Content:

Placental abruption is a complication in which the baby's place is separated from the wall of the uterus during pregnancy or childbirth. Premature detachment is accompanied by bleeding and can cause fetal death.

The anomaly can be complete or partial, central or marginal, the latter being the least dangerous. Placental abruption in the early stages can occur during pregnancy or during childbirth. If the pathology manifests itself before the 20th week, the chances of a successful outcome are higher than placental abruption in the later stages. This is due to the fact that in the early stages the baby’s place is actively growing and developing, and the affected part is compensated when it comes into contact with the wall of the organ.

Placental abruption is divided into:

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

Signs of pathology

The patient may experience heavy bleeding, but there may be no external signs. Another symptom is that the fetus stops moving. In almost all cases, lower back pain is observed.

Other symptoms of placental abruption:

• The mild form is not associated with pronounced symptoms. It is detected by ultrasound or during childbirth, when a small depression with blood clots is found in the child’s place.
• A moderate anomaly is accompanied by pain and mild bleeding. There may not be any bleeding. Palpation of the uterus reveals tension and mild local pain. When listening to the fetal heartbeat, hypoxia is detected.
• Premature placental abruption in severe form is manifested by severe pain, attacks of weakness, and anxiety. Sweating, shortness of breath, decreased blood pressure and temperature may occur. The uterus is tense and has asymmetrical contours. The fetal heartbeat cannot be heard.

The main symptoms of pathology in the first trimester:

• Placental abruption in the first trimester is accompanied by mild bleeding.
• There is pain and a feeling of heaviness in the lower abdomen.
• Fetal hypoxia.

Symptoms of pathology in the second trimester:

• Weakness.
• Dizziness.
• In addition to pain and possible bleeding, the tone of the uterus and noticeable pain on palpation are added.

Symptoms of pathology in the third trimester and during childbirth:

• Severe abdominal pain.
• Bleeding.
• Uterine tension.
• Detachment of the baby's place during childbirth is accompanied by the baby's meconium and the appearance of blood in the amniotic fluid.

Danger of placental abruption

If there is an anomaly, the integrity of the blood vessels is disrupted, and a hematoma forms between the walls. After this, the separation of the child's seat only accelerates.

Photo of placental abruption:

After the formation of a hematoma, thrombosis of the uterine vessels may occur, which stops the separation of the child's place. The process enters the stage of partial non-progressive anomaly. This poses little threat to the child; pregnancy and childbirth proceed normally in this case.

With progressive partial detachment, the separation process continues. The size of the hematoma increases, the detachment becomes progressive, and the child experiences oxygen starvation. With total (complete) detachment, the consequences for the child are fatal. Cardiac activity is disrupted and the fetus dies.

Complications of placental abruption

Bleeding may be strong, weak, or completely absent. This depends on the location and area of ​​the separation, as well as on blood clotting. Visible bleeding is observed with marginal detachment. Hidden (internal) bleeding occurs with central peeling.

Uterine tone and pain are observed in almost every case. The pain may be dull, may appear in paroxysms, radiate to the hips, lower back and vaginal area. Painful sensations during palpation of the uterus can be localized at the site of separation, or can spread throughout the abdomen.

With an increase in the area of ​​exfoliation and increased blood loss, oxygen starvation of the fetus begins. When the child's seat is separated by ¼ of the area, the first signs of hypoxia appear. When the gap increases to 1/3, hypoxia intensifies, and when peeling reaches ½ of the area, the fetus dies.

Causes of pathology

Placental abruption is a multifactorial pathology - its appearance is caused by a combination of several factors. Among the main causes of placental abruption are vascular pathologies, serious illnesses of the mother, and degenerative changes in the mucous membrane.

Other causes of placental abruption:

• High blood pressure in the mother.
• Fluctuations in blood pressure caused by stress or health problems.
• Degenerative changes in the mucous membrane caused by frequent or multiple births.
• Post-term pregnancy.
• Age after 35.
• Pregnancy that occurs after prolonged infertility.
• Anomalies of the uterus - bicornuate, saddle-shaped.
• Anomalies in the location and development of a child's place.
• Pregnancy after caesarean section.
• Toxicoses, preeclampsia, especially in the 1st trimester.
• Pathologies of the structure of the uterus.
• External abdominal injuries (fall, blow).
• Drinking alcohol and smoking.
• Poor nutrition.
• Allergic reactions to medications.
• Severe chronic, endocrine and infectious diseases.

Diagnosis of pathology

Diagnosis is made based on clinical manifestations. The problem is indicated by bloody discharge, the uterus in good shape, and a change in its shape. Detachment is usually accompanied by abdominal pain and signs of increasing fetal oxygen deficiency. The mother's medical history, her complaints, and the results of laboratory and clinical examinations are taken into account.

After examining the patient, the doctor decides how to determine the detachment of the child’s place and what examination methods to use. In the absence of pronounced symptoms, ultrasound is used.

Using ultrasound, the size of the area of ​​the separated child's place and the size of the hematoma are determined. A blood test is required to detect signs of anemia. The presence of anemia may indicate hidden or chronic blood loss.

What is placental abruption during pregnancy and why does it happen?

Bearing a child is a natural process, inherent in nature, however, it is associated with many risks. The health of the woman and the fetus is affected by both internal and external negative factors, leading to a complicated course of pregnancy. One of the negative processes is placental abruption.

The pathology has an ICD code of 045, occurs in 2 cases out of 100, but has a high rate of pregnancy termination and provokes fetal death and miscarriage.

Let's figure out why placental abruption occurs, how to recognize the first signs, and whether it is possible to maintain the pregnancy.

• Placenta and its role for the fetus
• Causes and consequences of placental abruption during pregnancy at different stages
  • Detachment in the early stages: what is dangerous in the first and second trimester
  • Risks in late pregnancy and the third trimester
• What types of placental abruption are there?
  • What is the danger of partial detachment in a normal location?
  • What does marginal detachment look like when the fetus is presented?
  • How does detachment manifest itself in the area of ​​the uterine pharynx?
• How does placental abruption manifest?
• Symptoms and sensations of a woman in the initial stages
  • What characteristic pain is observed in pathology?
  • How to determine in later stages
  • Nature of the discharge
  • Is there bleeding?
  • If detachment occurs during childbirth
• Diagnostics
  • Is the pathology visible on ultrasound?
  • What tests are taken?
  • How do doctors determine
  • Emergency cases for urgent medical care
• Fetal survival for different types and degrees of placental abruption: table by week
• Treatment
  • How it goes
  • What are they doing?
  • How to give birth
• How to prevent a dangerous pathology
• Doctors' recommendations

Afterbirth and its meaning

Contrary to popular belief, the placenta (otherwise the placenta or placenta) is not a solid shell in which the child develops. This is a disc-shaped embryonic organ that is normally attached to the posterior wall of the uterus.

What functions does the placenta perform?

• provides breathing and nutrition to the fetus;
• plays the role of the immune system, protecting the baby from infectious attacks;
• participates in the synthesis of hormones necessary to maintain pregnancy and labor.

The afterbirth is rejected by the body immediately after the birth of the child -. But its premature detachment is possible at any stage of gestation, as well as during childbirth.

What is placental abruption and what is the prognosis at different stages of gestation?

Medicine is not yet able to accurately identify the causes of the emerging pathology and reliably determine at what time a detachment may occur in a particular woman. But there are three areas that cause failure in the reproductive system:

1. Vascular changes, fragility and fragility of capillaries, developing with gestosis and persistent hypertension.
2. blood, increased coagulability.
3. Blunt abdominal trauma.

If, without obvious reasons, placental abruption occurs in the early stages of pregnancy, the reasons often remain unclear.

Prognosis in early gestation

The consequences of untimely passage of the placenta depend on the area of ​​the lesion and the duration of pregnancy. If no more than a third of the organ is detached, this will not have a significant impact on the development of the fetus, especially in the early stages. The placenta completes its formation in the first trimester; in the first trimester it is able to compensate for damage due to continued growth. The 2nd trimester is dangerous due to the formation of hematoma, compression of the fetus and the development of hypoxia.

The result of the separation of ½ of the part becomes.

Detachment of more than 75% of the surface of the placenta leads to bleeding and the threat of intrauterine death of the child from lack of oxygen.

Forecast for the last stages of gestation

Complete detachment, especially in the third trimester of pregnancy, is dangerous not only for the embryo, but also for the woman herself. The most common complication is the development of Cuveler's uterus, a condition where accumulated blood begins to saturate the muscle wall. Because of this, the organ loses its contractility and massive bleeding develops, which usually ends with the removal of the uterus. Another danger is disseminated intravascular coagulation syndrome, which disrupts the function of blood clotting and leads to bleeding not only from the uterus, but also from other organs.

Early detachment can be caused by other reasons, and the consequences in this case appear during childbirth. For example, multiple pregnancy, repeated surgical delivery, polyhydramnios become provoking factors.

Forms of placental abruption

The classification of premature detachment of the placenta allows us to determine the localization of the process and the area of ​​the lesion.

If the location of the placenta is normal

Premature abruption of a normal placenta is possible in three options:

1. Partial, non-growing, characterized by a small area of ​​damage, often occurs without clinical manifestations. The resulting hematoma does not have a negative effect on the fetus. With timely detection and appropriate treatment, the prognosis is favorable, and delivery occurs naturally.
2. Partial increasing - has a progressive course. A hematoma looks like a compaction gradually increasing in size. The useful placental area is reduced, which leads to oxygen starvation of the fetus. Urgent medical attention is required if detachment occurs in the third trimester, an emergency caesarean section is performed.
3. Total detachment always leads to the death of the baby in the womb, both in the short term and before birth.

If presentation is diagnosed

Presentation refers to the placement of the placenta in the lower part of the uterus. This arrangement is especially dangerous for the 3rd trimester and the labor period. Bleeding develops in 60% of cases:

• Central peeling occurs from the center to the periphery, so it often occurs without bleeding. In this case, a hematoma forms between the placenta and the uterine wall.
• Marginal abruption of a low-lying placenta is characterized by massive bleeding. The discharge of the placenta occurs along the periphery, from the edges to the center, so the dark red discharge pours out.

When the placenta is located in the uterine os

With a low-lying placenta covering the uterine os, complete detachment usually occurs during childbirth. The leading factor here is the contraction of the muscle wall. With a small area of ​​lag, spotting brown discharge of varying intensity is possible.

Clinical manifestations at different stages

Considering how the pathology manifests itself, it should be noted that the intensity of manifestations at different stages of gestation is different, but the general symptoms are similar. How to understand that premature placental rejection has begun during pregnancy:

• the tone of the uterus changes, which is felt as excessive tension;
• unusual vaginal discharge appears, and the color of the discharge varies from scarlet to dark brown;
• stomach pain in the lower part;
• when a significant mass is detached, they are noted.

Each stage of gestation has its own characteristics and possible consequences for the child.

How does a woman feel in the early stages?

The 1st trimester has the most favorable prognosis for the development of pathology. The thickness of the placenta during this period is no more than 18 mm, and it continues to grow.

The hematoma formed as a result of bleeding is in the stage of organization - this means that the formed blood clots are partially resolved and partially localized. The placenta, increasing its size, increases the area of ​​“adhesion” with the wall of the uterus; with appropriate treatment, nutrition and gas exchange are restored, and nothing threatens the baby.

In the early stages, the symptoms of detachment are low-intensity:

• nagging pain in the lower abdomen radiating to the lower back;
• moderate brownish discharge.

Ultrasound reveals a small compaction or depression.

The nature of pain in pathology

Sometimes women worry whether placental abruption can cause black stool to appear during bowel movements. The color of stool does not depend on the reproductive system, and therefore cannot be considered a sign of detachment.

Detachment during delivery

The likelihood of premature passage during labor is high if the placenta is incorrectly positioned.

How does placental abruption manifest during childbirth?

• cramping severe pain;
• intense blood loss;

Why is this situation dangerous? The baby may suffocate or die from asphyxia; the woman is threatened by massive bleeding. Therefore, emergency care consists of emergency surgical delivery.

What is the diagnosis based on?

The pathology is diagnosed based on the patient’s complaints, an objective examination, and data from special research methods.

Hardware surveillance

- an old but proven technique. It allows not only to detect a hematoma, but provides complete information about the area of ​​the lesion, location, and stage of the process.

CHT is an assessment of the child’s cardiac activity in combination with the frequency of uterine contractions. Gives a complete picture of the condition of the fetus, the presence of hypoxia.

Clinical observation and tests

In addition to a standard clinical blood test that can show the presence of anemia, cordocentesis is performed - blood sampling from the umbilical cord. The procedure is performed under local anesthesia and reliably determines deviations in the child’s development.

Objective examination

The primary diagnosis is established on the basis of an obstetric examination: increased uterine tension, vaginal discharge, pain on palpation, changes in fetal heart rate. The clinic and the woman’s complaints play an important role.

When is emergency care provided?

During pregnancy, every opportunity is used to preserve pregnancy and maintain pregnancy. In the later stages, with premature abruption of a normally located placenta, emergency care consists of cesarean section and operative delivery.

A planned operation is indicated for a short umbilical cord, or when the placenta does not adhere to the wall of the uterus. Such conditions always lead to premature passage of the placenta.

Risk table for different pathology options

A favorable outcome depends on the period at which the detachment occurred and the area of ​​discharge of the placenta. The table shows what the pathology threatens at different periods of development.

Total placental abruption almost always, at any stage, leads to intrauterine death of the baby.

Therapeutic measures

Bleeding and hematoma due to placental abruption require medical intervention.

Principles of treatment for placental abruption during pregnancy

After assessing the condition of the woman and the fetus, the question of what to do next is decided, what principles to follow:

• at or earlier, with a small area of ​​discharge and a non-progressive course, the woman can be treated at home under constant monitoring;
• if the resulting hematoma continues to grow, or there is a marginal detachment with significant bleeding, treatment is carried out in a hospital;
• with a large area of ​​detachment, intrauterine cleaning and termination of pregnancy cannot be avoided;
• in the long term, they try to maintain the pregnancy; if this is not possible, they resort to surgery;
• massive bleeding during childbirth occurs when the Cuveler uterus develops, which means removal of the organ.

What drugs are used for treatment

The pathology is treated depending on the duration of pregnancy and the amount of blood loss:

• in the early stages, suppositories with papaverine are prescribed to relieve spasms;
• duphaston in the first trimester in the form of suppositories;
• hemostatic agents in tablets for limited bleeding;
• inject hemostatic agents (for example, tranexam) in case of threatening blood loss;
• on no-spa and papaverine help normalize the tone of the uterus, duphaston or utrozhestan is also indicated;
• prescribe antiplatelet agents to prevent placental insufficiency (chimes);
• at ;
• in some cases, taking Wobenzym is indicated, but antibiotics are not used for this pathology.

Delivery options

In the early stages, a minor discharge heals on its own, and childbirth takes place naturally.

With more extensive damage, it is important to prevent the development of fetal hypoxia; after appropriate treatment, delivery proceeds safely.

With minor detachment during childbirth, surgical intervention is not indicated - women give birth naturally. But it is important to understand why detachment and bleeding occur in the later stages. This pathology is often a recurring phenomenon.

If detachment occurs during pushing, a cesarean section is performed.

Is there prevention?

There is no specific prevention for this pathology. But, understanding what placental abruption looks like and the mechanism of its occurrence, you can develop the necessary measures for timely detection. This includes:

• identification of risk groups;
• systematic examination;
• preventive medication (antiplatelet agents, multivitamins);
• timely treatment in a hospital setting.

Doctors' recommendations: what to do to avoid dangerous complications and consequences for mother and child during pregnancy

How to prevent placental abruption during pregnancy, and how to behave if pathology has already been detected:

• maintain physical and psychological peace, a woman should not get excited, nervous or worried;
• Not recommended ;
• you should reconsider and give preference to healthy products;
• protect yourself from viral diseases and pay attention to the recovery period, especially after;
• You should not go on vacation if you have any pathology or have a history of it;
• It is better to postpone having sex until a more favorable period.

Having found out what causes placental tissue detachment during pregnancy, it is worth remembering that the main role is played by the behavior of the woman herself. Attentive attitude towards yourself and your growing child can not only prevent pathology, but also minimize negative consequences.

Typically, the placenta is attached to the top of the uterus and remains there until the baby is born. During the last stage of labor, the placenta separates from the uterus and labor contractions push the placenta into the birth canal. This is called "birth of the placenta."

Approximately 1 in 100 pregnant women (1%). This usually occurs in the third trimester of pregnancy, but can occur any time after the 20th week of pregnancy.

Placental abruption can be mild, moderate or severe. If the detachment is mild, that is, not the entire placenta has separated from the wall of the uterus, but only a small part of it, as a rule, does not pose a serious danger. But if the abruption is severe (the distance between the placenta and the uterus is large), then the child may have the following problems:

• insufficient height and weight;
• premature birth (before the full 37 weeks of pregnancy);
• stillbirth (when a baby dies in the womb before birth but after 20 weeks of pregnancy).

Placental abruption is associated with approximately 1 in 10 preterm births (10%). The birth of a child prematurely threatens him with health problems in the neonatal period (the first four weeks of life), the first week is especially dangerous. If a child was born very premature, he may subsequently be diagnosed with a disability, and he may even die.

Symptoms of placental abruption

The main symptom of placental abruption is bleeding from the vagina. A woman may also experience discomfort and pain in the lower abdomen or back pain. Sometimes these symptoms can occur without vaginal bleeding if the separated placenta has blocked the os and blood simply cannot leak out. Therefore, if you suddenly experience abdominal pain, consult a doctor.

If the doctor suspects that a woman’s placenta has separated, she will be admitted to a hospital or maternity hospital. Accurate diagnosis is carried out using a medical examination and ultrasound.

Causes of placental abruption

It is impossible to pinpoint the exact reason why the detachment occurred. But it has been proven that women who:

• smoke cigarettes during pregnancy;
• use drugs, especially cocaine;
• over 35 years old;
• suffer from high blood (arterial) pressure;
• have an infection in the uterus;
• have problems with the uterus or umbilical cord;
• have previously encountered abruption in previous pregnancies (if a woman had abruption in a previous pregnancy, then the likelihood that it will happen again is more than 10%);
• pregnant with twins, triplets and more children;
• (excess amniotic fluid);
• whose membranes ruptured before the pregnancy reached a full 37 weeks;
• suffered an abdominal injury, for example, during a car accident or as a result of physical violence.

Treatment of placental abruption

Treatment depends on how severe the detachment is and how far into the pregnancy you are. In mild cases, the doctor will simply monitor the condition of the woman and her child. But in more serious cases, the woman is prescribed delivery, regardless of the stage of pregnancy.

If the pregnancy is still very early and the woman urgently needs to give birth, the doctor will prescribe corticosteroids - medications that help speed up the development of the baby's lungs and other organs.

1. Mild placental abruption – if a woman has a mild abruption at 24–34 weeks of pregnancy, she needs careful observation in the hospital. If tests and examinations show that she and her baby are doing well, the doctor will prescribe her treatment aimed at maintaining the pregnancy as long as possible. Often a woman is advised to stay in the hospital until she gives birth. But if the detachment is not accompanied by bleeding, then the woman can be sent home.

If a woman has a mild abruption at term, the doctor may recommend inducing labor or a cesarean section, or waiting for the natural onset of labor.

But a woman will definitely be prescribed an emergency delivery, even with mild abruption, if:

• placental abruption worsens;
• the woman is bleeding heavily;
• there are problems with the condition of the fetus.

2. Moderate (moderate) or severe placental abruption - in such cases, emergency delivery is usually recommended, usually by caesarean section.

If a woman has lost a lot of blood due to abruption, she may need a blood transfusion. In very rare cases, if a woman has heavy bleeding that cannot be stopped, she may need a hysterectomy - surgical removal of the uterus. A hysterectomy can prevent fatal bleeding and other health problems for the mother. Unfortunately, such a woman will never be able to get pregnant again.

In most cases prevent placental abruption during pregnancy impossible. But you can reduce your risk by not smoking or taking drugs, taking medication for hypertension (high blood pressure) if you have it, and always wearing a seat belt in your car.

Untimely (before the due date) separation of the placenta from the uterus is called premature placental abruption. It can occur during childbirth or during pregnancy.

The placenta should be separated only after birth. When the placenta separates from the lining of the uterine wall, vascular damage occurs and bleeding occurs. This pathology occurs in approximately 1.5% of cases.

Premature placental abruption occurs most often in women carrying a child for the first time. It also occurs during premature birth. This condition is considered extremely dangerous and requires immediate specialist intervention.

The baby's place or placenta is responsible for many biological processes that are responsible for the development of the child. It is the placenta that determines whether the child will develop or die.

Biological significance of the placenta

The baby's place begins to form already in the second week after conception. During this time, the fertilized egg makes a long journey through the fallopian tubes, then attaches to the wall of the uterus. The placenta reaches full maturity at approximately 12 weeks. The baby's place consists of an interlacing of blood vessels of the child and his mother. The placenta has a protective membrane through which the baby's waste products are excreted.

The placenta performs a gas exchange function. From the blood of the expectant mother, oxygen passes to the baby through the placenta, and carbon dioxide is removed from there. The baby in the womb can only breathe with the help of the placenta.

The placenta also performs excretory and nutritional functions. With the help of the placenta, food, nutrients, and water enter the baby's body.

The placenta produces various hormones that are necessary for the normal functioning of the unborn child. This means that the placenta performs a hormonal function.

Finally, the child's place plays a protective function, protecting the fetus from various viruses, bacteria, developing the immune system in the fetus.

The baby's place should be separated only in the third stage of labor. If this happens earlier, the child begins to suffer from a lack of oxygen and nutrients. When placental abruption occurs, large vessels are damaged and bleeding occurs, which is life-threatening for the mother and fetus.

Causes of placental abruption

There are a huge number of reasons at the moment:

• While pregnant, a woman experiences hypertension. Frequent pressure surges can cause placental abruption. This condition can be caused by stress or compression of the inferior vena cava when lying on your back for a long time.

• If previous pregnancies have already ended in placental abruption.

• The cause of premature detachment of the child's place may be multiple pregnancies or frequent births.

• Post-term pregnancy.

• A scar on the uterus after a previous caesarean section.

• Early toxicosis, gestosis, preeclampsia.

• The cause of premature placental abruption may be congenital anomalies of the uterus: saddle-shaped or bicornuate. Anomalies of blood vessels also play a significant role: they can be brittle and fragile.

• Rejection of the placenta can occur due to abnormalities in its development.

• The mother has a bleeding disorder.

• Various pathologies of labor can cause premature placental abruption. For example, a sharp drop in pressure in the uterus, rapid release of water, the birth of the first baby during a multiple pregnancy.

• The placenta can be separated if there is trauma to the abdomen as a result of a blow, fall, or car accident.

• Drug use, alcohol and smoking lead to early placental abruption. This can also include a decrease in hemoglobin in the blood.

• Various chronic diseases can lead to detachment of a child's place: diabetes mellitus; pyelonephritis; diseases of the thyroid gland, adrenal glands; obesity; incompatibility of mother and fetus according to Rh factor, blood group; antiphospholipid syndrome; systemic lupus erythematosus; uterine fibroids.

Symptoms of placental abruption

During detachment of the child's place, damage to the uteroplacental vessels occurs. Bleeding appears. It can be weak or quite strong. Blood accumulates between the placenta and the wall of the uterus, which leads to the formation of a hematoma. As blood accumulates, the hematoma increases, thereby further separating the placenta from the uterine wall.

If the area of ​​placental abruption is small, then after the formation of a retroplacental hematoma, thrombosis of the uterine vessels is possible, and further placental abruption stops. With significant placental abruption, heavy bleeding and extensive retroplacental hematoma, escaping blood can saturate the wall of the uterus, which leads to disruption of its contractility. This condition was called “Couvelaire’s uterus” after the French gynecologist A. Couvelaire, who first described a similar picture.

If placental abruption forms closer to its edge, then blood, penetrating between the membranes and the wall of the uterus, pours into the vagina, which is manifested by external bleeding. When bleeding occurs immediately after placental abruption, the blood flowing from the vagina is usually scarlet in color; dark blood with clots is noted if some time has passed from the moment of abruption to the appearance of bleeding.

When the placenta is located on the posterior wall, the pain is diffuse and unclear. The uterus is hypertonic, painful, and takes on an asymmetrical shape. Depending on the volume of blood loss, symptoms of hemorrhagic shock appear and increase: weakness, dizziness, vomiting, cold, pale and moist skin, dry mucous membranes, increased breathing and heart rate are proportional to the decrease in blood pressure.

There are three stages of placental abruption:

1. Lightweight. There are no symptoms. The beginning of the detachment process can be determined by ultrasound examination.

2. Average. A little blood is released from the genital tract, and pain is felt in the abdomen. There may be no blood. This depends on the size of the hematoma and the location of the detachment.

3. Heavy. There is anxiety, weakness, severe abdominal pain, dizziness. Bloody discharge from the vagina appears, and fainting may occur. When palpated, you can identify a protrusion on one side. There is no fetal heartbeat, parts of its body cannot be felt.

Simultaneously with the detachment, signs of an increasing lack of oxygen in the fetus appear. When the size of the retroplacental hematoma is 500 ml or more and/or the area of ​​detachment is more than 1/3, the probability of fetal death is highest.

Tactics for placental abruption

Treatment of premature abruption of a normally located placenta is based on the choice of a method of gentle and quick delivery with simultaneous measures taken to replenish blood loss, combat hemorrhagic shock, and control the blood coagulation system.

Obstetric tactics in choosing the method of delivery are determined by the time of abruption (depending on whether it occurred during pregnancy or childbirth), the severity of bleeding, and the condition of the mother and fetus.

In case of partial, small area, non-progressive premature abruption of a normally located placenta during pregnancy up to 36 weeks, if the condition of the pregnant woman and the fetus does not suffer, the bleeding is insignificant, then the pregnancy can be prolonged under hospital treatment conditions.

In this case, the woman is prescribed bed rest, antispasmodics and hemostatics, and iron supplements. Laboratory monitoring of the blood coagulation system is mandatory. If repeated episodes of bleeding occur, indicating progression of detachment, the question of delivery is raised.

In case of mature birth canal (softening, shortening of the cervix, patency of the cervical canal), an artificial opening of the amniotic sac is performed with possible delivery through the natural birth canal. However, more often they resort to cesarean section.

When the pregnancy is at full term and the placental abruption is small in area, the question of delivery is immediately raised. In the presence of a mature birth canal and in the first stage of labor, early amniotomy (opening of the amniotic sac) is performed, which helps reduce intrauterine pressure. This prevents further placental abruption.

Childbirth is carried out under careful monitoring of the condition of the fetus and contractile activity of the uterus. If the condition of the fetus worsens, bleeding increases, uterine hypertonicity appears between contractions, or the mother’s condition worsens, surgical delivery is resorted to.

In case of physiological childbirth and pathological bleeding, immediately after the birth of the child, a manual examination of the uterine cavity is required, and in the afterbirth and early postpartum period, bleeding is prevented with drugs that increase uterine contraction.

The causes of bleeding after delivery are a violation of the blood coagulation system and a decrease in uterine contractility. Therefore, careful monitoring of the nature of bloody discharge from the genital tract is carried out.

Simultaneously with delivery (caesarean section or physiological birth), measures are taken to restore the volume of circulating blood, maintain the vital functions of the mother, pain relief; in case of significant blood loss and severe anemia, transfusions of fresh donor blood, fresh frozen plasma, fibrinogen, and platelet mass are performed.

In case of premature abruption of a normally located placenta, a cesarean section is most often used. In case of pronounced clinical manifestations of premature placental abruption during pregnancy and in the first stage of labor, urgent delivery is performed by cesarean section, regardless of the duration of pregnancy and the condition of the fetus. During a cesarean section, after removing the fetus and placenta, the uterine cavity is cleared of blood and clots, after which all its walls are carefully examined to determine the condition of the uterine muscles. If they are soaked in blood, the uterus is removed, as it is the source of bleeding. If placental abruption occurs in the second stage of labor and there are conditions for the rapid completion of labor through the natural birth canal, the birth is completed by applying obstetric forceps or vacuum extraction of the fetus.

If you experience any abdominal pain or bleeding from the genital tract during pregnancy, you should immediately consult a doctor!

Prevention of placental abruption

The following measures are aimed at preventing early placental abruption:

• thorough examination and diagnosis of the condition of the uterus and pelvic area. Treatment of identified diseases;

• monitoring the condition of blood vessels before and after conception;

• monitoring blood pressure levels;

• try to avoid any injuries, heavy lifting, etc.;

• prevention and timely treatment of allergic reactions.