. To diagnose the degree of fetal hypoxia, cardiotocography is performed.

Treatment of placental abruption in early pregnancy

Despite the frightening diagnosis, rejection of placental tissue is not so dangerous if the lesion is not very large. The main thing is to diagnose it in time and start treatment. It is necessary to ensure that the pathology does not progress. With the right medical intervention carried out in time, pregnancy can be saved and minimally reduced. Negative consequences for the fetus.

If the focus of detachment is partial, and the pathology does not progress, in the first trimester the woman is placed in a hospital. The attending physician prescribes:

• Bed rest. Since physical exertion can become the causes of placental abruption in the early stages, it is important for the patient to ensure complete rest. It is also necessary to limit the impact, stress and strong emotional impressions.
• Sexual life with such a pathology in the first trimester of pregnancy is not recommended.
• Drugs that stop blood loss ("Vikasol").
• Drugs against anemia (replenishing iron deficiency). Foods that increase hemoglobin levels will also help.

• Medicines that reduce the tone of the uterus to reduce the tone of the uterus, antispasmodics ("Papaverine"). In addition, a solution of magnesium sulfate is prescribed in the form of droppers or injections.
• Medications for relief pain.
• A diet is required. Foods that can tone the uterus (chocolate, spicy dishes, spices) are excluded from the diet of a pregnant woman.
• Be sure to control the stool of a pregnant woman. She shouldn't be constipated. The act of defecation should be carried out easily, without strong tension and attempts.

The gynecologist will constantly monitor the patient's condition with the help of blood tests, dynamic ultrasound, coagulogram and dopplerography.

These measures will be able to protect the woman and the child from the further development of pathology.

If rejection began in the third trimester of pregnancy, retention is usually not practiced. Provided that the woman is already ready to give birth on her own, and her birth canal has entered active phase, the amniotic bladder is punctured. After that, regular contractions begin. The process takes place under the careful control of cardiac monitors.

A woman who is unable to give birth on her own is scheduled for a caesarean section. In severe cases (with internal bleeding), stimulation will be performed at any term of the fetus. When the baby's head is already in the narrow part of the mother's pelvis, special obstetric forceps are used. With placental rejection, delay will lead to the death of the child, so he needs to be helped to be born faster.

After removing the child and the "children's place", you need to make sure that there are no blood clots left. Changes in the myometrium of the uterus can lead to its removal.

At the end of the procedure, drugs are prescribed that prevent blood loss, painkillers. If necessary, a woman is prescribed anti-shock therapy.

Consequences of pathology

A mild form of placental tissue rejection, with timely diagnosis and proper treatment, can do without consequences. Placental abruption (early) medium degree in half of the cases ends in fetal death. With a severe form of pathology, the child does not survive. There is a serious risk for the mother.

The consequences for a pregnant woman can be fatal. The development of heavy bleeding leads to the formation of a hematoma behind the uterus. This phenomenon is called the uterus of Couvelaire (after the French gynecologist who first described it). In severe cases, in order to save the patient's life, doctors have to remove this organ. Thus, the development of placental rejection can deprive a woman of reproductive function.

Large blood loss leads to anemia and the development of thrombohemorrhagic syndrome. Together, these factors can lead to a fatal outcome for a woman.

The worst option for the consequences of placental abruption in early pregnancy for the embryo is its death. It occurs when rejection exceeds the threshold of 1/3 of the part. If such detachment occurs in the last weeks of pregnancy, an emergency birth can save the baby. The baby will be born prematurely, which involves a rehabilitation period.

If the detachment was mild to moderate, while it does not progress, then the woman can carry the pregnancy under full medical supervision.

Rejection of any degree is accompanied by fetal hypoxia, since the child begins to receive less oxygen from the mother through the vessels and nutrients. With rejection of 1/4 part, the fetus is diagnosed initial stage hypoxia. With detachment from 1/4 to 1/3 - a severe stage of oxygen starvation. This condition will affect the health of the newborn and its development in the future. The baby will need to be observed by a neurologist throughout childhood.

The period of pregnancy does not go smoothly for every woman, and no one can be insured against various pathologies. One of the most dangerous complications placental abruption in early pregnancy. Fortunately, this pathology is not very common; according to statistics, no more than 1.7% of pregnant women are affected by it. About the nature of this disease, causes and symptoms, as well as preventive measures ah, let's talk below.

The placenta is organ that connects the lining of the uterus to the fetus. It is formed in the second week () of pregnancy, when the fertilized egg is fixed in the uterus. The placenta reaches maturity only to, and until that moment it grows and forms.

The placenta has a complex structure, which is a plexus of the circulatory systems of the mother and fetus, between which there is protective barrier. This kind of membrane protects the child from harmful substances, which can get from the mother's body, and ensures the removal of fetal waste products.

Functions of the placenta:

• Nutritious, excretory. Through the placenta, all the substances necessary for development come to the child and waste products are removed.
• Respiratory. The placenta ensures that oxygen enters the baby's blood, and then removes the resulting carbon dioxide from it.
• Immune. The placenta allows maternal antibodies to the fetus, which provides it with immunological protection.
• Hormonal. The placenta produces hormones that are responsible for the development of a woman's mammary glands and preparing them for milk production, the growth of the mucous membranes of the uterus, preventing the release of new eggs and a number of other functions.

What is placental abruption

Placental abruption- the process of separating it from the uterine mucosa. It may be partial or complete. During detachment, blood collects between the fetus and the walls of the uterus, pushing the placenta away from the walls.

This process is completely natural and occurs in the third stage of pregnancy. But it happens that under the influence of various adverse factors, placental abruption occurs ahead of time. We will talk about what the consequences of such a pathology can be below.

Placental abruption in different trimesters of pregnancy

Depending on the timing of pregnancy, the process of separation of the placenta proceeds in different ways and leads to different consequences.

• First trimester. At this stage, it is important to quickly diagnose the pathology. Surgical treatment help to completely avoid the consequences, and the subsequent growth of the placenta compensates for the insufficient area of ​​​​contact with the walls of the uterus. In this case, the complication will not have any detrimental effects on the development of the child and the course of pregnancy.
• Second trimester. During this period, the actions of doctors will depend on specific date pregnancy. This is due to the fact that the placenta grows until the middle of the second trimester, and an increase in the area of ​​​​the organ itself compensates for the detachment. If the pathology began to develop at the end of this period, then the only way to save the child is a caesarean section.
• Third trimester. Separation of the placenta in late pregnancy is considered the most dangerous, and with serious consequences, as the placenta loses its ability to grow and can be severe. Therefore, urgent delivery is usually performed. However, in some cases, with a slight detachment, doctors can place the pregnant woman in a hospital, where, under constant supervision, she can carry the baby.

Causes of placental abruption during pregnancy

Causes of detachment of a normally located placenta include:

• preeclampsia and;
• hypertension (high blood pressure);
• increased fragility of capillaries;
• chronic diseases of the genitourinary system;
• anomalies in the structure of the uterus itself;
• delayed pregnancy;
• previous multiple births;
• placental abruption may be an allergic reaction to medications;
• the age of the woman in labor - the older the woman, the higher the likelihood of pathology;
• abdominal trauma (fall, blow);
• chronic, hereditary and infectious diseases(for example, pyelonephritis).

Also exists a number of factors which can (but not always) cause pathology. Among them:

• bad habits (drug addiction, smoking, alcoholism);
• damage to the uterus as a result of physical trauma in the past;
• the formation of fibromyoma (benign tumor) in the area of ​​attachment of the placenta;
• the presence of postoperative scars in the space of contact between the uterus and the placenta.

Symptoms and diagnosis of placental abruption

Signs of placental abruption:

• . This is usually the first symptom of the pathology. Allocations can be plentiful and not very, have saturated color, usually without clots. In rare cases, detachment may begin without bleeding.
• Dull pain in the lumbar region and. They may have a paroxysmal form. When feeling the uterus, a woman feels pain.
• Contractions that don't stop.
• The activity of the fetus decreases, its heartbeat is disturbed.
• Seizures may occur.
• A pregnant woman experiences severe weakness, may faint. Her skin turns pale, sweating intensifies.

Primary diagnosis carried out according to the presence of the symptoms described above. To confirm the diagnosis or insufficient symptoms (no bleeding or pain), use. The pictures clearly show the area of ​​detachment and the size of the resulting hematoma.

In any case, even if not all the symptoms of the pathology appear, it is necessary urgently seek medical attention. The sooner placental abruption is diagnosed, the higher the chance of saving the baby.

Treatment of placental abruption not prescribed by a doctor in all cases. In this case, the duration of pregnancy, the abundance of bleeding and the health indicators of the woman and her baby are of great importance. If the time permits and the condition of the mother worsens, then doctors prefer to carry out a quick delivery. With placental abruption in early pregnancy, drug treatment is carried out.

But in the case when the area of ​​detachment is small, and nothing threatens the woman's health, it is prescribed treatment that includes:

• mandatory bed rest;
• drugs that relax the uterus;
• hemostatic drugs;
• antispasmodic agents;
• drugs for anemia.

In addition, patients are constantly monitored for their condition, they conduct ultrasound examinations (monitoring the fetal heartbeat and monitoring the tone of the uterus), dopplerometry (measurement of blood flow velocity in the vessels of the uterus).

If treatment doesn't help and the expectant mother's condition worsens, doctors usually perform an emergency caesarean section.

Many women, aware of the possibility premature detachment placenta, think about how to avoid this. This issue is especially worrisome for those who have already suffered this pathology in previous pregnancies.

Unfortunately, recurrence of the disease very high in subsequent pregnancies. After the first pregnancy with placental abruption, 17% of women experience a recurrence of the complication. And after two similar pregnancies - in 25%.

At the moment, there is no therapy that could completely protect a woman from this pathology. However, there is a number of preventive measures to help reduce the risk of disease. Among them:

• systematic visits to a gynecologist;
• tracking blood pressure;
• absence of mechanical injuries (falls, bumps);
• regular ultrasound examinations;
• rejection of bad habits;
• lack of allergic reactions;
• timely treatment of diseases that arose during pregnancy;
• absence of stressful situations.

What should a woman do if she has a placental abruption? If the term is already long, and it is not long before the birth, it is better to agree to a quick delivery. The fact is that detachment can begin to progress, and this will threaten the child with death.

If the deadline is still far away, the condition of the mother and child does not cause serious concern, and the process of detachment is static, then it is better to postpone delivery. Here it is necessary to proceed from the ratio of the degrees of risk premature birth and possible progression of detachment. In this case, you can consult a doctor to determine the degree of danger to the child and mother when choosing one or another solution.

Video about placental abruption in a pregnant woman

In the video below, you can learn more about what is placenta what it consists of, how it looks, what functions it performs. And also what changes occur with the placenta throughout the entire period of gestation.

You can talk a lot about the danger of placental abruption, about the symptoms and ways to avoid this pathology, but these are just words. The most valuable thing, in such a situation, is experience. Therefore, if among those reading this article there are women who have just encountered this situation or have already experienced it, share with us please!

The placenta or baby's place is a unique embryonic organ that connects the mother's body with the fetal body, provides the unborn baby with oxygen, nutrients, provides immune and physiological protection, due to which the embryo, and then the fetus, develops normally. Unfortunately, not all pregnancies go smoothly, and some expectant mothers develop such a complication as premature detachment of the placenta.

To understand the essence of this problem, you need to understand what the placenta is and what it is. This is an organ that functions and exists in the female body only during pregnancy, and after the birth of the child, it exfoliates and leaves the birth canal along with the membranes of the fetus.

It performs a number of important functions:

• during pregnancy, it takes on the role of an endocrine organ, synthesizing hormones (hCG, progesterone, estrogen, lactogen, prolactin, etc.) necessary for the preservation and growth of the fetus, as well as stimulation of lactation;
• carries out the process of gas exchange between the body of the mother and the child;
• all the necessary nutrients come through the placenta, thanks to which the baby grows and develops normally;
• performs a complex mechanism of the fetal immune defense, preventing the cells of the mother's body from recognizing a foreign object in the child, and does not allow its rejection.

But at the same time, the mother's antibodies easily penetrate through it, protecting the baby from possible infections.

Where is the placenta located and what are its features

Most often, this important organ is located on back wall in the body of the uterus, less often - in the anterior and very rarely - on the side. This is a normally located placenta. As the uterus grows in size, the placenta moves upward.

In some women, the baby seat is very low and may overlap internal os, which excludes the possibility of normal physiological childbirth and is a direct indication of caesarean section. This is enough serious complication is called "placenta previa" and, in turn, can lead to the development of bleeding.

By the 16th week of pregnancy, the placenta is usually already fully formed, from 20-21 weeks active placental exchange begins, and by the 36th week it becomes fully functionally mature. After the 40th week, its physiological aging begins.

So, normally, detachment of a normally located placenta from the walls of the uterus occurs after the birth of the baby. If it is separated earlier - during pregnancy or in the I-II stages of labor, such a pathology is called premature detachment of a normally located placenta, which leads to bleeding.

The frequency of premature detachments is approximately 0.05 to 1.5% of all pregnancies. This insidious pathology refers to severe forms of complications of pregnancy and childbirth and, unfortunately, is accompanied by high maternal and perinatal mortality. The thing is that the peculiarity of the vessels of the placenta is that they do not collapse so that the fetal blood flow does not suffer, so blood loss is always significant.

In order to determine the state of the placenta, as well as to predict further developments, during ultrasound examinations, the doctor, in addition to determining the biometric parameters of the fetus, carefully examines the location of the placenta, its structure, thickness, and studies the placental blood flow.

Why Premature Detachment Occurs

No doctor will tell you why or why placental abruption occurs. The reasons can be completely different, therefore, in obstetrics, they are of the opinion that this is a multifactorial pathology, i.e. it occurs when a combination of several provoking factors. By the way, if a pregnant woman already had premature detachment in her anamnesis, the risk of recurrent increases with each subsequent birth.

The most common trigger factors include:

• premature ripening and aging of the placenta or its incomplete presentation;
• arterial hypertension as a symptom of gestosis or jumps in blood pressure in the syndrome of the inferior vena cava (squeezing of the vein by the pregnant uterus in the supine position);
• frequent childbirth and multiple pregnancy;
• placental abruption during pregnancy is more often observed in women treated for infertility;
• the risk of this complication becomes higher with the age of the pregnant woman, moreover, often in pregnant women over 35 years old, an additional lobe of the placenta can form, which often comes off during childbirth, which provokes complete detachment;
• caesarean sections (even one) in history;
• abnormal structure of the uterus (saddle or bicornuate);
• anomalies in the development of blood vessels, increased fragility of capillaries;
• coagulopathy;
• severe anemia;
• polyhydramnios;
• short umbilical cord;
• chronic extragenital pathology (for example, diabetes, obesity, systemic diseases, oncological diseases, etc.);
• blunt abdominal trauma.

Not the last role in the fact that placental abruption occurs during pregnancy is played by bad habits, as well as harmful conditions labor.

Also, if necessary, treatment of any extragenital pathology, a pregnant woman should ask her doctor which drugs lead to placental abruption and avoid taking them.

How to understand that detachment has begun

Obstetricians distinguish the symptoms of premature detachment of the placenta into the classic triad:

• uterine bleeding;
• pain and severe tension of the uterus;
• fetal cardiac dysfunction.

Since the placenta begins to separate from the walls of the uterus, it is bleeding that is most associated with further pathological changes. Having accumulated between the wall of the uterus and the placenta, the blood forms a hematoma, which compresses the adjacent area of ​​the placenta and it ceases to function. As a result, there are pathological signs from the heart of the child. Enlargement of the hematoma enhances the detachment.

Degrees of severity of detachment

IN obstetric practice premature detachment of a normally located placenta is divided into three degrees of severity:

1. Light degree- usually does not manifest itself symptomatically, more often it is found after childbirth when examining a child's place. Sometimes a mild degree of detachment becomes a diagnostic finding during an ultrasound examination.
2. Average degree characterized by the appearance of pain in the abdomen, as well as scanty spotting. On examination, a moderately tense uterus is determined. The fetal heartbeat is heard, but violations may be detected, indicating its oxygen starvation.
3. Severe degree placental abruption appears suddenly, the pregnant woman is tormented by severe arching pains in the abdomen, dizziness (even to fainting), severe weakness, severe anxiety. Shortness of breath, tachycardia appear, blood pressure drops sharply, the skin turns pale, covered with cold sweat. Brown discharge during placental abruption may be scanty at first, and then be replaced by bleeding.

When examining the uterus, its asymmetric shape and strong tension are determined. If there is a protrusion, then it is quite painful on palpation. Fetal heart sounds may not be heard.

Also, placental abruption is divided into partial (marginal or central) and total. What threatens premature detachment? Partial placental abruption can be diagnosed and compensated in time. Total abruption of the placenta leads to massive bleeding, it can even cause death, both for the mother and the child.

What is dangerous detachment

The consequences directly depend on the scale of exfoliation. First of all, these are very serious consequences for the child. When detachment occurs, bleeding begins, the fetal cardiac activity suffers. The greater the volume of blood loss, the worse the condition of the baby:

• detachment of ¼ of the placenta leads to yet compensated hypoxia;
• detachment 1/3 - leads to severe oxygen starvation, and as a result, to a slowdown heart rate;
• if ½ of the placenta exfoliates, the child dies.

To avoid serious consequences, the treatment of this pathology should begin immediately.

What is the uterus of Cuveler

Another thing that threatens placental abruption with massive bleeding is a rather serious complication - Kuveler's uterus. When the placenta and myometrium are impregnated with blood, uteroplacental apoplexy occurs - the muscular layer of the uterus is a hematoma, loses its ability to contract, bleeds and provokes the development of DIC - a total violation of blood clotting.

The uterus of Kuveler is treated only surgically. Regardless of the term, the pregnant woman is given an urgent caesarean section. Save the uterus with this diagnosis is very rare. More often, the operation ends with extirpation without appendages (the uterus and cervix are removed).

How detachment manifests itself at different stages of pregnancy

First trimester

A small detachment of the placenta in early pregnancy is diagnosed during an ultrasound examination, since retroplacental hematoma is most often formed. Detachment of the placenta in the early stages is quite common. Carrying out timely adequate treatment in the first trimester may prevent undesirable consequences. Over time, the increase in the size of the placenta compensates for the lost contact area, and the pregnancy will proceed normally.

Second trimester

At earlier terms in the second trimester, with placental abruption, tocolytic therapy is prescribed to relieve high muscle tone uterus, as well as in order to compensate for fetal hypoxia. With detachment at the end of the second trimester, there may be a question of an emergency caesarean section.

third trimester

Placental abruption in late pregnancy threatens the life of the mother and baby the most. Since in the third trimester the placenta has already matured and has lost its compensatory capabilities. IN this case, according to vital signs, the pregnant woman should be delivered immediately. Placental abruption before childbirth is an indication for an urgent caesarean section.

It should be noted that there are cases when, with partial detachment without further progress, in stationary conditions, it is possible to maintain the pregnancy until the due date.

Premature detachment of a normally located placenta can also occur during childbirth.

In this case, the obstetrician-gynecologist assesses the situation, which can be resolved in several ways:

• stimulation with urgent delivery (sometimes, with the imposition of obstetric forceps);
• caesarean section in the absence of labor.

Slowdown or increase in the fetal heart rate during childbirth, as well as the appearance of amniotic fluid blood and meconium may be signs of placental abruption.

Diagnosis of premature detachment

Difficulties with the diagnosis of this pathology usually does not arise. Clinical manifestations are quite characteristic, in addition, every pregnant woman should undergo periodic examinations and ultrasound diagnostics.

In order to determine the maturity of the placenta, its possible detachment, as well as the presence of umbilical cord nodes, a planned ultrasound examination is mandatory at 33 weeks of gestation.

Until the end of pregnancy, it is imperative to monitor the cardiac activity of the fetus.

If a pregnant woman has complaints about bleeding, in addition to ultrasound diagnostics, the doctor must definitely look at the woman on the chair in order to exclude the presence of other causes of bleeding. These can be polyps, cervical ruptures or infectious diseases. In addition, the doctor assesses the condition of the uterine pharynx, as well as the possible opening of the cervix.

Treatment of exfoliating placenta

When premature detachment is diagnosed, the doctor must decide the further tactics of pregnancy management.

How to treat placental abruption depends on the following points:

• duration of pregnancy;
• the state of the pregnant woman and the vital signs of the child;
• symptoms of bleeding and amount of blood loss.

If the condition of the pregnant woman and child allows, the treatment of this condition can be conservative with the obligatory observance of bed rest in a hospital setting.

In the early stages, placental abruption can be prevented with the help of tocolytic therapy:

• magnesium sulfate;
• no-shpa;
• papaverine;
• other antispasmodics.

In complex treatment, in addition to antispasmodics, the following are also used:

• hemostatic drugs (tranexam, dicynone, etc.);
• antianemic agents (iron preparations, vitamins).

During therapy, monitoring of blood pressure, blood clotting, ultrasound examinations, cardiotocography, doplerometry is mandatory. Those. future mom and her baby should be constantly under medical supervision.

To avoid placental insufficiency and fetal hypoxia for preventive purposes, pregnant women are prescribed Curantil, which dilates blood vessels quite gently and also induces the production of interferon, i.e. boosts immunity. However, if detachment is suspected, Curantyl's intake should be urgently canceled, otherwise, it can provoke even more blood loss.

Drawing conclusions

Premature detachment of a normally located placenta is not yet a sentence, but this is exactly the condition that requires immediate medical intervention. A pregnant woman must understand that at this moment in the hands of doctors not only her own life but also the life of a little man.

Therefore, if there are incomprehensible, pulling pains in the lower abdomen, especially radiating to the perineum, spotting or bleeding, you should urgently contact your doctor or call an ambulance. Responsible behavior and conscious reaction will allow the baby to be born.

placenta plays important role in fetal development. Through it, the baby eats and breathes, so deviations from the norm are dangerous at any stage. If future mother suddenly a placental abruption was discovered in the early stages of pregnancy, prompt observation and intervention of specialists is required. The cost of delay may be the life of the baby.

Read in this article

Placenta: concept, functions, possible problems

After the conception of the child begins to form fertilized egg. It is fixed on the wall of the uterus and continuously grows. At this stage, the chorion appears. These are villi that tear the surface of the fetus. Small vessels pass through the outgrowths of the chorion, with the help of which penetration into the inner membrane of the uterus and fixation in it occurs. The chorionic villi are immersed in blood from the outside. Such a system allows the fetus to receive oxygen, nutrients, and in return to give carbon dioxide and waste products.

The placenta for a child is the lungs, kidneys, digestive organs, skin. The consequence of detachment of the chorion in the early stages of pregnancy may be a miscarriage, therefore, it is impossible to do without surgical intervention.

Life cycle of a children's place

The placenta forms during the first 12 weeks of pregnancy. What follows is continuous growth. By 34 weeks, the baby's place reaches its maximum size and begins to age. This natural process, which can be divided into 4 stages:

• lasts up to 27-30 weeks;
• active growth from 27-34 weeks;
• maturity period, which covers 34-39 weeks;
• aging from 37 weeks to childbirth.

Violation of the stages of aging

Sometimes the aging of the placenta occurs prematurely. It can be caused by the characteristics of the woman's body or a number of pathologies:

• the second half of the term;
• toxic substances and medical preparations;
• uterine injury;
• multiple pregnancy;
• , drugs;
• chronic diseases;
• malnutrition or diet;
• and consequences of previous difficult births;
• infections in the uterine cavity.

Early maturation of the placenta during pregnancy leads to oxygen starvation of the fetus and a lack of nutrients. He can lose weight, develop abnormally and be born unhealthy. To avoid serious consequences, you need to be regularly observed by a doctor, undergo a course of treatment.

What is a detachment?

Detachment of a child's place is its separation from inner surface uterus. It may be partial or complete. The resulting void is filled with blood, which further repels the chorion. The process of separation should occur in childbirth, but it can also be premature. Chorionic detachment in early pregnancy is dangerous for the baby, because it can leave him without oxygen and useful nutrients.

Degrees of detachment of the child's place:

• The discharge area is less than 1/3, which does not harm the child, can be compensated for by his growth. Pregnancy is saved and continued.
• Detachment by half can lead the fetus to death from oxygen starvation.
• Full. Almost always carries the death of the baby.

The last one ends, and the first two are classified as a threat spontaneous interruption pregnancy.

Why is the chorion rejected?

According to statistics, 0.4-1.4% of pregnant women face the problem of premature rejection of a child's place. This can happen in the first or second birth period, but most often the latter poses the greatest danger. Among the causes of placental abruption in early pregnancy are:

• woman's age;
• the presence of harmful addictions;
• a large number of births;
• malnutrition;
• infection or inflammation in the uterus;
• chronic diseases;
• abdominal trauma;
• pathology of the uterus or placenta;
• preeclampsia;
• a long period of infertility before conception.

Symptoms of premature rejection

The main signs of placental abruption in early pregnancy:

• - can be external or internal. If separation occurs at the edges, then discharge appears from the vagina. Internal bleeding is more difficult to detect. It occurs with the central detachment of the child's place, when the edges remain attached, and fluid accumulates in the resulting space. An urgent surgical intervention is needed (sometimes with complete removal of the uterus). It will be about saving the mother. The fetus usually does not survive.
• Mild aching pain, provoked by increased. May give to the groin area or thigh and be clear sign internal bleeding.
• Violation in the cardiac activity of the fetus. The condition will be affected by maternal blood loss and the amount of detachment. Insufficiency will appear already when 1/4 of the area of ​​\u200b\u200bthe child's place is discharged. Severe oxygen starvation occurs at 1/3 of the part, after which death may occur. If half of the placenta has passed, then the pregnancy will be impossible to maintain.
• Nausea, vomiting, dizziness, anxiety.

Identification and prompt elimination of the problem with placental abruption

A small detachment of the placenta in early pregnancy is not always accompanied by visible symptoms. It can be detected only with the help of timely diagnostics. It is important to regularly attend scheduled medical consultations.

Diagnosing the condition of the placenta

It is possible to diagnose placental rejection in early pregnancy during the procedure. This procedure allows you to identify retroplacental hematoma, accompanied by destroyed or oppressed tissues. On early stages neoplasms may not yet be. Diagnosis is made by excluding diseases with similar symptoms. If the placenta is rejected, an ultrasound can detect blood clots behind it. The vagina can be carefully examined to exclude their damage, the presence of infections, tumors and other abnormalities.

Predictions for the departure of a child's place

This pathology is not uncommon. Prompt and qualified treatment can prevent its consequences. Timely detection of the problem and taking measures can stop the process and give a positive prognosis for the course of pregnancy in the future.

A small detachment of the placenta requires inpatient observation and treatment. The assistance provided will allow the child to develop normally. It is unacceptable to ignore any alarming symptoms during pregnancy. The departure of a child's place is serious pathology. It can lead to irreparable consequences.

The question of the treatment of detachment of a child's place - not an easy task. Often you have to choose operative delivery. Additionally, blood clotting is monitored. It is important to deal with the shock state of a woman and replenish blood loss.

How is placental abruption treated?

The appointment of treatment for placental abruption in early pregnancy and beyond depends on various factors:

• the general condition of the woman and the child;
• trimester of pregnancy or childbirth;
• volume of blood loss.

Operative delivery can be replaced by treatment if:

• gestational age less than 36 weeks;
• a small area of ​​detachment and there is no progression of the process;
• cessation of discharges or small volumes;
• lack of signs of lack of oxygen for the child;
• well-being of the pregnant woman and hospital stay.

Doctors prescribe mandatory bed rest for the expectant mother, regular ultrasound, as well as dopleometry and cardiotocography. Her condition must be strictly controlled. Laboratory tests of blood for clotting are carried out.

For treatment, antispasmodic drugs (,), hemostatic (Vikasol), anti-anemic (with a high concentration of iron) and aimed at relaxing the uterus can be used. In the presence of other diseases or complications, concomitant therapy is additionally prescribed.

Operative delivery may be prescribed if spotting begins to appear during observation in the hospital. This is a sign of the progress of placental abruption. In the later stages, an emergency caesarean section is most often used. But natural childbirth can also be stimulated. The decision is made based on the condition of the mother and baby.

Surgical intervention takes place under the continuous supervision of doctors over the state of the child's cardiac system. Natural childbirth will require a mandatory manual examination of the uterine cavity after their completion. At caesarean section, her condition is also assessed. If the muscle layer is saturated with blood, a complete removal of the uterus is necessary in order to avoid further bleeding.

Preventive measures for exfoliation of the placenta

There are no specific measures to prevent the pathology of a child's place today. This is due to the lack of confirmed causes of placental abruption in early pregnancy. Only a number of factors have been identified that may predispose a woman to the appearance of such disorders.

Prevention usually consists of:

• regular visits to the doctor and the passage of the required examinations;
• timely delivery of all tests;
• avoidance of stressful situations;
• good and;
• complete rest;
• healthy lifestyle;
• prevention of possible injuries;
• a sufficient number of walks in the air;
• control .

Taking any medication should be strictly prescribed by a doctor and only when absolutely necessary. Treatment of chronic diseases can be regarded as the prevention of the occurrence of complications and exfoliation of the child's place.

Subsequent pregnancies: will there be a recurrence?

For women who have had placental abruption in early pregnancy, there is a high probability of a recurrence of the situation in the future. About 25% of cases end the same way. Medicine cannot yet completely exclude the possibility of exfoliation of the child's place during subsequent pregnancies. However, you can try to prevent the repetition of violations on your own. To do this, it is worth adhering to the above preventive measures in order to minimize all risk factors.

Departure of a child's place is a serious and dangerous pathology for a pregnant woman and her child. Many women face it. It is important to seek help immediately if you experience any worrisome symptoms. If there is no threat to life and health, then the pregnancy will continue, but under closer control, most likely in a hospital. The progression of the pathology in the later stages will require operative delivery. According to the condition of mother and baby, stimulation can be chosen natural childbirth or caesarean section. If you do not pay due attention to the exfoliation of the child's place, the consequences will be severe and irreversible. In the early stages, everything will end in a miscarriage.

Take care of yourself and your child! Don't neglect to see a doctor!

Thank you

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

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

Why does placental abruption occur?

Unambiguously identify the factor causing the development of placental abruption, medical science so far failed. It is believed that this disorder is multifactorial - that is, a combination of several predisposing factors often leads to its appearance.

Currently allocate whole line causes of placental abruption during pregnancy or childbirth:

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

What are the symptoms of placental abruption?

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

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

3. Severe form placental abruption is manifested by sudden severe arching pains in the abdomen, dizziness, severe weakness, anxiety. Sometimes fainting may occur. Sweating, shortness of breath, increased heart rate, lower body temperature and blood pressure may occur. There is also 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 palpated. 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 its heartbeat is not heard.

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

Uterine bleeding

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

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

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

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

Abdominal pain and uterine tension

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

Violation of the activity of the heart in the fetus

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

Placental abruption at different stages of pregnancy

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

Premature abruption of the placenta in the early stages

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

Placental abruption in the second trimester

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

Detachment of the placenta in the later stages

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

Placental abruption during childbirth

With polyhydramnios or multiple pregnancy placental abruption can occur directly during childbirth. In such cases, depending on the stage of labor, either they are stimulated (up to the use of forceps), or, if generic activity is absent, proceed to delivery by caesarean section. At the first stage of labor, premature detachment is most often manifested by bloody discharge with clots. At the same time, with external bleeding during contractions, the release of blood does not increase, but, on the contrary, stops. There is a pathological tension of the uterus, it does not relax completely between contractions. In vaginal examinations, tension is also determined amniotic sac, and when it is opened, the outflowing fetal waters are stained with blood. There may be signs of impaired fetal life: an increase or slowdown in its heartbeat, and in the amniotic fluid, in addition to blood, impurities of meconium, the primary feces, may appear. Often, the appearance of these symptoms is the only sign of the onset of premature placental abruption in the second stage of labor.

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

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

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

Diagnosis of placental abruption

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

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

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

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

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

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

What to do with placental abruption?

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

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

Treatment of premature placental abruption

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

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

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

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

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

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

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

IN without fail therapy should be concomitant diseases and complications.

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

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

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

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

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

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

Pregnancy after placental abruption

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

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

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

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

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

• Control your blood pressure. If you have hypertension, try to treat it as effectively as possible. Your doctor will prescribe you medicines to lower blood pressure, which will be safe for the child.
• Be sure to visit all scheduled checkups V antenatal clinic. Periodically undergo an ultrasound examination.
• If you have negative Rh factor, and the father of the child is positive, and in the second or third trimester of pregnancy you had vaginal bleeding, then you need to enter anti-D immunoglobulin to prevent the development of Rh conflict.
• Do not smoke, do not use drugs, and limit your alcohol intake.
• Strictly observe all safety requirements, be sure to buckle up in the car. The cause of the onset of placental abruption can be the most minor injuries at first glance.
• If complications or exacerbations of chronic diseases occur, it is necessary to start their treatment as soon as possible. Especially close attention specialists give pregnant women who have late toxicosis. At 36-38 weeks of pregnancy, patients with a similar complication must be hospitalized in the maternity hospital without fail.

Prevention of placental abruption

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

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