Detachment of the placenta during pregnancy consequences. Causes and consequences of placental abruption in early pregnancy: what is the danger and how to treat
Women during their entire pregnancy are exposed to a large number of dangers that can cause harm to fetal health and expectant mother. And in the most severe case, they can cause spontaneous abortion. Placental abruption is one of the anomalies.
Placental abruption in early pregnancy is its mildest manifestation, causing minimal harm to the developing fetus.
The role of the placenta for fetal development
The placenta is also called the "baby place". This is a connective tissue that is formed from a branched chorion and with its appearance resembles a cake about 20 cm in size. It directly separates the embryo with the fetal egg from the mother's body. The placenta is in its normal position on the wall of the uterus- near its bottom, back and front.
The placenta is a rather complex structure, which consists of the blood vessels of the fetus and mother, reliably protecting the child from the penetration of harmful substances from the mother's body and helps the baby's waste products to exit directly.
Functions of the placenta:
- Excretory (with the help of the placenta, all the substances of the child's vital activity come out of the mother's body).
- Nutritious (makes it possible to saturate the baby with water, minerals and vitamins that are required for its development).
- Hormonal (produces hormones), which are needed for the normal course of pregnancy and the full development of the fetus - plays the role of the endocrine gland).
- Protective (on itself bears the immunological protection of the child, due to the passage of mother's antibodies to the fetus).
- Gas exchange (this is a kind of "respiratory apparatus" of the child, oxygen passes into the blood of the fetus with the help of the placenta, and carbon dioxide enters the mother's body back).
In its natural position, the placenta, being between amniotic fluid and walls uterus, subject to pressure from both sides. It helps a kind of balance. And when some deviation appears in this state, then one side creates more pressure, in this case, premature detachment of the placenta in the early stages can be considered.
What is placental abruption in early pregnancy?
Placental abruption appears at any time. Placental abruption in early pregnancy is a pathology in which the "baby place" is separated from the uterus. Branch can appear on the other side - separation from the chorion fertilized egg. These complications in themselves carry a danger to the life and health of the fetus and mother.
Placental abruption can have several forms of manifestation:
The reasons
One can note such groups of factors and causes that affect premature detachment of the placenta:
- predisposing;
- etiological.
Etiological reasons:
Risk factors that provoke the appearance of premature placental abruption:
All these reasons, indirectly or directly, cause the pathology of placental abruption in early pregnancy. In order to respond in a timely manner, it is necessary to know the symptoms of this disease and immediately contact a specialist.
Symptoms
Most often, placental abruption begins to be accompanied by bleeding that occurs due to damage to capillaries and blood vessels. If the placenta separates from the uterus, then blood begins to accumulate in the space that has appeared, this causes a hematoma.
As already described above, placental abruption can take place in several ways. In the simplest form, the symptoms are almost not expressed. And this pathology can be determined only by performing an ultrasound scan. In other cases, symptoms are more severe and include fetal immobility, lower back pain, and bleeding.
The following groups of symptoms are noted: abdominal pain, uterine bleeding, disruption of the heart in the fetus, uterine tension. It is necessary to consider each group in more detail.
Uterine bleeding
Bleeding counts the most common symptoms detachment of the placenta. In about 4 cases out of 5, spotting is noted from the vagina. Taking into account the general condition of blood coagulation and the size of the detachment in a pregnant woman, bleeding from the uterus can be profuse or insignificant.
But there may be no visible bleeding. Blood can accumulate in a place where the placenta has detached from the walls of the uterus, most often this is common with detachment in the middle section of the placenta. This is considered the most dangerous manifestation of the disease, since bleeding from capillaries and vessels does not stop, but it is characterized by an internal manifestation. The medical term for this occurrence of placental abruption is retroplacental hematoma.
During central placental abruption blood accumulates more and more in the space that has appeared, this begins to lead to an increase in the size of the detachment. As a result, the walls of the uterus are saturated with blood. In this case, we will already be talking about saving the life of a woman, since the fetus is threatened with death in 100% of cases.
Marginal bleeding is not so dangerous, since blood does not accumulate in the uterus, but is brought out, causing visible bleeding. When the blood has a scarlet color, then detachment has just occurred, when the shade of blood discharge has a darker color, then a certain time has passed between bloody discharge and detachment.
Sometimes noted mixed bleeding. In this situation, it is impossible to accurately assess the volume of blood loss by determining only external secretions. In this case, it is already necessary to take into account the general condition of the woman.
Therefore, you must be attentive to your feelings, since the absence of secretions does not mean at all that the pathology does not exist.
Uterine tension and abdominal pain
A symptom of placental abruption in the absence of visible bleeding may be pain. As a rule, this pain is characterized as dull and manifested by peculiar attacks. Also, there is no clear localization of this pain. Most often, it gives to the thigh, to the perineal region or to the lower back.
During the palpation of the uterus, pain is noted, both without a clear location, and local. When pressing on the uterus, more acute pain appears during internal bleeding. You can also determine the tension of the uterus and its density.
Fetal heart failure
The higher level of blood loss and the larger the area of placental abruption, the greater the likelihood of a violation in the fetus of the heart. The presence of this symptom indicates hypoxia in the baby. This symptom appears at stages 2 and 3 of detachment (more than a quarter of the total area). The death of the fetus is inevitable when detachment occurs from half of the total area.
One way or another, during the appearance of any of these symptoms, you should contact a specialist as soon as possible.
Diagnosis of the disease
Diagnosis of this disease, as a rule, does not cause difficulties. Detachment can be determined already during the collection of anamnesis of the pregnant woman and the initial examination. Doctors perform all the required laboratory examinations, study the medical record and complaints of the pregnant woman. The presence of pain, an increase in the tone of the uterus and the presence of bloody discharge are determined. The condition of detachment is also characterized by oxygen starvation of the unborn baby.
Diagnosis with ultrasound gives complete confirmation of the disease. With the help of ultrasound examination, it is possible to determine the volume of retroplacental hematoma, the area of placental abruption, the presence of internal bleeding.
When a woman has bleeding, this is not always the cause of exfoliation. The doctor examines the vagina and cervix to identify its opening, benign neoplasms, and infectious diseases.
Treatment of the disease
The choice of treatment method depends directly on the condition of the fetus and mother, general symptoms and the nature of placental abruption. All measures are aimed at sparing and careful treatment of the disease, since at the same time it is necessary to carry out procedures to stop bleeding.
During a slight detachment, the following activities are performed:
- exclusion of any loads, even small ones;
- being in bed and complete rest;
- tocolytic treatment - relaxation of the tone of the uterus;
- pregnant women are prescribed vitamins;
- iron-containing preparations (fight against anemia);
- means to stop bleeding (Vikasol, ascorbic acid);
- antispasmodics (Papaverine, No-shpa, Magnesia, Metacin).
All treatment in early pregnancy should be under regular control of the heartbeat fetus and the general condition of the child.
Disease prevention
A set of preventive measures:
- treatment of diseases of all body systems;
- treatment of any diseases of the genitourinary organs;
- regular monitoring of pressure;
- in the presence of a Rh conflict, maximum attention to one's condition is required;
- prevent possible injury;
- rejection of bad habits;
- scheduled examinations by a specialist;
- control of the circulatory system;
- exclusion of stress;
- when allergies are present, their timely control is required.
The health of a pregnant woman is the main value that needs to be preserved and protected how the condition and life of the child directly depends on her health. Pay attention to any change in the body and any little thing. By doing this, you will be able to help your child and yourself in a timely manner.
Bloody discharge during pregnancy is always frightening and alarming for a woman. Often behind them lies a life-threatening condition - placental abruption. "Children's place" performs many functions, but the main one is the transfer of oxygen and nutrients to the baby. Placental abruption in early pregnancy is a condition in which the "baby place" begins to be torn away from the walls of the uterus. In time, the pathology detected in most cases will help to save the pregnancy. But why does placental abruption occur? And what are its main symptoms and directions of treatment?
The frequency of this pathology varies from 1.5 to 5%. Placental abruption may occur with or without overt clinical symptoms. The prognosis for the development of the unborn baby largely depends on the area of the formed hematoma. In some cases, placental abruption can endanger not only pregnancy, but also the life of a woman.
A bit of physiology
The placenta is a special organ in a woman's body that forms during pregnancy. After fertilization and receipt of the fetal egg in the uterine cavity for 5-6 days, a group of cells is released in it, which begin to penetrate into the nearby wall with the help of special villi. The latter penetrate between the vascular plexuses, cells. This is how the placenta is formed.
Its synonyms are:
- chorion (if we are talking about early terms);
- "baby place", placenta (after childbirth).
The placenta is finally formed at 16-18 weeks of pregnancy. The tissues of the woman and the fetal egg are involved in its formation, therefore, the fruit and maternal parts of the organ are subsequently isolated. One side of it is turned to the wall of the uterus, the other - to the developing fetus, which is connected to the "children's place" with the help of the umbilical cord.
Why is a "children's place" necessary?
The main functions of the placenta are as follows.
- Fetal nutrition. Nutrients, vitamins, microelements, that is, “building material” for a developing fetus, enter the baby through the placenta through the vessels of the umbilical cord. If this function is violated, growth retardation, pregnancy fading occurs.
- "Breath" of the fetus. Together with nutrients, oxygen enters the child through the arteries of the umbilical cord, and carbon dioxide flows through the veins. The lungs of a child begin to function fully only after birth. Up to this point, the placenta plays an important role in gas exchange.
- Protects the fetus. The placenta forms a kind of protection for the child from various substances, drugs, bacteria and viruses. Its tissues form a hemato-placental barrier, which selectively passes only the necessary substances to the fetus. Similarly, the placenta prevents a woman's immune cells from "recognizing" half-foreign (paternal) genetic material for her. Otherwise, it would be impossible to bear the pregnancy.
- Forms hormone-like substances. The placenta, in addition to its main functions, from the moment of its formation begins to synthesize substances similar in function to hormones. In it, for example, hCG (chorionic gonadotropin), prolactin, progesterone, estrogens, serotonin are formed. They are necessary both for the normal growth and development of the embryo and the successful course of pregnancy, as well as for the final preparation of the female body for childbirth and subsequent lactation.
What is dangerous placental abruption in early and late pregnancy
Placental abruption is a condition in which it separates from the wall of the uterus. Since the "children's place" is extremely rich in blood vessels, detachment is accompanied by bleeding. If the blood is not able to go outside, a hematoma is formed. If the detachment occurs close to the cervix, then the blood exits through the cervical canal. In this case, the woman notes bloody discharge from the vagina.
Detachment is a life-threatening condition for a woman and a fetus, especially if it occurs in the second and third trimesters. Partial abruption of the placenta in late pregnancy often entails an emergency caesarean section.
When the risk of developing a pathology increases
Placental abruption is the body's first step in getting rid of the fertilized egg and the developing embryo. A woman needs to understand that the presence of symptoms of this condition is evidence of a threatened abortion. The causes of placental abruption can be both on the part of the mother and the embryo.
If the problem is in a woman
The risk group for miscarriage, and, consequently, for detachment of the chorion, includes the following women.
- In the presence of genital infections. Any inflammatory processes in the vagina and cervix can lead to abortion. Timely treatment of genital infections will avoid such unpleasant complications, even if there are already signs of detachment of the fetal egg.
- With chronic endometritis. Inflammation in the uterine cavity affects the process of introduction of the fetal egg into the wall. Penetration (invasion) may be defective. As a result, a slight or even severe detachment of the placenta is formed in the early stages.
- Multiparous. In women with more than three births in the past, the likelihood of various inflammatory processes, including chronic endometritis, is increased. This is associated with an increased risk of placental abruption at different times.
- With a history of infertility. Such problems imply various hormonal disorders, including a lack of progesterone - the "pregnancy" hormone. Timely correction can help to continue the pregnancy without any consequences.
- with somatic diseases. Some pathologies can provoke a similar termination of pregnancy at different times. For example, diabetes mellitus, arterial hypertension, metabolic disorders, systemic autoimmune diseases. As a rule, they are associated with circulatory or immune response disorders.
- If there were injuries in the abdomen. In a normal pregnancy, in the case of a blunt injury, a hematoma may form in the area of attachment of the fetal egg. The consequences of such placental abruption for a child will depend on its size and the presence of concomitant problems in a woman. This can be observed after amniocentesis - amniotic fluid sampling for further research. For this, a puncture of the wall of the uterus and abdomen is performed.
- in stressful situations. Strong psycho-emotional experiences can also lead to the threat of termination of pregnancy, even in the absence of other provoking factors.
- After 35 years. At this age, the likelihood of hormonal disruptions, chronic inflammatory processes increases. In parallel with this, the risk of detachment increases.
- With early toxicosis. Severe nausea and vomiting (more than five times a day) can lead to an imbalance of microelements in the body, dehydration and other problems. As a result, this provokes the rejection of the fetal egg.
- With anomalies of the genital organs. In the presence of pathology in the structure of the genital organs (bicornuate uterus, with a complete and incomplete septum, unicornuate uterus, saddle-shaped), the process of implantation of the fetal egg may be disrupted. This is especially true in cases where the chorion begins to form in the pathological zone (for example, at the bottom with a saddle uterus, near the septum).
- If there are blood diseases. Blood clotting disorders can lead to placental abruption and life-threatening bleeding. Often a woman may not even know about them. For example, thrombophilias (conditions with a propensity for blood to increase thrombosis) are hidden.
- After IVF. When using assisted reproductive technologies, it is often necessary to resort to the creation of an artificial hormonal background, to carry out additional diagnostic manipulations. After IVF, detachment can occur for no apparent reason.
- With multiple pregnancy. With twins, triplets and more fruits, the load on the woman's body increases. Failures occur more often, including detachment.
- With an abnormal location of the placenta. Already in the early stages, placental abruption can be triggered by the wrong location of the chorion. Ideally, it should be fixed along the back or front wall near the bottom. When the placenta is closer to the cervix, the risk of detachment and bleeding increases.
If problems in the embryo
Detachment may be the beginning of an abortion in case of inferiority of the embryo. For example, if he has vices that are incompatible with life, genetic disorders. In these cases, all measures aimed at maintaining pregnancy are most often ineffective.
When the chances of a successful pregnancy are higher
The causes and consequences of placental abruption in early pregnancy are interrelated. But one can never reliably say how such a complication will affect the developing embryo. There are frequent cases of a small detachment of the placenta during pregnancy and subsequent fading of the fetus, and vice versa, when, with a significant area of detachment, there is no effect on the baby, and gestation ends in a successful birth.
The likelihood of a successful pregnancy is higher if several of the following factors are combined in a woman:
- up to 12 weeks;
- the detachment area is small (no more than 2-3 cm);
- conservative treatment gave a significant effect;
- pregnancy is natural;
- no other diseases;
- woman under 35;
- history of no more than two pregnancies.
Assess the risks and the likelihood of whether it is possible to maintain pregnancy with placental abruption in this case, only a specialist can during the dynamic observation and treatment of a woman.
Effect on the fetus
If we consider the effect of detachment on the fetus, it may be as follows.
- There are no violations. In this case, the amount of incoming oxygen and nutrients is sufficient for normal growth and development of the embryo. Subsequently, when performing ultrasound, recording CTG (cardiotocogram - fetal heart rhythm), no changes are detected.
- Compensation for violations. Each centimeter of detachment leads to a "shutdown" of the work of the placenta. But the redistribution of blood flow does not lead to significant changes in the parameters of the body of a developing baby. Subsequently, the detachment site can be detected at the birth of the placenta. Against the background of the red surface of the maternal side of the "children's place", it looks pale and more dense to the touch.
- Death or serious changes in the fetus. With a large area of detachment, the risk of death of the fetal egg with the embryo and even a full-fledged fetus in the later stages increases. In such situations, life-threatening bleeding sometimes develops, when all the forces of doctors are aimed at saving the woman.
Symptoms
Symptoms of placental abruption in the early stages largely depend on the cause that caused the violation, as well as on the size and location of the hematoma.
- Isolation of blood. Most often, the first symptom of detachment is bleeding. Its intensity depends on the area of detachment and the possibility of blood escaping through the cervical canal (from minor spotting to massive blood loss). If the detachment site is located, for example, at the bottom of the uterus, there may be no discharge at all.
- Pain. May be the only symptom or accompany bleeding. The pain can be sharp, unbearable, or aching in nature, as with menstruation. It can be constant or intermittent, aggravated after overwork or physical exertion, stress.
The following symptoms may also be additionally determined:
- weakness, dizziness;
- lowering blood pressure;
- increased heart rate of a woman;
- reduction of fetal movements (after 18 weeks);
- excessively violent fetal movements (after 18 weeks);
- pronounced tone of the uterus.
In the 1st trimester of pregnancy, you can often encounter an asymptomatic course of detachment, when neither pain nor discharge bother you. As a rule, this is due to early diagnosis using an ultrasound method, when the clinical picture has not yet developed. Early treatment gives a high chance of successful gestation.
How to identify the condition
Diagnosis of detachment is carried out taking into account the complaints of the woman, a general examination and a special examination. Complaints are established based on the symptoms that a woman has. Most often, this is the discharge of blood or pain in the lower abdomen.
During a general examination, the doctor may notice the following:
- bloody discharge from the cervical canal;
- increased tone of the uterus.
The most informative method has an ultrasound method. With its help, you can not only confirm / refute the diagnosis, but also determine the size of the detachment, the location of the hematoma, track the dynamics and effectiveness of the treatment (the area increases or not). Ultrasound also allows you to establish the state of the embryo, in particular, its heartbeat and growth rate. The absence of heart sounds after seven weeks is a sign of an undeveloped pregnancy.
Treatment
With severe bleeding in the 2nd and 3rd trimesters, the question of performing a caesarean section is always decided. If the period is less than 12 weeks - about curettage of the uterine cavity. Any delay could cost the woman's life.
With minor or moderate bleeding and a live embryo, conservative treatment is prescribed, but always in a hospital. At home, a woman with an aggravation of the situation and the progression of detachment will not be able to receive proper assistance.
The following medicines are used.
- Hormonal tablets. This group includes progesterone preparations (Dufaston, Utrozhestan), they are used up to the 2nd trimester. There are certain schemes for stopping bleeding. On the example of "Duphaston" it looks like this. Once you should drink 40 mg of the drug, then every eight hours take an additional one tablet. During the week, the daily dose can reach 40 mg, after which it is necessary to switch to a maintenance dosage of 20 mg.
- Hemostatic drugs. Permitted during pregnancy include "Vikasol", "Etamzilat sodium", "Ascorutin". With pronounced secretions, intramuscular or intravenous injections are carried out, then you can switch to tablet forms. Also, folk remedies can be used to stop bleeding, for example, infusions of nettle or water pepper.
- Spasmolytic therapy. It is prescribed after the cessation of discharge and is used to reduce the tone of the uterus and maintain pregnancy. Most often, "No-shpu", "Drotaverin", "Papaverin" are prescribed. Magnesia should only be used after 22 weeks of pregnancy.
- Vitamins. Vitamins A, E and C are used. They help stop bleeding and maintain pregnancy. Iron preparations are prescribed in the presence of anemia, which is evidence of bleeding. In this case, it is necessary to regularly take blood tests to monitor the level of hemoglobin.
In parallel with the main treatment, concomitant diseases are treated, for example, inflammation in the vagina, control of blood sugar or pressure. If this is what became the causal factor in the development of detachment, compensation for conditions will help maintain the pregnancy.
Forecast
The prognosis of the course of pregnancy in each case is individual. But, the more massive the bleeding and the longer the period, the higher the likelihood of the most unpleasant consequences.
The basics of detachment prevention include the following:
- careful preparation for pregnancy;
- proper and balanced nutrition;
- avoidance of stress, overwork;
- tracking and compensation of all existing diseases;
- regular examinations at the gynecologist;
- compliance with all doctor's recommendations.
Having experienced failure once, women worry about a new pregnancy after placental abruption. If the cause is eliminated, you should not worry. Reviews of mothers who have already taken place confirm this. But often, to clarify the problem, you have to perform numerous examinations and then undergo treatment.
Placental abruption is a formidable condition during pregnancy that can endanger the life of the woman and the developing baby. Management tactics and prognosis in such situations largely depend on the duration of pregnancy and the extent of the hematoma. Treatment of placental abruption in the early stages should be carried out only in a hospital under the supervision of specialists.
Women who have become mothers, and those who are expecting replenishment in the family, know how important the placenta plays for the preservation and full development of the fetus. Alas, pregnancy does not always proceed without complications, there are problems with this organ. The most common pathology is placental abruption. Without timely treatment, it is fraught with the most sad consequences.
Formation and function of the placenta during pregnancy
The placenta, baby place or placenta is an organ that is formed in the uterine cavity during the period of bearing a child by a woman. It is the link between mother and baby. The importance of the placenta is difficult to overestimate, since it is responsible for all biological processes that ensure the existence of the fetus. Any deviation of this body from the norm can cause the death of the baby.
The main placental functions include:
- Gas exchange. Like all living things, the fetus needs oxygen. It enters the baby's blood from maternal blood, and this happens through the placenta. Carbon dioxide is also released through the placenta. Problems with these organs provoke a violation of these processes.
- Nutrition and excretion. The fetus develops normally when provided with nutrients, vitamins and water. Without a placenta, he simply cannot receive them. In addition, he is responsible for the excretion of waste products of the crumbs.
- Production of hormones. The placental organ to some extent plays the role of an endocrine gland, producing most of the hormones necessary for the normal course of gestation.
- Protection. The child's place acts as an immunological barrier for the baby.
When does the placenta normally separate from the uterine wall?
The place of localization of the placental body usually becomes the bottom of the uterus, its posterior, anterior or lateral wall. Sometimes there is a low placentation, when the child's place is attached to the internal pharynx.
At the beginning of gestation, before the formation of the placenta, the chorion performs the functions of ensuring the life and development of the child. It is held in place firmly due to the fact that the uterus exerts pressure on it from the outside, and the fetal egg from the inside. Subsequently, the embryo will attach to the uterus, and the placenta will form at the site of attachment. Usually, this part of the uterine wall is practically not subjected to contractions when the contractions of the uterus itself begin. In view of this, premature detachment of the placenta is rare.
If the pregnancy passes without serious deviations or complications, then detachment of the placenta occurs after childbirth, when the fetus is already out. If the placenta has moved away from the endometrium before the birth of the baby, we are talking about premature detachment of a normally located placenta - PONRP. It happens before childbirth - in the early and late periods - or occurs during them.
Causes of premature exfoliation of a child's place
Detachment of the placenta is called its partial or complete separation from the uterine mucosa, which causes disturbances in its functioning or complete cessation of the organ. There are three degrees of premature placental abruption:
- Slight detachment - less than 1/3. The chances of keeping the baby and carrying the pregnancy normally remain high.
- Detachment by 50%. As a result of such rejection of the chorion, fetal hypoxia develops, which in itself is dangerous and can be the cause of the death of the crumbs.
- Complete detachment. The fruit dies.
The causes of premature abruption of the placenta can be a variety of factors, and sometimes finding out why this happened is a difficult task. Placental abruption is caused by:
- vascular problems caused by late preeclampsia or hypertension;
- trauma to the abdomen due to impact;
- polyhydramnios;
- multiple pregnancy;
- hypovitaminosis;
- nephritis;
- chronic diseases of the endocrine system, such as diabetes.
In normal position
The way the child's place is located can also affect its premature departure. However, it is not uncommon for premature detachment of a normally located placenta (PONRP) to occur. Reasons for rejection include:
- the age of the mother is over 35 years old, when it is possible to form an additional small placental part, which is easily torn off during delivery, after which complete detachment occurs;
- pathologies in the structure of the uterus, which include anomalies, synechia, hypoplasia, cervical insufficiency, complications after abortions and operations, adenomyosis;
- hormonal disruptions due to dysfunction of the ovaries or placenta;
- infectious diseases of both general and gynecological nature;
- unhealthy lifestyle of a pregnant woman, bad habits and unbalanced diet;
- allergy;
- severe anemia;
- short umbilical cord;
- history of caesarean section.
With abnormal attachment
Many factors can provoke abruption of a normally located placenta, although in general only 0.1%–0.3% of expectant mothers face such a problem. Another significant reason for detachment of the chorion may be an anomaly in its structure, attachment, development, as well as the incorrect location of the placental organ itself.
For example, in the case of pregnancy after a cesarean section, a child seat can be attached at the site of a postoperative scar. This increases the risk of placental abruption, which will threaten up to 8-9 months of pregnancy.
The second example of an abnormal location is attachment in the region of the myomatous node. Its tissues are much denser than the uterine walls, which makes the placental attachment inferior.
Pregnancy prognosis in case of placental abruption, treatment
With a significant or repeated rejection, it will not be possible to save the fetus. Treatment with preservation of pregnancy is possible only with small areas of exfoliated placental tissue. The woman is prescribed bed rest and taking certain medications. Usually prescribed:
- Drugs that stop bleeding. Their use is relevant in the presence of significant blood loss.
- Antispasmodics. Eliminate pain and lower the tone of the uterus.
- Analogues of corpus luteum hormones. Contribute to a decrease in uterine tone.
- Preparations containing iron. Restore its deficiency in the body due to blood loss, prevent the development of anemia.
- Progesterone. For example, Duphaston, Utrozhestan. Stop the PONRP process.
- Means that improve blood flow in the placenta, thereby preventing the formation of blood clots.
- Vitamins.
Early (up to 9-13 weeks)
The least dangerous for the mother and the baby is considered to be a slight detachment of the placenta in the early stages, up to the 13th week, without pronounced manifestations in the form of severe pain, bleeding and fetal hypoxia. Pathology is diagnosed during ultrasound.
The most common factor causing placental abruption in early pregnancy is retroplacental hematoma, which is easy to detect with ultrasound. This is the main sign of an endometrial problem early in pregnancy. Symptoms in the form of brown discharge at this stage of premature detachment of the placenta do not appear.
In the second trimester
The prognosis and symptoms of placental abruption in the second trimester no longer look so encouraging, and much depends on the gestational age. In the first half of the second trimester, the placental organ still continues to grow, which can compensate for the consequences of the pathology, but at a later date, that is, in the sixth month, a caesarean section may already be required.
The characteristic signs of placental abruption are:
- tension and high tone of the uterine muscles;
- increased activity of fetal movements due to the onset of hypoxia.
The actions of doctors are largely determined by the gestational age, the condition of the mother and fetus, the severity of symptoms, that is, the abundance of brown discharge. Alas, with the rapid development of the pathological process, it is impossible to save the baby even with the help of drug treatment or surgical intervention.
At a later date
The most unfavorable prognosis of pathology is possible in the third trimester. During this period, the growth of the placental organ cannot be counted on.
Symptoms of placental abruption are:
- abdominal pain;
- tension and soreness of the uterus;
- copious brown discharge.
The only solution is an emergency delivery, usually operative. If the detachment is insignificant and does not progress, and the bleeding is small or absent, it is possible to carry the baby before the due date, but only in stationary conditions.
Tactics of conducting labor in case of early detachment of the placenta (before the birth of the child)
Departure of the placental place also happens directly during childbirth. This happens when the first child is born from twins or labor activity goes with deviations. With a slight marginal detachment of the placenta, when the condition of the woman and the fetus remains satisfactory, and the tone of the uterus is normal, natural childbirth can be carried out with constant monitoring of the condition of the fetus (via CTG) and the pressure of the woman in labor.
With the help of amniotomy, they reduce bleeding and speed up the process of childbirth. During the entire delivery process, the doctor monitors the baby's heartbeat and the contractile activity of the uterus. In addition, central venous catheterization and infusion therapy may be prescribed. Epidural anesthesia is also relevant. After the head appears, oxytocin is used to increase uterine contractions and reduce the amount of bleeding.
The tactics of conducting childbirth with a progressive discharge of a child's place is determined by how far the baby has managed to advance. If he has reached the very exit with the anterior presentation, obstetric forceps are used, and with the pelvic presentation, the fetus is extracted by the pelvic end. Otherwise, when the fetus is still in the wide part of the pelvic cavity and above, an emergency caesarean section is required.
The main danger in PONRP for a child is acute hypoxia. Untimely obstetric care may result in antenatal fetal death.
Is it possible to prevent premature separation of a child's place?
The course of pregnancy is sometimes complicated by PONRP, and this can happen at any time before delivery. Detachment of a child's place from the endometrium threatens with the most unfortunate consequences, so women are looking for ways to prevent pathology. Alas, due to the fact that it can be very difficult to determine the source of the problem, there are no specific preventive measures today. You can try to reduce the risks of developing a pathological process by following these recommendations:
- Undergo a full examination at the stage of pregnancy planning. This will help to identify and eliminate existing diseases even before conception.
- Visit the doctor regularly when carrying a baby.
- Take medications only after consultation with your doctor.
- Lead a healthy lifestyle. Give up drinking and smoking, avoid injuries and stressful situations, regularly walk in the fresh air, eat right.
Premature placental abruption - too early, before the birth of the fetus, separation of the placenta from the uterine wall. This serious complication requires urgent medical attention.
Normally, the placenta is located on the wall of the uterus in the upper parts of its body - at the bottom, back and front walls. Premature separation of the placenta in these cases is called premature detachment of the normally located placenta. Placental abruption can occur both during childbirth and during pregnancy. This complication threatens the life of the fetus, as well as the health and life of the mother due to bleeding.
The placenta is constantly under pressure from the muscles of the uterus on the one hand and the fetal egg with amniotic fluid on the other. The balancing of these two opposing forces, as well as the significant elasticity of the placental tissue due to its spongy structure, as well as the fact that the area of the uterine wall corresponding to the attachment of the placenta is reduced less, prevent premature detachment of the placenta.
The modern rhythm of life and an abundance of stress often cause placental abruption in early pregnancy. With such a pathology, many women lie in conservation. During the first trimester, any negative impact on the physical or moral state of the mother can be fatal. But if you notice the deviation in time, there is every chance to avoid the loss of the child.
What is placenta
The placenta is a unique organ, it is formed in the female body and is needed only during pregnancy. It has a round shape, flattened on the sides, which is why it has such a name. From the Latin "placenta" is translated as "flat cake". The umbilical cord emerges from the middle of the organ.
The second name of the placenta is "children's place." It begins to form from the third week of pregnancy, and ends by 12-13 weeks, but the placenta continues to develop until the end of pregnancy, successively going through several stages.
The placenta should depart after the birth of the child. If it separates from the walls of the uterus in the first trimester, the diagnosis is "placental abruption in the early stages." Treatment in this situation should begin immediately.
The placenta has four degrees of maturity:
- Zero - up to 27-30 weeks. The use of tobacco and alcohol can contribute to the fact that the first degree of maturity will come ahead of time.
- The first is from 30 to 34 weeks. During this period, it stops growing, and begins to thicken.
- The second - from 34 to 37 weeks. This is the most stable stage.
- The third - from 37 weeks. From this moment on, the process of natural aging starts in the placental tissue. If it starts earlier, the child will not receive the necessary substances and oxygen to the fullest. This can lead to the development of fetal pathologies and even death.
Excessive diets and lack of weight also cause premature aging of the “children's place”. Pregnancy is not the time to diet.
The placenta consists of two circulatory systems that do not mix, they are separated by a membrane called the placental barrier. The child's blood circulates through special villi that permeate the entire "children's place". Maternal blood washes them from the outside, but transfers oxygen and nutrients through the vessels. The embryo pumps carbon dioxide and metabolic products back to the mother. Being in the womb, the child does not breathe easy.
The placental barrier serves as a filter for substances coming from the mother's body. It lets in useful ones, but blocks those that can harm the child. An interesting feature is that toxins from the baby are transmitted to the woman, and in the opposite direction - practically none.
One of the main functions of the placenta is to produce hormones. The sex hormone begins to appear when the placenta is fully formed, it is necessary to maintain pregnancy. With its appearance, the threat of losing a child drops significantly, doctors no longer need to administer hormonal drugs to a woman.
At first, the placenta grows faster than the baby. By the end of the first trimester (14th week), the embryo weighs about 25 grams, and the “baby place” is several times larger. By the end of pregnancy, the placenta can reach a mass of 500-600 grams, and its circumference is up to 18 cm.
Severity
If the affected area is large, placental abruption can lead to fetal death. Due to tissue separation, blood circulation between mother and child is disturbed. Detachment has several degrees of severity:
- Mild - a small detachment of the placenta in the early stages. There may be no pronounced symptoms, it is possible to notice it only upon examination.
- Medium - accompanied by painful sensations in the abdomen, the uterus becomes stone, bleeding is observed.
- Severe placental abruption in early pregnancy. Symptoms of a critical situation are also manifested by blood discharge of varying intensity. Additionally, nausea, vomiting, loss of consciousness, palpitations, asymmetric position of the uterus can be observed. Rejection of the placenta by 1/3-1/2 leads to fetal death. There is also a serious risk for the mother.
Types of delamination
Tissue rejection can be different: a small detachment of the placenta (in the early stages of pregnancy it occurs quite often) and a complete detachment of the "children's place". With a total lesion, the death of the fetus occurs.
Partial withdrawal of the placenta from the wall of the uterus is observed in a separate part of the organ. It can increase in area or remain the same size throughout pregnancy with thrombosis of the uterine vessels.
The marginal separation of the placental tissue and the central one are also distinguished. In the latter form, there is no external bleeding.
It should be noted that during the first six weeks of pregnancy, the placenta as such is not yet. In the very early stages, it is called the chorion and is located around the entire fetal egg. As a rule, detachment of the chorion leads to spontaneous miscarriage.
The reasons
There are a lot of reasons for placental abruption in early pregnancy, sometimes they act in combination.
Symptoms of pathology
In the early stages, the symptoms of mild placental abruption often do not manifest themselves. A woman may feel a pulling pain in the lower abdomen, but do not attach any importance to this, considering it to be the norm.
The average degree is characterized by pain in the lower abdomen (as a rule, they have a pulling character), slight bleeding. On palpation, the doctor detects uterine hypertonicity.
Severe pathology manifests itself in the form of symptoms:
If at least one symptom is detected, an immediate medical examination is required.
Diagnostics
As already mentioned, it is difficult to visually determine the rejection of placental tissues in a mild form, it can only be noticed during a routine examination or after the birth of a child and a “children's place”.
With an average and severe form of pathology, it is easier to make a diagnosis. The doctor takes into account the general symptoms and condition of the pregnant woman. For reliability, a gynecological examination with palpation is performed.
Regardless of the cause of placental abruption in early pregnancy, the observing gynecologist should determine the size of the site of rejection, as well as its localization. For this, an ultrasound examination is prescribed.
Dopplerography will determine whether there are violations of the movement of blood through the vessels between the fetus and the mother. To diagnose the degree of fetal hypoxia, cardiotocography is performed.
Treatment of placental abruption in early pregnancy
Despite the frightening diagnosis, rejection of placental tissue is not so dangerous if the lesion is not very large. The main thing is to diagnose it in time and start treatment. It is necessary to ensure that the pathology does not progress. With the right medical intervention carried out in time, pregnancy can be saved and the negative consequences for the fetus are minimally reduced.
If the focus of detachment is partial, and the pathology does not progress, in the first trimester the woman is placed in a hospital. The attending physician prescribes:
- Bed rest. Since physical exertion can become the causes of placental abruption in the early stages, it is important for the patient to ensure complete rest. It is also necessary to limit exposure, stress and strong emotional impressions.
- Sexual life with such a pathology in the first trimester of pregnancy is not recommended.
- Drugs that stop blood loss ("Vikasol").
- Drugs against anemia (replenishing iron deficiency). Foods that increase hemoglobin levels will also help.
- Medicines that reduce the tone of the uterus to reduce the tone of the uterus, antispasmodics ("Papaverine"). In addition, a solution of magnesium sulfate is prescribed in the form of droppers or injections.
- Medicines to relieve pain.
- A diet is required. Foods that can tone the uterus (chocolate, spicy dishes, spices) are excluded from the diet of a pregnant woman.
- Be sure to control the stool of a pregnant woman. She shouldn't be constipated. The act of defecation should be carried out easily, without strong tension and attempts.
The gynecologist will constantly monitor the patient's condition with the help of blood tests, dynamic ultrasound, coagulogram and dopplerography.
These measures will be able to protect the woman and the child from the further development of pathology.
If rejection began in the third trimester of pregnancy, retention is usually not practiced. Provided that the woman is already ready to give birth on her own, and her birth canal has entered the active phase, the amniotic bladder is punctured. After that, regular contractions begin. The process takes place under the careful control of cardiac monitors.
A woman who is unable to give birth on her own is scheduled for a caesarean section. In severe cases (with internal bleeding), stimulation will be performed at any term of the fetus. When the baby's head is already in the narrow part of the mother's pelvis, special obstetric forceps are used. With placental rejection, delay will lead to the death of the child, so he needs to be helped to be born faster.
After removing the child and the "children's place", you need to make sure that there are no blood clots left. Changes in the myometrium of the uterus can lead to its removal.
At the end of the procedure, drugs are prescribed that prevent blood loss, painkillers. If necessary, a woman is prescribed anti-shock therapy.
Consequences of pathology
A mild form of placental tissue rejection, with timely diagnosis and proper treatment, can do without consequences. Placental abruption (in the early stages) of moderate degree in half of the cases ends in fetal death. With a severe form of pathology, the child does not survive. There is a serious risk for the mother.
The consequences for a pregnant woman can be fatal. The development of heavy bleeding leads to the formation of a hematoma behind the uterus. This phenomenon is called the uterus of Couvelaire (after the French gynecologist who first described it). In severe cases, in order to save the patient's life, doctors have to remove this organ. Thus, the development of placental rejection can deprive a woman of reproductive function.
Large blood loss leads to anemia and the development of thrombohemorrhagic syndrome. Together, these factors can lead to a fatal outcome for a woman.
The worst option for the consequences of placental abruption in early pregnancy for the embryo is its death. It occurs when rejection exceeds the threshold of 1/3 of the part. If such a detachment occurs in the last weeks of pregnancy, an emergency birth can save the baby. The baby will be born prematurely, which involves a rehabilitation period.
If the detachment was mild to moderate, while it does not progress, then the woman can carry the pregnancy under full medical supervision.
Rejection of any degree is accompanied by fetal hypoxia, since the child begins to receive less oxygen and nutrients from the mother through the vessels. With rejection of 1/4 of the fetus, the initial stage of hypoxia is diagnosed. With detachment from 1/4 to 1/3 - a severe stage of oxygen starvation. This condition will affect the health of the newborn and its development in the future. The baby will need to be observed by a neurologist throughout childhood.