The placenta is a completely unique organ that can only be found in the body of a pregnant woman. It is born together with the child (10-15 minutes later than the fetus) and after that it is formed only at the next one. People call the placenta "children's place" because it serves as an inseparable bond between mother and child. Violation of this connection is very dangerous for the unborn baby.

The placenta is an important and unique organ that exists only during pregnancy.

Some consider the placenta to be the entire shell in which the child finds inside. But this is not entirely true. The placenta is just a small portion of the membrane adjacent to the back wall of the uterus. It provides a link between the fetus and the mother's body. The rest of the shell is called afterbirth.

The placenta has the shape of a disc, penetrated by a network of blood vessels. Detachment of the placenta early dates leads to impaired blood circulation and oxygen metabolism in the body of the embryo, which can be dangerous not only for the life of the child, but also for the life of the mother.

The placenta in its final form is formed only by the 15th week, when the blood flow of the mother and child is completely separated.

Up to this point, the placenta does not yet have a clear structure. Until the 6th week, they speak only of the chorion, the rudimentary organ, from which the placenta is then formed.

The placenta performs several important functions:

• Respiration and gas exchange. Oxygen enters the fetus through the placenta and bloodstream. Oxygen is actively supplied to the child, and carbon dioxide is excreted.
• Excretion of waste products. Other substances are also removed from the baby's body through the placenta.
• Food. All nutrients, vitamins, minerals necessary for a growing organism, come to the fetus through the placenta. Therefore, impaired circulation in the placenta can lead to developmental delay.
• Working out. The placenta activates the production of hormones necessary for the development of the fetus and to prepare for lactation.
• Child protection. Through the placenta, various things come from the mother to the fetus, which protect it from infection. The placenta also protects the fetus from the immune system of the mother's body, which can recognize it as a threat.

It is worth remembering that in addition to nutrients through the placenta, harmful substances, toxins, nicotine, alcohol, drugs and infections also enter the child's body. A pregnant woman should take care of herself and lead a healthy lifestyle, which will have a beneficial effect on both the condition of the placenta and the health of the unborn baby.

Causes of placental abruption in the early stages

Placental abruption can occur at any stage of pregnancy and even during the birth itself. At any time and in any situation, placental abruption can be dangerous, so medical attention and supervision are necessary.

Early pregnancy is considered up to 20 weeks. In this case, detachment can occur both on the 8th and on the 19th week. It is sometimes impossible to determine the cause of what happened, since the causes of detachment have not been sufficiently studied.

However, there are certain most common causes of placental abruption:

• Numerous genera. If the birth is not the first, the condition worsens, which is reflected in the placenta. It can age prematurely, which causes detachment.
• Bad habits. Alcohol, smoking, fatty foods, taking drugs without consulting a doctor can provoke circulatory disorders and placental abruption.
• Preeclampsia. In this condition, there is a violation of blood flow, increased blood pressure. The vessels of the placenta become more fragile, weak, which provokes detachment.
• Autoimmune diseases. With such the immune system a person reacts inadequately to stimuli, recognizing the cells of his own body as foreign. In the same way, the placenta and fetus can suffer.
• intrauterine infection. Infection provokes many problems: from abnormalities in the development of the fetus to placental abruption and intrauterine death. Any infection that enters the body of a pregnant woman requires the attention of doctors and immediate treatment.
• Pathology of the uterus. In some cases, placental abruption can only be explained by pathological processes in the uterus. They are dangerous in that it is quite difficult to identify and prevent them.
• Abdominal injury. Injuries can occur during a fall, accident, blow to the abdomen. This can be dangerous for the baby and provoke placental abruption and premature birth.
• . Some cardiovascular diseases, as well as chronic diseases, can lead to detachment.

Signs and Diagnosis

Pain in the lower abdomen and spotting are signs of placental abruption

In the initial stages, placental abruption may be asymptomatic. It can only be detected with . The doctor determines the presence of a hematoma in the area of ​​​​attachment of the placenta.

If the placenta has passed slightly, then the blood will accumulate between it and the uterus, and there will be no external bleeding. However, more often this phenomenon is accompanied by pain in the abdomen and uterine tone (tension, hard stomach).

The main symptoms of placental abruption in the early stages:

• Bloody discharge from the vagina. Blood at any time scares expectant mothers, they tend to see a doctor faster, and rightly so. If placental abruption occurs from one side, blood will come out, this is an alarming symptom that should never be ignored. With timely assistance, you can stop blood loss and save the pregnancy. The most dangerous are internal bleeding, which can lead to the death of the mother and child.
• Stomach ache. They can occur with or without bleeding. Placental abruption is almost never without pain. The pain can be of varying intensity, strong and numbing or pulling and aching. In any case, the appearance of pain requires a visit to the doctor. Severe pain may indicate dangerous internal bleeding.
• Violation of the heart rhythm and oxygen starvation. For more later dates mothers-to-be celebrate active stirring a child or the absence of movements, but in the early stages such symptoms are impossible. Usually they talk about the fetal heart rate during the planned one. If violations are noted and there are signs of detachment on ultrasound, the pregnant woman is placed in a hospital for preservation.

Detachment is more often indicated by symptoms, after which the doctor prescribes an ultrasound supplement for confirmation. It is very important to inform the doctor in time about what worries the pregnant woman and not to avoid treatment in the hospital. Also, if a detachment is suspected, the doctor will examine the patient on the chair to determine if the cervix has opened.

Treatment

Treatment is prescribed by the doctor according to the situation, depending on the condition of the fetus and the patient. Placental abruption has its own stages and features. With a small detachment in the early stages and timely assistance, the prognosis is very favorable. The patient is prescribed drugs that relieve the tone of the uterus, vitamins, iron preparations, hemostatic agents. With proper treatment and the absence of serious pathologies, the placenta adheres to the wall of the uterus by increasing its area with the course of pregnancy. In the future, pregnancy can proceed without complications, subject to all the recommendations of the doctor. This detachment is called partial and non-progressive.

If placental abruption is partial, but progresses, this condition of the patient is considered more dangerous. It is necessary to stop the growing hematoma and restore the nutrition of the fetus. To do this, a pregnant woman is placed in a hospital, carefully observed, prescribed bed rest, various drugs to reduce the tone of the uterus and to alleviate blood loss. If no means can help, the hematoma grows, the question arises of urgent delivery. In the first trimester, the child, as a rule, dies, but with timely help, you can save your mother.

Complete abruption of the placenta is rare.

In this case, the supply of oxygen and nutrients to the fetus is completely stopped, it dies. Only possible treatment in this case, emergency delivery.Doctors may refuse to induce labor and try to keep the pregnancy if the pregnancy is short and the baby has little chance of surviving after delivery, and if there are no signs that the detachment is progressing, blood loss is small, and there are no obvious signs of oxygen starvation in the fetus.

Useful video - Placenta during pregnancy.

To improve the condition, a woman is prescribed antispasmodic drugs (No-shpa, Drotaverine, Papaverine in the form of suppositories, Magnesia), hemostatic drugs (Vikasol in the form of tablets or injections of Decinon), as well as iron preparations to prevent development.In no case should you try to treat detachment at home without consulting a doctor. Without professional medical care this condition can lead to the death of the mother and child.

Complications and prevention

Undoubtedly, the most terrible consequence of detachment is the death of the mother and child. Doctors are doing their best to prevent such an outcome. If the child cannot be saved, the life of the mother must be saved.

One of the abruptions of the placenta is the accumulation in the uterus. For an emergency caesarean section (which is often the most the best option delivery during detachment), the uterus is examined. If there is a danger that a hematoma will form and grow on the uterus, the uterus is removed. In this case, further pregnancies will be impossible.

If the uterus is not affected, the woman is faced with the question: when can you get pregnant again and how to prevent placental abruption in the next pregnancy.

It is difficult to talk about prevention methods, since the causes of detachment in each case are difficult to determine. You can only reduce the risk of detachment, but not completely prevent it:

• Before the next pregnancy, it is recommended to go through a complete one (preferably for the future father too). The woman is checked for the condition of the uterus, fertility, and infections. If something is found, it must be treated before the start of pregnancy.
• During pregnancy, you must register and visit the doctor regularly, take everything and go through. Any drugs should be taken only after consulting a gynecologist.
• A pregnant woman should avoid infections, injuries (ice and uncomfortable shoes are especially dangerous), bad habits. This will significantly reduce the risk of placental abruption.
• A pregnant woman needs to visit regularly fresh air, walk. Proper nutrition and lack of stress are also important. If necessary, you can sign up for a psychological support group for pregnant women.

Among the questions frequently asked by pregnant women, in particular, on the website www.site, those related to placental abruption - normally located and presenting to the fetus - are a significant number. Apparently, for everyone who does not even know the terminology, the phrase is associated with an emergency, difficult situation. And that's right.
Placental abruption is a complication of pregnancy that occurs both during pregnancy and during childbirth. In general, placental abruption is a premature separation of the placenta from the uterine mucosa, occurring with damage to the uteroplacental vessels and bleeding of one or another localization and severity. Detachment is marginal - along the edge of the placenta - in this case, the blood pours out and all this does not go unnoticed. Freshly separated blood will be scarlet, curdled - dark. A small detachment does not affect the condition of the fetus, it continues to receive the necessary oxygen and nutrients from the mother's body. Much more dangerous due to difficult diagnosis is the detachment that occurred in the center of the placenta, when the outflow of blood accumulates between the uterus and the placenta, finding no way out - this phenomenon is called a retroplacental hematoma. It contributes to further detachment, the blood permeates the layers of the uterus through and through and sometimes even pours into the abdominal cavity. You can detect the process when you feel the uterus, on ultrasound, in addition, any placental abruption is accompanied by pain, sometimes significant, and any bleeding - by pallor, weakness, acceleration of the pulse - tachycardia. With the beginning of the suffering of the fetus, the frequency of its heartbeats also changes. Detachment of one quarter of the area of ​​the placenta is considered dangerous for the fetus. With an increase in the area to one third, we can already talk about intrauterine death of the fetus, with detachment of half, this becomes inevitable. Of course, the mother also suffers greatly, since the vessels of the exfoliated part of the placenta gape, the woman loses a lot of blood with all the ensuing consequences, up to hemorrhagic shock. It is clear that such bleeding can be stopped only by urgent delivery.
Why does this terrible complication arise? Often this happens “like a bolt from the blue” and it seems that nothing foreshadowed trouble. This also happens, although there are some "harbingers" of the catastrophe, they just need to be seen.
It contributes to the detachment of the placenta of gestosis, especially their severe forms - after all, it is the vessels that suffer, they become fragile and brittle. Possible violations of the blood coagulation system, also accompanying the pathology of pregnancy.
Of course, direct trauma to the abdomen during a fall, bruise, or accident can lead to an acute condition. There is sudden intense stress. Smoking, excessive alcohol and medications are not good for the mother's blood vessels, more often in combination with anemia and other factors. Placental abruption can be an allergic reaction to the transfusion of protein preparations, blood components, which pregnant women sometimes have to do. Rarely, but there is an autoimmune form - the production of antibodies to one's own tissues, for example, with rheumatism or lupus erythematosus. In addition, a slight pathology of labor can also cause placental abruption - a rapid outflow of water when the fetal bladder opens and a subsequent pressure drop, rapid delivery with a short umbilical cord, sharp jumps in arterial or venous pressure - "inferior vena cava syndrome".
Diagnosis of placental abruption is usually not difficult, its clinic is extremely unambiguous and visible, in difficult cases they use the help of ultrasound.
From the point of view of treatment, it all depends on the period of childbirth and the degree of placental abruption. Sometimes small clots on the placenta are found only after childbirth. Sometimes massive bleeding requires the involvement of resuscitators, several surgical interventions with amputation of the organ and has the most serious consequences for the health of the mother and the life of the child - you need to know this in order to navigate in terms and not refuse the most incomprehensible, undesirable measures offered by doctors in the event of a vascular accident that has begun .

After conception, there is an increased division of cells, gradually they will become the organs and systems of the child. At the same time, one of the most important organs during pregnancy, the placenta, begins to form. It performs several functions at the same time - nutrition, oxygen supply and protection. If abnormalities associated with the child's place are found, there is a threat to the embryo.

Placenta

Consists of connective tissue through which the connection between mother and child is made. In addition to nutritional properties, it helps to remove waste products, frequent change amniotic fluid makes this process completely safe for the fetus. It also stimulates the synthesis of important hormones - progesterone and hCG, a decrease in the level of which leads to the threat of interruption. While the baby's immune system is just being formed, its duties are performed by the child's place, antibodies produced by the mother's body pass through the tissue walls.

Placental abruption in early pregnancy can be either partial or complete. The connective tissue is separated from the abdominal cavity of the uterus, and blood vessels of the endometrium begin to accumulate in the resulting gaps. These clots create pressure that pushes the placenta, along with the embryo, away from the muscular organ, destroying all important connections. With the further development of the pathology, the child does not receive nutrients and oxygen, which becomes a threat to maintaining its viability.

Normally, this process can occur in the third trimester, just before the onset of labor. In the early stages, as well as up to 36 weeks, this dangerous condition requires immediate treatment.

The reasons

It is impossible to reliably state that certain factors lead to detachment today. There are only alleged conditions that provoke this dangerous phenomenon.

Causes of placental abruption:

• bad habits - smoking, drinking alcohol, drugs, leads to disruption of the work of all systems and organs, including pathologies of the placenta;
• lack of proper varied nutrition, the right amount of minerals, vitamins, nutrients does not enter the body;
• upon detection of violations of the vascular system, in particular difficulty in the patency of blood;
• with hypertension, different degrees of obesity, diabetes a pregnant woman is at risk;
• inflammation and pathology of the organs of the reproductive system, in particular uterine fibroids;
• autoimmune conditions are rare diseases in which female body antibodies produced destroy healthy cells;
• allergy to medications, such a reaction can also be observed in the case of a transfusion of donor blood;
• with blows, injuries, bruises directed to the abdomen, the risks of detachment of the connective tissue increase sharply.

How to determine

This is a pathological condition that requires immediate intervention. In the early stages, as well as later, the manifestations are the same.

Detachment symptoms:

• uterine hypertonicity is expressed by a pulling aching pain in the lower abdomen, often it can be given in the lower back, pressure is felt in the perineum, with internal bleeding, discomfort cannot be tolerated, the pain intensifies, becomes acute;
• a clear sign is bleeding, both uterine and vaginal, if the placenta exfoliates in the center, this leads to internal bleeding, the most dangerous of all possible, in this case we are talking no longer about the preservation of pregnancy, since the fetus dies, but about saving the life of the mother;
• deviations in the heartbeat of the embryo are observed, and it is not surprising that the nutritional functions of the placenta are disturbed, oxygen and the necessary substances are not supplied in the proper amount, depending on the degree of detachment, the baby may experience hypoxia or die;
• vomiting, nausea, chills are indirect symptoms that are sometimes confused with toxicosis, but together with bleeding and pain in the lower abdomen, they become clear signs of disturbances in the placenta.

The most optimistic forecasts if the detachment occurred in the first trimester. Timely diagnosis and treatment in most cases gives a positive result, and the child can be saved.

The consequences of placental abruption in the early stages during the treatment are minimal for the embryo. Drug therapy depends on the degree of deviations that have arisen. At the first stage, the tissue discharge to an area of ​​less than 1/3 is ascertained; in such cases, it is possible to maintain the viability of the fetus and its further development complies with the norms. At grade 2, the risk of hypoxia increases, fading, miscarriage, or deviations in formation may occur. internal organs. Complete detachment is grade 3, it is not possible to save the pregnancy.

At 1-2 degrees, there is a threat of miscarriage, appropriate therapy is carried out. At grade 3, a miscarriage is diagnosed, the woman will need treatment and rehabilitation.

Diagnosis and treatment

If a pregnant woman shows the main symptoms of premature detachment, the condition is confirmed by ultrasound. Thanks to the study, it is also possible to determine the degree of discharge - non-progressive, progressive partial, and the most dangerous - total.

When choosing the appropriate treatment plan, the doctor takes into account important indicators - the condition of the pregnant woman and the embryo, the amount of blood lost and the severity of the bleeding itself. The woman is immediately hospitalized for tests and monitoring of her condition.

• detachment of the placenta does not progress, and captures a minimal area;
• there are no signs of oxygen starvation, which means that there is no threat to disrupt the normal formation of the child;
• the woman's condition has stabilized and she feels satisfactory;
• a small amount of blood lost, and the bleeding itself has stopped.

For treatment, a pregnant woman needs to go to the hospital. Compliance with bed rest, monitoring of blood clotting and ultrasound will allow you to constantly monitor the further development of her condition.

It also justifies the use of the following drugs:

• antispasmodics - help to relax the walls of the uterus, stop contractions;
• drugs acting on the circulatory system;
• along with the diet, anemia is treated.

The main measures are aimed at relieving symptoms and recovery normal flow pregnancy. From psychological state women are also much affected. She must stop crying and getting nervous, imagining terrible scenarios for the development of events. Only peace and positive attitude help to quickly bring the condition of the placenta and uterus back to normal, preserving the long-awaited pregnancy.

If expectant management does not work and the detachment begins to progress again, the question of surgical intervention becomes.

Risk group

If a woman has already experienced premature detachment during a previous gestation, the likelihood of recurrence dangerous deviation increases up to 30%. Naturally, constant monitoring of the course of pregnancy by doctors is important. But the mother herself can do a lot to prevent the onset of pathology.

Preventive measures:

• basics healthy lifestyle life, rejection of bad habits, rational nutrition, proper sleep, walks in the fresh air;
• the psycho-emotional stability of the mother can positively affect any unfavorable forecasts, her optimistic attitude and good spirits will save her from unnecessary worries and fears;
• regular examination, both by a gynecologist and narrow specialists, especially if chronic diseases are present;
• constant monitoring of blood pressure;
• compliance with safety rules - buckle up in the car, try to protect yourself from dangerous situations;
• if infections occur, immediately begin their treatment, do not start the course of the disease.

If the pregnancy could not be maintained after placental abruption, doctors recommend postponing the planning of the next conception for at least a year. There is a high probability of a recurrence of the situation, therefore, during this period, a woman should prepare as much as possible, improving her health indicators. A complex of vitamins is prescribed, if necessary, hormone therapy is carried out. Future mom should give up bad habits, will give positive results of playing sports.

Premature separation of the placenta can occur in any trimester of pregnancy. External blood loss is not always noticeable. Bleeding is internal, which is no less dangerous for the fetus and the woman herself.

Causes of placental abruption and how to prevent fetal death

Detachment of the placenta can lead to the loss of a child. Such an outcome is possible in severe cases, late admission to the hospital. Systematic consultations and scheduled examinations will help to track the pathology in a timely manner.

The placenta and its role for the fetus

The placenta or baby's place is formed during pregnancy. By the second trimester, it already clearly fulfills its functions: protective, gas exchange or respiratory, trophic. The placenta provides the fetus with oxygen and nutrients. Also, the body protects the baby from infections, pathological microflora.

Consequences and causes of placental abruption during pregnancy at different times

With untimely detachment of the placenta, there is a partial or complete extinction of the functioning of the organ. In severe cases, the fetus dies.

Detachment in the early stages: what is dangerous in the first and second trimester

The period of the first trimester, or rather the period from conception to the 12th week, is an early period of pregnancy.

At this time, the embryo develops very actively in all directions. If something goes wrong, including a detachment, then the organs may not form as they should.

Risks in late placental abruption in the third trimester

If the detachment of the organ is noted after the 13th week and before the 27th, then there is a serious lack of oxygen in the fetus. Nutrients are hard to come by. Because of this, the fetus will be smaller than the prescribed size, which indicates its developmental delay.

The third trimester is a late period, more often detachment appears at this time. This pathological condition is manifested by fetoplacental insufficiency. As a result, developmental delay, the risk of losing a child. If detachment is noted before delivery, a caesarean section is determined.

What are the types of placental abruption?

The placenta can exfoliate partially or completely (totally). The second option is the most dangerous and requires immediate medical attention.

Depending on the location, detachment happens:

• peripheral or marginal;
• central.

If we talk about central rejection, then there may not be blood on the linen. The bleeding is internal, and even more dangerous.

What is the dangerous partial detachment with a normal location

If the placental rejection is partial, has a normal location, then the pathology does not announce itself in any way - there are no symptoms. Not for a child negative impact. It is important to identify this dysfunction and begin immediate treatment. Only the right therapy will prevent negative consequences.

A partial detachment is characterized by a slight rejection. It may or may not progress. If the deterioration is actively developing, then problems appear during the pregnancy itself, during delivery.

What does marginal detachment look like with fetal presentation

If there is a presentation and partial detachment (marginal), then severe bleeding occurs.

How does detachment appear in the area of ​​​​the uterine pharynx

Detachment in the area of ​​the uterine pharynx is observed more often during delivery.

If the rejection is partial, then brownish discharge appears. They may be in small or large quantities. It all depends on the severity of the pathological process.

How does placental abruption manifest?

Consider all the possible symptoms that occur in the case of placental detachment.

1. The occurrence of bleeding. Blood may or may not come out of the genital tract. Internal hemorrhages are visible on ultrasound. There is an option when the blood goes out and accumulates inside. Red and brownish shades may be present on linen in varying amounts.
2. Paroxysmal or dull pain in the region of the uterus. If the bleeding is inside, then the soreness is especially sensitive. It is also more noticeable during probing, pressing on the organ.
3. Excessive fetal activity or vice versa. Thus, it is realistic to identify hypoxia that occurs against the background of detachment.
4. Failure in the child's heart rhythm, dysfunction can be heard with auscultation or echocardiography.
5. Excessive tension of the main organ - the stomach in the uterus becomes tight.

Given all the symptoms, it makes sense to divide the placental abruption into forms, depending on the severity of the course, the pathology can be:

• light;
• moderate;
• severe.

If the form is mild, then all the signs are almost invisible, or completely absent.

In severe - takes place:

• sharp and intense pain syndrome;
• general weakness;
• cardiopalmus;
• pre-fainting state;
• severe blood loss;
• the occurrence of dizziness;
• skin is pale.

In this situation, there is no fetal heart rate on auscultation.

Symptoms and sensations of a woman in the initial stages

Initially, the detachment is insignificant. There may be slight pain in the lower abdomen and lower back. Brownish daub rarely appears on linen. With ultrasound diagnostics, compaction is determined.

What is the characteristic pain observed in pathology

Pain is varied:

• pulling;
• pulsating;
• bursting;
• aching;
• sharp;
• radiating to the lumbar region.

The place where the pain is concentrated is the area of ​​the uterus.

The strength of discomfort is directly related to the severity of the pathology.

How to determine at a later date

If at the beginning of pregnancy it is difficult to identify the pathological process, then in the later stages it is easy to do, since the symptoms are obvious, namely:

• excessive activity of the baby (this is how he makes the blood flow better, extracting insufficient oxygen);
• uterine tone;
• decrease in basal temperature;
• the presence of bleeding, discharge on linen of a dark red or brownish color;
• the presence of a hematoma on the placenta, which is distinguishable by ultrasound;
• pain throughout the abdomen, most present below;
• anemia, manifested by dizziness, weakness, pre-syncope;
• a bad rhythm is heard in the fetus.

For all the above symptoms, it is easy to recognize placental abruption.

Is there bleeding

Bleeding is present, but not in all cases is manifested externally. If the central part of the organ is affected, then there is an internal hemorrhage, which is diagnosed using instrumental studies. If the marginal part is affected, then the discharge comes out.

If detachment occurred during childbirth

If the afterbirth is in the wrong location, then placental abruption can also occur during delivery.

It is characterized by:

• severe blood loss;
• impressive cramping pains;
• bad shade of amniotic fluid.

This situation is dangerous both for the woman in labor and for her baby. The baby can die due to suffocation, and the woman, in turn, loses a lot of blood. To get out of this situation, doctors must work quickly, make an emergency caesarean section in 5-7 minutes.

Diagnostics

Placental abruption can be diagnosed with:

• ultrasound diagnostics;
• collection of anamnesis;
• analyses.

Is the pathology visible on ultrasound

Such a deviation from the norm is clearly visible on the monitor screen during ultrasound diagnostics. In this way, a hematoma, its size and location is detected. You can see if there are blood clots behind the child's place.

Ultrasound is advisable to do in general three times during pregnancy in different trimesters. More often if necessary. This allows you to keep the whole situation under control.

What tests are given

Every month, and sometimes more often, a pregnant woman takes a general blood and urine test. The results show whether there is anemia, hidden bleeding and violations of the main organ. In addition to these basic and mandatory laboratory tests, they are sent to cordocentesis, where blood is taken from the umbilical cord. This is necessary to determine the deviations in the development of the baby.

How doctors determine

Before being sent for instrumental studies, doctors examine a woman in the office, they are interested in her well-being. Based on the data obtained, an initial diagnosis is made. It is then confirmed on the basis of other indicators.

The gynecologist will definitely feel the stomach, or rather the uterus, can examine it in the gynecological chair. If the organ is tense, there is a reddish discharge from the vagina, there is pain during palpation and changes in the baby's heartbeat are heard - all this indicates a pathological condition.

Emergency cases for urgent medical care

Emergency care - surgery, it is advisable for complete or half detachment of the placenta. In such cases, the condition of the woman is extremely serious, there is:

• profuse blood loss;
• severe pain;
• weakness and fainting, etc.

A caesarean section will be appropriate for premature rejection of a child's place for periods of more than 35 weeks. In this case, it is realistic to save the baby, and not let him die from hypoxia. If the detachment is partial, and the terms have not reached the 35-week period, then they try to save the pregnancy in every possible way.

Fetal survival with different variants and degrees of placental abruption: in the form of a table by week

Depending on the degree of damage to the organ, the options for further events differ. Consider in the table what outcome is expected in a given situation.

If there is a complete detachment of the child's place, the fetus dies. In such a situation, surgical intervention is indicated.

Treatment

A pregnant woman can be treated at home or in a hospital. It all depends on the severity of the course of the pathological process.

How does it go

After a detailed diagnosis and a clearly established, refined diagnosis, the question is decided which treatment will save the pregnancy. On the different terms act differently:

1. If it is the 6th week and earlier, the doctor prescribes medications, rest, sends the woman to outpatient treatment. This will be appropriate if the hematoma is not growing.
2. If there is bleeding and the size of the detachment increases, the lady is placed in the hospital. She is closely monitored.
3. If the detachment of the organ is 50% or more, you will have to do a purge, terminate the pregnancy, and do a caesarean section. Everything depends on the time frame.
4. If the fetus is already formed and able to breathe on its own, an operation is performed. The child is saved.
5. If detachment occurred during delivery, there is severe blood loss, then the uterus can be removed.

What do they do

You can fight the pathological condition with the help of:

• candles with papaverine;
• Duphaston;
• hemostatics;
• hemostatic drugs;
• Utrozhestan;
• No-Shpy;
• antiplatelet agents, for example, Curantil;
• iron-containing agents for bleeding.

All of the above is prescribed strictly according to the indications individually for each woman.

How they give birth

If the hematoma was partial at an early stage, then after treatment everything heals, the woman gives birth through the birth canal.

If the detachment is large, it is necessary to prevent hypoxia and freezing of the fetus. For a period of more than the 35th week, an operation is performed. It is also appropriate if the rejection of the child's place occurred during contractions.

How to prevent a dangerous pathology

Unfortunately, nothing can be done for prevention. Nobody is immune from this.

The best ways to prevent deterioration and total detachment are:

• regular check-ups with a doctor;
• intake of vitamins, macro and microelements;
• proper nutrition;
• peace;
• timely therapy.

If a woman is at risk, she should be given special attention by the doctor.

To protect yourself and your baby, doctors recommend:

1. Be less nervous.
2. Refuse physical activity.
3. Forget about taking hot baths.
4. Eat only healthy and rich in vitamins and macro and microelements food.
5. Try to avoid crowded places during the autumn-winter period, so as not to get sick with the flu or acute respiratory infections.
6. Don't get cold.
7. With detachment of the placenta, refuse sexual intimacy.

If a woman follows all the doctor's instructions, then the pregnancy will end safely.

Placental rejection can occur at any time. It is important to prevent the progression of the pathological process. In order to avoid hypoxia and lag in the development of the fetus, it should be treated in a timely manner.

Useful video

Update: October 2018

A pregnancy that proceeds without complications and ends safely in the birth of a live and healthy baby is a rarity, especially at the present time. One of the terrible complications of gestation is considered to be premature detachment of the placenta, which does not always end successfully, without consequences for the mother and fetus.

This complication, fortunately, is quite rare and occurs in 0.3 - 1.5% of cases. The highest frequency of this obstetric pathology occurs in the 1st trimester, but the prognosis in such cases is more favorable.

Placenta as an organ and its functions

The placenta refers to provisional or temporary organs that form during pregnancy. Another name for the placenta is a child's place, and after the end of the straining period, the separation of the placenta (afterbirth) begins, therefore the third stage of labor is called the afterbirth (see).

The placenta (translated from Latin as a cake) is necessary for the connection between the mother's body and the fetus. The formation of this organ begins on the 10-13th day after the fertilization of the egg. The final completion of the development of the child's place occurs by the 16th - 18th week, when the transition from the histotrophic nutrition of the embryo to the hematotrophic takes place. As a result of this transition, a hematoplacental barrier is formed, due to which the placenta performs its functions. The "duties" of the children's place include:

gas exchange

From the mother's blood, oxygen enters the blood of the fetus, and carbon dioxide, formed during the breathing of the unborn child, enters back into the woman's blood. Thus, the placenta carries out the breathing of the fetus (respiratory function).

Nutritious

In the intervillous space, located between the wall of the uterus and the villi of the placenta, the mother's blood enters, containing nutrients, vitamins and minerals, from where the listed components enter the placental vessels and are delivered to the fetus.

excretory

In the process of life of the unborn child, metabolites (urea, creatinine, creatine) of metabolism are formed, which are removed by the placenta.

Hormonal

Children's place plays the role of the endocrine gland. The placenta synthesizes a number of hormones that are necessary for the normal course of the gestational period. These include chorionic gonadotropin, which supports the functions of the placenta and promotes the synthesis of progesterone by the corpus luteum. Placental lactogen is involved in the development of the mammary glands during gestation, in addition, this hormone prepares the mammary glands for milk production. , which is responsible for the synthesis of milk, and stimulating the growth of the uterine mucosa and preventing new ovulation, serotonin, relaxin and other hormones.

Protective

The child's place allows maternal antibodies to the fetus, thereby providing immunity to the still unformed child. In most cases, the placenta prevents the development of an immune conflict between maternal and fetal organisms. Also, a child's place is involved in the formation and regulation of immunity in a woman and fetus. However, it should be remembered that the placenta is not able to protect the child from the penetration of a number of drugs, drugs, ethyl alcohol, nicotine and viruses into his body.

Normal localization of the placenta is the area of ​​the uterine fundus with a transition to the posterior (more often) or anterior wall.

What is placental abruption?

Detachment of a normally located placenta is a dangerous complication of pregnancy, when this organ is separated from the uterine walls even before the birth of the fetus, which can occur both during pregnancy and during childbirth.

The child's place is under constant pressure from the muscular layer of the uterus "outside" and gestational sac and amniotic fluid"from the inside", that is, from the other side. But both opposing forces are balanced, in addition, due to the spongy structure of the placental tissue, the placenta has considerable elasticity, which allows it to stretch during the growth of the uterus without the risk of detachment. Also, the part of the uterine wall where the placenta is attached is able to contract less, which also reduces the risk of developing the described complication.

Why is this happening?

Why placental abruption happens, medicine has not been able to explain exactly. It is impossible to name one specific cause of this complication, since such a violation is a manifestation of a systemic pathology in a woman, and in some cases it is hidden. Typically, there is a combination of several factors:

• vascular pathology (vasculopathy)
• bleeding disorder
• mechanical factor.

The following factors predispose to the development of complications:

During childbirth, the development of the described pathology is due to: anomalies of the birth forces (discoordination, dystocia of the cervix), a rapid drop in intrauterine pressure (during amniotomy and outflow of water), the birth of the first child during multiple pregnancy, which "pulls" the placenta towards itself, rapid and rapid delivery. A short umbilical cord or a late opening of the amniotic sac also lead to this complication. The risk of premature rejection of the child's place is also high during labor stimulation with oxytocin.

The risk of developing complications will also increase in the case of obstetric manipulations during childbirth (external rotation on the leg, extraction of the fetus by the pelvic end).

Classification

Depending on the period when the rejection of the child's place happened:

• early detachment of the placenta;
• detachment during childbirth (pulling period and the period of contractions);
• placental abruption in the later stages (see);

Depending on the area of ​​detachment:

• complete (the entire placenta exfoliates, the child instantly dies);
• partial (only part of the child's place is separated from the wall of the uterus);

Depending on the location of the exfoliated placenta:

• marginal detachment or peripheral - detachment of placental tissue occurs along the periphery, from the edge (in this case, there is external bleeding);
• central detachment (the lag of the placenta from the wall of the uterus occurs in its center, while external bleeding may not be);

According to the course of the pathological process:

• progressive detachment (growing retrochorial hematoma aggravates the process of placental exfoliation and aggravates the condition of the mother and fetus);
• non-progressive (uterine vessels are thrombosed, internal bleeding stops, subsequently calcifications are deposited in the hematoma and, in general, the pregnancy proceeds normally).

Clinical picture

Placental abruption has very characteristic symptoms, on the basis of which a diagnosis can be made even without additional examination.

In the first trimester

As noted, this pathology can occur at any gestational age, but in the first trimester it has a favorable prognosis. Placental abruption in the early stages is a consequence of the threat of interruption and manifests itself:

• aching pains or sipping in the lower abdomen and lower back
• slight or moderate bleeding
• decrease in basal body temperature.

With timely and adequate treatment, in many cases it is possible to stop the detachment of the ovum that has begun and prolong the pregnancy. The consequences for pregnancy as it progresses are practically reduced to zero, since the growing placenta eventually compensates for the area of ​​lost contact with the uterine wall.

This complication in a short time on ultrasound is determined as a retrochorial hematoma, which does not increase and is in a stable condition. Although it is not always possible to visualize a retrochorial hematoma using ultrasound, the diagnosis is already made post factum, when a dark red blood clot of a small color and / or an impression (fossa) of a gray-burgundy color is found on the placenta in the aftermath.

Signs of placental abruption in the second and third trimesters

Uterine bleeding

Bleeding is caused by ruptures of the vessels connecting the wall of the uterus and the placenta, as a result, the released blood begins to accumulate in the uteroplacental space, which contributes to the continuation of exfoliation, the formation of a hematoma that presses on the child's place and disrupts its functioning.

The intensity of discharge during detachment can vary from slight to very abundant. Their expression depends on:

• the places where the breakup took place
• the size of the detachment area and the state of the blood coagulation system.

In addition, bleeding can be of three types:

• external or visible
• internal
• mixed.

external bleeding- in four out of five cases of the development of this complication, external bleeding occurs (which does not exclude the presence of internal bleeding). External hemorrhage is characteristic of the marginal detachment of the child's place, when the blood has an exit from the uteroplacental space and pours into the vagina.

Internal - if a retroplacental hematoma is located in the bottom of the uterus, then the color of the discharge will be dark, the lower the placenta is located and the fresher its detachment, the brighter the spotting. In the case of accumulation of blood in the uteroplacental space and the absence of the possibility for its outflow, they speak of internal bleeding, which is typical for the central detachment of the child's place.

At the same time, along the edge, the placenta is still connected to the walls of the uterus, and in the zither there is a hematoma, which over time (counting for hours, and sometimes for minutes) grows, as the accumulating blood separates the placenta more and more from the uterus.

At the same time, not only the child's place itself is saturated with blood, which, accordingly, disrupts its work, but also the wall of the uterus, which leads to a violation of its contractile activity. Imbibition (impregnation) of the uterus with blood is called the Cuweler's uterus. As the detachment continues, and, accordingly, bleeding, the condition of the pregnant woman worsens, hemorrhagic shock and blood clotting disorders (DIC) develop.

Pain syndrome

Another characteristic sign of detachment of a child's place is pain. The pain is constant, dull and/or bursting. Depending on the location of the placenta, the localization of pain also differs. If the child's place is attached for the most part along the posterior uterine wall, then the pain is localized in the lumbar region. When the placenta is attached along the anterior wall, the pain is expressed in front, in some cases a tense and sharply painful swelling is felt. The pain is also accompanied by uterine hypertonicity, since the retroplacental hematoma irritates the uterus, in response it begins to contract, but is able to relax.

The pressure of a retroplacental hematoma on the uterine walls, their stretching, soaking with blood and irritation of the peritoneum causes pain.

Intrauterine fetal hypoxia

Violation of the child's cardiac activity is another mandatory symptom of this complication. Due to impaired functioning of the placenta due to ruptures of blood vessels and soaking it with blood, the fetus receives less oxygen, which is manifested by intrauterine hypoxia (bradycardia and tachycardia). Moreover, the more massive the area of ​​detachment, the worse the prognosis for the child.

Adrift, detachment of a child's place has 3 degrees of severity

Light degree

It is diagnosed either after childbirth, or by ultrasound signs, while the condition of the woman and the fetus does not suffer, there is no characteristic clinic.

Moderate degree

The exfoliation of the child's place occurs on a quarter to a third of the total area. There are slight or moderate bleeding from the genital tract, uterine hypertonicity, abdominal pain, fetal suffering (bradycardia), and signs of hemorrhagic shock are increasing.

Severe degree

Pain in the abdomen is very strong, bursting, arose suddenly, the woman notes dizziness, severe weakness up to loss of consciousness. Spotting is slight or moderate, the uterus is dense, sharply painful, has an asymmetric shape. The volume of the detachment area of ​​the child's place is half or more. The fetus suffers and, in the absence of immediate assistance, dies in utero. The signs of DIC are rapidly growing, the woman's condition is deteriorating sharply and threatens to die.

Treatment

What to do with the development of such a complication depends on the situation in which the following indicators are evaluated:

• intensity of bleeding and volume of blood loss;
• the condition of the mother and fetus;
• gestational age;
• when the detachment occurred (during childbirth or during pregnancy);
• indicators of hemostasis.

In the early stages

In case of exfoliation of the placenta in the early stages, the woman is subject to hospitalization with the appointment of preserving therapy and hemostatic drugs:

• To relax the uterus, antispasmodics are used (magne-B6)
• progesterone-containing drugs (utrogestan, duphaston)
• physical (bed rest) and emotional rest
• of hemostatics, dicynone, vikasol, vitamin C are used
• at the same time, antianemic therapy with iron preparations (sorbifer-durules, tardiferon, fenyuls) is also carried out.

At a later date

At a later date (less than 36 weeks), conservative treatment is possible if the situation meets the following conditions:

• the general condition of both the woman and the child is satisfactory (there are no signs of intrauterine hypoxia);
• detachment of the child's place is partial and does not tend to progress;
• bleeding is insignificant;
• the total volume of blood loss is small (there are no signs of a violation of the hemostasis system and hemorrhagic shock).

In this case, the woman is under continuous observation in the hospital, the condition of the fetus is monitored:

• with the help of regular ultrasound, cardiotocography and dopplerometry
• woman is placed on bed rest
• tocolytics (partusisten, ginipral intravenously)
• antispasmodics (magnesia, no-shpa and others)
• antiplatelet agents to improve blood rheology and uteroplacental circulation (trental, chimes)
• iron-containing preparations
• sedatives
• if indicated, fresh frozen plasma is transfused.

Severe and moderate degree

With moderate and severe placental abruption, the pregnant woman is subject to immediate delivery, regardless of the gestational age. The satisfactory condition of the fetus or its intrauterine death in the matter of delivery does not matter, a caesarean section is performed according to vital indications on the part of the mother.

During the surgical intervention, the uterus is carefully examined, if the uterus of Kuveler is diagnosed, then the extension of the operation to the extirpation of the organ is shown. In parallel, the fight against DIC, the restoration of blood loss (plasma transfusion, platelet and erythrocyte mass) is being carried out.

• In the event of a detachment in childbirth and a satisfactory condition of the fetus and the woman in labor, minor bleeding, childbirth continues in a natural way, monitoring the fetus. Early amniotomy allows in some cases to stop bleeding and progression of detachment.
• If placental abruption happened in the pressing period, then childbirth either ends caesarean section(location of the head in the wide part of the small pelvis) or by applying obstetric forceps (the head is already in the narrow part or lower).