The placenta is called a very important organ, which initially develops from the same cells as the baby himself. Until 11-16 weeks, it is called the chorion, the villous membrane of the embryo: its villi penetrate the thickness of the uterine wall, oxygen and nutrition enter the baby through them, and its waste products and carbon dioxide are removed. After this period, a full-fledged placenta is formed, which also has a lot of villi, but, in addition to nutrition, it also produces hormones (in particular, progesterone) that help maintain pregnancy (before the formation of the placenta, this function is performed by

The placenta does not have a contractile function, but is attached to the uterus - a strong and large muscle, which even before the onset of childbirth periodically “trains” for a short time, which is expressed in the reduction of its individual sections for a short period of time. Usually the placenta adjusts to these movements, and nothing happens to it, but sometimes a situation arises when a larger or smaller section of it exfoliates from the uterine wall. Then the fetus suffers, as its nutrition is disturbed. In addition, this condition can lead to the death of the mother and fetus, so the symptoms of placental abruption should be brought to the attention of both pregnant women and their families.

What is placental abruption?

Normally, the placenta should attach closer to the top, that is, the bottom of the uterus, usually along its back wall, but sometimes it is located closer to the exit - the cervical canal. This is called It can be full or central when the baby's place is on both sides of the exit from the uterus, blocking the exit from it. It may also be that the placenta is simply a little lower than it should be. Such placentation is a factor predisposing to detachment.

Thus, a normally located or placenta previa can exfoliate. The symptoms of placental abruption depend on how exactly it is located.

Also, the manifestations will depend on such factors:

The detachment continues or she was able to stop;

Where did it separate from the wall of the uterus - in the center or on the edge;

At what time of pregnancy or even childbirth did such a condition develop: placental abruption on early dates, if a very small part of it has moved away from the wall of the uterus, it has a mild course and a favorable prognosis, since subsequently the child's place will still grow and develop, and it is likely that the defect will close and "outgrow".

There are three main features:

1) Bleeding from the vagina of varying intensity.

2) Pain in the abdomen, its lower parts.

3) Signs of fetal suffering: a change in heart rate, an increase or decrease in its motor activity.

Symptoms, depending on the clinical situation, are as follows:

I. If placenta previa abruption occurs from the edge, there is mainly only bleeding, there is almost no pain. If such a small area exfoliated, the fetus does not suffer.

II. If the placenta, wherever it is located, exfoliates in the central area, and the bleeding stops (that is, the detachment is non-progressive), then there may be no symptoms. A woman learns about this case on an ultrasound scan or later, after the fact, a little brown blood is released.

III. If detachment of a normally located placenta in the marginal segment exfoliates, two of the three symptoms may be present: bleeding and pain. If the bleeding does not stop, then the fetus begins to suffer, contractions and (or miscarriage, if it is placental abruption in the first trimester) may begin.

IV. When the detachment of the central part of the placenta occurs, blood accumulates behind the placenta. This is called retroplacental hematoma. She herself, even if the bleeding has stopped, is able to exfoliate the placenta further. As a result, a significant area, and even the whole placenta, can exfoliate. Blood with such a partial detachment is not always released to the outside. Then the symptoms of placental abruption are as follows: weakness, pallor, a woman's heart palpitations, she feels pain in the abdomen, uterine tension, the baby first moves more often, then it can calm down altogether. With further impregnation of the walls of the uterus with blood from the hematoma, the pain intensifies, the uterus does not relax. If the blood finds a way out, then it is poured out of the vagina.

V. The placenta can exfoliate during childbirth. Then bleeding also occurs, clots may be released. The uterus does not relax well outside of contractions, if the fetus suffers, then its dark feces - meconium - are excreted. These signs should be noted by obstetrician-gynecologists

What to do if you think you have a detached placenta?

With any discharge, even if it is a brown “daub”, you must take a horizontal position and inform your gynecologist who is observing you about this. If scarlet blood is released, you need to lie down immediately, do not even get up to go to the toilet, be sure to call an ambulance and ensure yourself maximum peace. If the child (according to ultrasound) developed normally, you do not have severe gestosis or chronic pathology, there is a high probability that you will stop the bleeding with the strictest bed rest, and then help will arrive in time. in the case of placental abruption does not mean that you can get up, for several days you will even have to go to the toilet lying down, on the ship.

Content:

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

The anomaly can be complete or partial, central or marginal, the latter being the least dangerous. Early placental abruption can occur during pregnancy or during childbirth. If the pathology manifested itself before 20 weeks, the chances of a successful outcome are higher than placental abruption at later dates. This is due to the fact that in the early stages the child's place is actively growing and developing, and the affected part is compensated in 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 external signs may or may not be present. Another symptom is that the fetus stops moving. In almost all cases, 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 cavity with blood clots is found in the child's place.
• An anomaly of moderate severity is accompanied by pain and weak bleeding. There may or may not be bleeding. Palpation of the uterus reveals tension and mild local pain. When listening to the fetal heartbeat, hypoxia is detected.
• Premature abruption of the placenta in severe form is manifested by severe pain, bouts of weakness, anxiety. Sweating, shortness of breath, lowering pressure and temperature may occur. The uterus is tense, has asymmetric contours. The fetal heartbeat is not audible.

The main symptoms of pathology in the first trimester:

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

Symptoms of pathology in the second trimester:

• Weakness.
• Dizziness.
• The tone of the uterus and tangible pain on palpation are added to the pain syndrome and possible bleeding.

Symptoms of pathology in the third trimester and during childbirth:

• Severe pain in the abdomen.
• Bleeding.
• Tension of the uterus.
• Detachment of the child's place during childbirth is accompanied by meconium of the child and the appearance of blood in the amniotic fluid.

Danger of placental abruption

With an anomaly, the integrity of the blood vessels is violated, a hematoma forms between the walls. After that, the separation of the children's place 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 passes into the stage of a partial non-progressive anomaly. This does not threaten the child, pregnancy and childbirth in this case proceed normally.

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

Complications of placental abruption

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

The tone of the uterus and pain syndrome is observed in almost every case. The pain may be dull, it may appear paroxysmal, give to the hips, lower back and vaginal area. Pain during palpation of the uterus can be localized at the site of separation, and can spread throughout the abdomen.

With an increase in the area of ​​exfoliation and increased blood loss, oxygen starvation of the fetus begins. When separating a child's place on ¼ of the area, the first signs of hypoxia appear. With an increase in the gap to 1/3, hypoxia intensifies, and when peeling up to 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 maternal illnesses, and degenerative changes in the mucous membrane.

Other causes of placental abruption:

• Maternal high blood pressure.
• Pressure fluctuations caused by stress or health problems.
• Degenerative changes in the mucous membrane caused by frequent or multiple births.
• Postponed pregnancy.
• Age after 35.
• Pregnancy after prolonged infertility.
• Anomalies in the development of the uterus - bicornuate, saddle.
• Anomalies in the location and development of the child's place.
• Pregnancy after caesarean section.
• Toxicosis, preeclampsia, especially in the 1st trimester.
• Pathology of the structure of the uterus.
• External injuries of the abdomen (fall, blow).
• Drinking alcohol and smoking.
• Wrong nutrition.
• Allergic reactions to medicines.
• Severe chronic, endocrine and infectious diseases.

Diagnosis of pathology

The diagnosis is made on the basis of clinical manifestations. The problem is indicated by spotting, the uterus is in good shape, 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, 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 methods of examination to use. In the absence of pronounced symptoms, ultrasound is used.

By using ultrasound the size of the area of ​​the separated children's place and the size of the hematoma are determined. A blood test is required to detect signs of anemia. The presence of anemia can signal latent or chronic blood loss.

Throughout pregnancy, women face many dangers that can harm their health. future mother and fetus. And in the worst case, they can become a prerequisite for spontaneous abortion. Detachment of the placenta is one of the pathologies that manifests itself in pregnant women at any time.

Early placental abruption is the mildest manifestation of placenta and causes less harm to the developing fetus.

What is the placenta and its role for the fetus

The placenta has another name - a child's place. This is a special connective tissue formed from a branched chorion, which, by its appearance resembles a thick cake with a diameter of 18 cm. It directly separates the fetal egg with the embryo from the mother's body. The placenta in the normal state is located on the wall of the uterus - at its bottom, front and back.

The placenta is a very complex structure, consisting of the blood vessels of the mother and the fetus, which reliably protects it from harmful substances from the mother's body and helps to remove the waste products of the fetus itself.

Functions of the placenta:

• Nutritious (the placenta helps to saturate the fetus with vitamins, minerals and water necessary for its development).
• Excretory (with the help of the placenta, all harmful substances of the fetal vital activity are excreted).
• Gas exchange (this is a kind of "respiratory apparatus" of the fetus, with the help of the placenta, oxygen enters the blood of the fetus, and carbon dioxide is released back, which enters the mother's body).
• Protective (the placenta bears the immunological protection of the fetus, passing the mother's antibodies to it).
• Hormonal (the placenta produces hormones necessary for full development fetus and the normal course of pregnancy - acts as an endocrine gland).

In its normal state, the placenta, located between the walls of the uterus and amniotic fluid, subjected to two-sided pressure. This promotes a kind of balance. And, if there is any deviation in this condition, one side exerts more pressure, we can talk about premature detachment of the placenta or chorion.

Detachment of the placenta (chorion) - what is it?

Placental abruption can occur at any stage of pregnancy. Premature separation of the placenta is a pathological condition in which the baby's place is separated from the uterus. Detachment can also occur on the other hand - separation of the fetal egg from the chorion (detachment of the fetal egg). Such complications pose a danger to the health and life of the mother and fetus.

Placental abruption has three forms of manifestation:

• partial non-progressive (detachment of a small part of the placenta, less than 1/3, which does not harm the fetus and you can save the pregnancy);
• partial progressive (occurs when placental abruption is about half, there is a risk of hypoxia in the fetus, which can lead to his death);
• total (this is a complete detachment of the placenta, in which the child 100% dies).

Causes of placental abruption in early pregnancy

The following groups of causes and factors affecting premature detachment placenta:

• etiological factors (directly provoke the development of such a complication);
• predisposing factors (risk factors that may not cause detachment).

Etiological factors:

• increased fragility and fragility of blood vessels and capillaries, which is caused by the loss of their elasticity, can also cause poor blood permeability through them;
• abnormal structure of the uterus (such pathologies include bicornuity and saddle uterus);
• high blood pressure in a pregnant woman (hypertension);
• fluctuations in blood pressure from lower to higher, which can be caused by neuropsychological conditions of a pregnant woman (stress);
• toxicosis and gestosis in early pregnancy (with gestosis, protein in the urine increases, pressure rises, edema appears and capillaries and blood vessels become fragile);
• various diseases of the systems of a pregnant woman (diseases of the endocrine gland, kidneys, diseases of the cardiovascular system, diabetes mellitus);
• one of the important causes of detachment is the insufficiency of the placenta itself, a violation of its main functions (abnormal location of the placenta or its development);
• chronic disease of the genitourinary organs in a pregnant woman;
• high probability of occurrence premature detachment placenta in post-term pregnancy;
• a large number of births, as well as multiple births, can also contribute to the appearance of this pathology (multiple births violate the uterine mucosa, which in turn provokes placental abruption);
• autoimmune reactions (the production of antibodies to one's own tissues, which leads to their rejection - a rather rare manifestation);
• allergic reactions, including medical preparations(protein solutions, blood transfusion).

Risk factors that can cause premature placental abruption:

• the presence of such a pathology in previous pregnancies (indicated in the anamnesis, which makes it possible at the very beginning of pregnancy to monitor the state of the placenta);
• the age of the pregnant woman is also important (the older the pregnant woman, the higher the risk of detachment - most often the risk increases after 34 years);
• if a pregnant woman had a birth by caesarean section (in this case, a scar appears on the placental site), the risk of placental abruption pathology increases);
• long treatment for infertility can also cause detachment;
• the presence of bad habits in a pregnant woman (smoking, drinking alcohol and drugs);
• trauma to the abdomen in a woman, thereby provoking trauma to the uterus (may cause detachment).

All these reasons, directly or indirectly, can cause the pathology of placental abruption in early pregnancy. For a timely response, you need to know the symptoms of this disease and immediately consult a doctor.

Symptoms of placental abruption

Placental abruption in most cases is accompanied by bleeding, which occurs due to damage to blood vessels and capillaries. When the placenta begins to separate from the uterus, blood accumulates in the resulting space, which causes a hematoma.

As we noted above, placental abruption occurs in three forms. In its simplest form (partial, non-progressive), there are practically no symptoms. And you can find out about this pathology only by performing an ultrasound. In the other two, symptoms are pronounced and include bleeding, lower back pain, and fetal immobility.

The following groups of symptoms are distinguished: uterine bleeding, abdominal pain and uterine tension, disruption of the heart in the fetus. Let's look at each group in more detail.

Uterine bleeding

Bleeding is the most common symptom of placental abruption. On average, four out of five cases of bleeding from the vagina are observed. Depending on the size of the detachment and the general condition of the blood coagulation of the pregnant woman, uterine bleeding may be slight or heavy.

• However, there may be no visible bleeding. Blood can accumulate in the place where the placenta has detached from the walls of the uterus, this is especially common in the case of detachment in the central part of the placenta. This is a particularly dangerous manifestation of pathology, since bleeding from vessels and capillaries does not stop, but it has an internal manifestation. The scientific name for this manifestation of placental abruption is retroplacental hematoma. With a central detachment of the placenta, blood accumulates more and more in the formed space, which leads to an increase in the area of ​​the detachment. As a result, the walls of the uterus are saturated with blood. In this case, we will already talk about saving the life of the mother, while the fetus is threatened with death in 100% of cases.
• Marginal bleeding is less dangerous because the blood does not accumulate in the uterus, but comes out, causing visible or external bleeding. If the blood is scarlet, the detachment has just occurred, if the color of the spotting is darker, some time has passed between the detachment and the spotting.
• Mixed bleeding may occur. In this case, it is impossible to accurately estimate the amount of blood loss, referring only to external secretions. Here it is already necessary to take into account the general condition of the pregnant woman.

Therefore, you need to be attentive to your feelings, because the absence of secretions does not mean at all that there is no pathology.

Abdominal pain and uterine tension

In the absence of visible bleeding, pain can become a symptom of placental abruption. Most often, this pain appears as a kind of attacks and is characterized as dull. There is also no clear localization of this pain. In most cases, it can give to the lower back, to the perineal region or to the thigh.

When feeling the uterus, pain appears, both local and without a clear location. More acute pain when pressing on the uterus is manifested by internal bleeding. You can also identify the density of the uterus and its tension.

Violation of the activity of the heart in the fetus

The larger the area of ​​​​placental abruption and the higher the level of blood loss, the greater the likelihood of a violation of cardiac activity in the fetus. The presence of such a symptom indicates fetal hypoxia. Such a symptom manifests itself in the second and third stages of placental abruption (more than a quarter of the entire area). If detachment occurs from half of the entire area, fetal death is inevitable.

In any case, if any of these symptoms appear, you should immediately consult a doctor.

Diagnosis of placental abruption

Diagnosis of this pathology is usually never difficult. Placental abruption can be diagnosed already at the initial examination and history of the pregnant woman. Doctors carefully study the patient's complaints, medical record and carry out all the necessary laboratory tests. It turns out the presence of bleeding, increased tone of the uterus and the presence of pain. Also, the state of detachment is characterized by oxygen starvation of the fetus.

Diagnosis by ultrasound provides complete confirmation of the diagnosis. With the help of ultrasound, it becomes possible to find out the presence of internal bleeding, the area of ​​placental abruption, the volume of retroplacental hematoma.

If a pregnant woman has spotting, this is not always the cause of placental abruption only. The doctor examines the cervix and vagina in order to identify infectious diseases, benign formations, as well as the opening of the cervix.

Treatment of premature detachment of the placenta

The choice of treatment directly depends on the nature of placental abruption, on the general symptoms and the condition of the mother and fetus. All activities are aimed at careful and sparing treatment of pathology, because in parallel it is necessary to carry out procedures to stop bleeding.

With a slight detachment of the placenta, the following measures are carried out:

• complete rest and being in bed (at home or in the hospital at the discretion of the doctor);
• exclusion of any loads, even minor ones;
• the patient is prescribed vitamins;
• tocolytic therapy - relaxation of the tone of the uterus;
• antispasmodics (No-shpa, Papaverine, Metacin, Magnesia);
• drugs to stop bleeding (Ascorbic acid, Vikasol);
• fight against anemia (iron-containing drugs).

All treatment of placental abruption in early pregnancy should be carried out under constant monitoring of the condition of the fetus and its heartbeat.

If the abruption of the placenta is severe, we can already talk about terminating the pregnancy and saving the life of the mother.

Therefore, for a successful outcome, it is imperative to consult a doctor at the slightest symptom.

Prevention of placental abruption in the early stages

In subsequent pregnancies, it is necessary to reduce the risk of the return of this complication. After all, any disease is easier to prevent than to treat it later.

A set of preventive measures:

• timely treatment of all diseases of the genitourinary organs of a pregnant woman;
• treatment of diseases of other body systems;
• maximum attention to one's condition in the presence of a Rh conflict;
• constant control of your pressure;
• exclusion of all bad habits;
• avoidance of all kinds of injuries;
• control of the state of the circulatory system;
• scheduled medical examinations;
• if there are allergies, timely control;
• complete elimination of stressful situations.

The health of a pregnant woman is a value that needs to be protected and protected. After all, the life and condition of the baby directly depends on her health. Be attentive, pay attention to any trifle and any change in the body. Thus, you will help yourself and your child in time.

The placenta is a full-fledged organ that develops in the uterus of every woman during pregnancy and provides an uninterrupted connection between the organisms of the mother and the fetus. Its functions are very multifaceted and are responsible for maintaining pregnancy and ensuring the normal development of the fetus.

When should the placenta exfoliate?

What is the role of the placenta:

1. Performs gas exchange function. Oxygen is supplied from the mother's blood through the placenta to the child, and carbon dioxide is excreted back.
2. Provides the child with nutrients, removes the products of his vital activity.
3. Protects against infections, and also participates in the formation of the child's immunity.
4. Synthesizes hormones that are responsible for the development of pregnancy (progesterone, estrogen, human chorionic gonadotropin, etc.).

The formation and growth of the placenta begins at 2-4 weeks of gestation, but changes in it occur throughout the entire period. It is located, as a rule, on the anterior or posterior wall of the uterus.

In a normal pregnancy, the placenta should separate from the endometrium of the uterus after the baby is born. Normally, it departs almost immediately, within 10-15 minutes. The process of rejection is accompanied by the release of a large amount of blood and dark-colored blood clots.

What is dangerous premature detachment of a normally located placenta

Premature placental abruption (PONRP), that is, its rejection from the walls of the uterus even before the onset of labor, is, without exaggeration, a serious complication that is extremely dangerous for pregnancy and the life of the fetus and requires immediate medical attention.

Pathology is accompanied by a violation of the integrity of blood vessels, due to which a hematoma forms between the walls. After that, the separation of the placenta (children's place) is even faster and the patient needs emergency help.

Often, after the appearance of a hematoma, thrombosis of the vessels of the uterus occurs, which can stop premature detachment. In such cases, the pathology is considered partial and not progressive. The condition does little to threaten the fetus and woman, and pregnancy and generic activity usually proceed without complications.

With progressive detachment, rejection continues, as a result of which the hematoma gradually increases in size. For a child, this is fraught with oxygen starvation. Total, that is, complete detachment of the placenta, unfortunately, inevitably leads to the death of the fetus.

Causes of the disease

Medicine has not yet been able to determine the pathogenesis, that is, the immediate causes that provoke PONRP.

But experts believe that complications can lead bad habits, constant stress, sudden changes in pressure, abdominal trauma.

Also, the cause of pathology can be a number of the following factors:

• hypertension in a pregnant woman;
• endocrine disorders: diabetes mellitus, obesity, thyroid disorders;
• diseases affecting blood vessels (primarily vasculitis, glomerulonephritis, lupus erythematosus);
• bleeding disorders (coagulopathy);
• preeclampsia is a disease that is accompanied by very high blood pressure, convulsions and loss of consciousness, which is dangerous for both the life of the pregnant woman and the life of the child;
• placental insufficiency;
• severe emotional stress, shock (the level of hormones of adrenaline, cortisone and others increases in the blood, which increases the risk of PONRP);
• pathology of the uterus;
• gestation of the fetus;
• Rhesus conflict, incompatibility with the child by blood type;
• deformation of the uterine wall caused by previous instrumental abortions, operations, multiple births;
• too much stretching of the uterus, which is often observed with multiple pregnancy, polyhydramnios, large fruit;
• sex in the last stages - intimate relationships are not contraindicated, but they should be as careful as possible, since any strong stimulation during this period, like mechanical trauma, can provoke premature rejection of the placenta;
• pregnancy that occurred after a long period of infertility;
• drug allergy;
• lack of folic acid, protein and vitamin B12 in the diet.

How to diagnose a disease

Diagnosis of PONRP is based on the clinic (clinical manifestations), anamnesis, complaints of the pregnant woman, as well as on the results of studies.

What symptoms may indicate premature detachment of a normally located child's place? It depends on the classification of pathology, medical history, etiology.

The most characteristic manifestations:

1. Bleeding from the genital tract. The sign is observed in approximately 80% of pregnant women with PONRP. Volumes and color of secretions can have different severity. So, with marginal detachment (from the edge of the organ), dark red blood is released from the vagina. If the process occurs in the center (central detachment), there are no external spotting, since blood is trapped between the placenta and the uterine wall. With detachment with combined bleeding, part of the blood remains inside, and part is released outside. The danger of this form lies in the fact that even with a small blood loss, the condition of the woman and the fetus can significantly worsen. Also, bleeding in PONRP is internal.
2. Abdominal pain. Pathology is manifested by pain in the abdomen and tension of the uterus (hypertonicity). The pain is dull or cutting, often paroxysmal, can radiate (give) to the lower back, thigh, perineum or pubic region. The severity of pain does not always depend on the volume of secretions. Sometimes severe pain occurs with internal bleeding, as blood accumulates inside and stretches the uterine walls. As a result, the pain intensifies and quickly spreads to other parts of the body.
3. Tension of the uterus. This organ responds to prolonged bleeding with strong tension. This, like blood loss, also increases the risk of hypoxia in the baby.
4. Low blood pressure.
5. General weakness, pallor, dizziness.
6. Change in fetal heart rate: slow or, conversely, accelerated.
7. Child hypoxia(oxygen starvation).

All pregnant women with suspected placental abruption are prescribed a number of laboratory tests and examinations.

Ultrasound examination makes it possible to unambiguously diagnose the presence of pathology, measure its area and establish the exact location of the hematoma. Also, with the help of ultrasound, the doctor measures the heart rate of the fetus to confirm its viability.

In cases where the detachment is insignificant and there is no pronounced vaginal bleeding, a Doppler study is prescribed. This is necessary to determine the child's condition and develop a treatment plan.

Treatment Methods

If the detachment has already occurred, then it is impossible to attach it back and make it function as before. The tactics of treating pathology depends on the severity of the situation, the condition of the patient and the fetus. Also important is the duration of pregnancy.

Conservative treatment is acceptable if, as a result of examination and laboratory tests, the doctor confirms a slight detachment and a satisfactory condition of the patient and fetus.

In such cases, the goals of therapy are as follows:

• cessation of bleeding;
• regulation of blood pressure and replenishment of blood volume;
• relaxation of the uterus;
• therapy aimed at treating diseases that provoked premature detachment.

A pregnant woman must ensure the supervision of a doctor, rest and bed rest. In moderate and severe forms, intensive care is necessary. In cases of significant blood loss, a blood transfusion should be performed immediately. If necessary, the patient is also mechanically ventilated.

In a critical condition, an urgent surgical intervention is indicated - a caesarean section.

Complications and consequences

Premature detachment of a normally located placenta is a serious pathology that is not only life-threatening, but has the risk of many complications and consequences.

For example:

1. Cuweler's mother. With a central detachment, the blood collects in a "pocket", between the wall of the uterus and the placenta, which causes the tissues to burst, and the wall of the uterus is saturated with blood.
2. The loss of a large amount of blood and a critical drop in blood pressure are fraught with oxygen starvation and hemorrhagic shock.
3. Violation of blood clotting. There is a risk of bleeding (uterine, intestinal, nasal, pulmonary, etc.).
4. Fetal hypoxia and its consequences in born child: hyperactivity syndrome, pain syndrome, convulsions, lag in psycho-speech development, etc.
5. Fetal death (antenatal or intranatal).

Features of pregnancy and childbirth in this condition

The decision on the method of delivery is made by the doctor, taking into account all medical indicators. As a rule, with a mild form of pathology, if there are no other contraindications, natural childbirth is possible, without stimulation and surgical intervention. The process requires constant supervision by the doctor.

In cases where the patient's well-being is normal, but minor discharges are repeated, a decision is made in favor of a caesarean section. Severe cases in which natural childbirth is not possible or contraindicated require immediate operative delivery.

Preventive measures

• pregnancy planning, diagnosis and treatment of gynecological and chronic diseases;
• timely registration in the antenatal clinic (this must be done up to 12 weeks);
• regular visits to an obstetrician-gynecologist;
• taking multivitamins for pregnant women and following all doctor's orders;
• avoid stress, do not lift weights, exclude intense physical activity;
• monitor your well-being: pain and uncharacteristic vaginal discharge are a reason to consult your doctor;
• blood pressure should be normal, so monitor it and adjust if necessary;
• be careful to avoid injury.

Expert opinion in this video:

Conclusion

Remember that premature detachment of the placenta is an extremely dangerous condition for both the expectant mother and the fetus, so in no case should you ignore any symptoms and do not try to heal yourself. Only a qualified specialist can diagnose the problem and prescribe adequate and correct treatment!

The pregnancy is nearing its end and the expectant mother is already looking forward to meeting her long-awaited baby soon.

But this can be prevented by a dangerous pathology that occurs in the last trimester of pregnancy -.

This condition is very dangerous for the child, so the mother needs to know its symptoms and the sequence of necessary actions.

The placenta (children's place) is a special organ that is formed during pregnancy and provides a connection between the child and the mother. The life, development and nutrition of the fetus depends on its work.

Nutrients, oxygen, maternal antibodies come to the baby through the placenta.

The formation of the placenta begins at the 2nd week of pregnancy. Its growth and development continues up to 12 weeks, after which it begins to fully function.

The placenta is attached to the anterior, posterior wall or bottom of the uterus. On one side it is attached to the wall of the uterus, on the other side it is connected to the fetus through the umbilical cord.

Factors leading to placental abruption in the later stages

Normally, the placenta should peel off the surface of the uterus after the baby is born.

If it is separated from the epithelium of the uterus ahead of time, its premature detachment takes place.

It can begin during the period of bearing a child or during childbirth; may be partial or complete.

In this case, damage to the uteroplacental vessels occurs and bleeding of varying intensity occurs. The risk of this pathology in a future mother is 0.5-1.5%.

Currently, not all the causes leading to placental abruption in late pregnancy are known. It is believed that this pathology occurs as a result of the combined influence of several adverse factors. These include:

• uteroplacental insufficiency, as a result of which the placenta ceases to function correctly;
• , which can provoke a violation of the patency of its vessels.
• Injuries to the abdomen as a result of a fall, impact or car accident;
• , which provokes pathologies of the vessels of the uterus;
• chronic diseases, the course of which is aggravated during pregnancy;
• . This risk factor is noted in 40% of women in labor who have had placental abruption;
• delayed pregnancy. In this case, the risk of pathology increases due to;
• inflammatory diseases of the genitourinary system;
• numerous births in history, which can cause thinning of the uterine mucosa;
• taking medications that may have similar side effects;
• bad habits that lead to thinning of the walls of blood vessels;
• premature rupture of the membranes of the fetal bladder;
• submucosal fibromyoma or postoperative scar in the area of ​​the placental site.

The negative impact of many of these factors can be prevented or mitigated.

To do this, it is enough to constantly be observed by a doctor and treat the relevant diseases in a timely manner.

Symptoms to watch out for

Typical symptoms of detachment of a child's place in the last weeks of pregnancy include:

• bleeding;
• pain;
• violations of the child's cardiac activity;
• decreased fetal movement.

Depending on the location of the detachment, bleeding is external and internal.

Marginal detachment (when the edge of the placenta exfoliates from the wall of the uterus) is always accompanied by bloody discharge from the vagina.

If the placenta has separated from the uterine lining in the center, and its edges are still attached to the wall, internal bleeding will begin.

In this case, the blood will accumulate in the cavity between the placenta and the uterus and impregnate its wall. Sometimes this leads to the development of a complication called Cuveler's uterus.

After delivery, the blood-soaked uterine wall cannot contract normally, making it difficult for doctors to stop the bleeding. In this case, to save the life of the woman in labor, she undergoes an operation to remove the uterus.

Detachment of a child's place is always accompanied painful sensations. In this case, the woman feels a dull, paroxysmal pain that can radiate to the thigh, lower back or perineum. It is felt more strongly in case of internal bleeding.

Pain is accompanied by tension of the uterus, which is determined by the doctor during palpation.

Violation of the cardiac activity of the fetus, caused by a lack of oxygen, is determined by detachment of 25% of the total area of ​​the child's place. If the process captures 30% of the area of ​​the placenta, the child experiences a critical lack of oxygen, with detachment of 50% of the area, he dies in the womb.

To determine the uterine nature of bleeding, the doctor examines the vagina and cervix.

This allows you to assess whether infectious changes, polyps or cervical dilatation caused the bleeding.

The ultrasound procedure allows you to unambiguously determine the presence, size and location of the detachment.

A small detachment may not be detected by ultrasound, but in this case, blood clots are visualized behind the placenta.

This allows you to exclude another common cause of bleeding - placenta previa.

Medical actions in case of detachment

In the last trimester of pregnancy, detachment of the child's place is more common and worse tolerated by the child. The placenta no longer increases in size, so the development of fetoplacental insufficiency is inevitable.

The strategy of medical intervention in the event of this deviation depends on the duration of pregnancy, the severity of bleeding and the well-being of the mother and fetus.

Under certain conditions, the doctor may decide to prolong the pregnancy:

• gestational age does not exceed 36 weeks;
• the detachment area is small and does not increase;
• the volume of blood loss is small;
• the child has no signs of hypoxia;
• satisfactory health of the pregnant woman.

Until delivery, the woman must remain in the hospital under the supervision of specialists who will monitor the condition of the fetus and the progression of detachment. For this, ultrasound procedures are regularly prescribed, and.

Be sure to carry out therapy, hemostatic agents, antispasmodics and.

Preservation after extensive placental abruption is impossible.

If the baby is full-term and the birth canal is ready, the woman is given an amniotomy (puncture of the fetal bladder) and the process of natural childbirth is started. During childbirth, doctors use equipment to monitor the baby's heartbeat.

After his birth, the uterus is examined manually and bleeding is prevented with the help of drugs that enhance uterine contractions.

In the case of progressive detachment, which is accompanied by a deterioration in the child's condition, an emergency caesarean section is performed.

After removing the child, the doctor examines the walls of the uterus and assesses the condition of its muscular layer.

If it is soaked with blood, a hysterectomy (removal of the uterus) is performed.

What threatens the child with placental abruption?

Placental abruption is one of the most common causes of stillbirth in the last trimester of pregnancy. Approximately 15% of children die when this pathology occurs.

Serious violations that a child has to face as a result of detachment of a child's place are hypoxia (lack of oxygen) and problems provoked by prematurity in the case.

The result of intrauterine hypoxia is often various neurological disorders and developmental delays.

Prevention of detachment during subsequent pregnancies

The risk of re-exfoliation of the placenta in women who have experienced this deviation in a previous pregnancy reaches 25%. Modern medicine is unable to offer a treatment regimen that would avoid premature detachment of the child's place.

Therefore, a woman should try to exclude those factors that increase the risk of developing this deviation. To do this, you must adhere to the following recommendations:

• control blood pressure;
• to refuse from bad habits;
• avoid injury;
• attend scheduled gynecological examinations;
• periodically do ultrasound;
• do not provoke allergic reactions with unusual food, clothing.

If a woman has chronic diseases, you need to take care of their treatment even before pregnancy. This is especially true of inflammatory processes of the pelvic organs.

Premature abruption of the placenta is a serious condition that threatens the life and health of the mother and child. Therefore, it is impossible to ignore the signs that may indicate the onset of detachment (bleeding, pain and fading of fetal movements).

When such symptoms appear, you should immediately call an ambulance, because delay can be fatal. If the woman is in the hands of doctors in time, the consequences for the child will be minimal.