The term “detachment” or “detachment” is relevant for two conditions: on later during pregnancy it is used to describe the critical condition of the placenta (when there is a threat of miscarriage or fetal death), in early pregnancy - ovum(all with the same outcome). The causes of premature placental abruption are often late toxicosis or injury. Today we will talk about detachment, which occurs in the first trimester.

First, to make it easier to understand, it’s worth conducting a short educational program on anatomy. It is known that the uterus is a muscular organ that, regardless of whether one is pregnant or not, periodically contracts. Usually these reductions are minor. With the onset of pregnancy, a fertilized egg is attached to the uterine cavity, which gradually increases in size. With the development of the fetus, the placenta begins to form, which at this stage is called the chorion. What does he look like? In general, the chorion is the villous membrane of the embryo, which consists of special outgrowths (villi) covering the entire fertilized egg. With the help of these villi, inside which small vessels pass, the fetus is immersed in the mucous membrane of the uterus and is fixed in it. The outside of the villi is washed with the mother's blood. Thus, thanks to the work of the chorion, the child receives oxygen and nutrients from the mother and gives her carbon dioxide and metabolic products to be removed. It follows from this that maintaining the placenta in a healthy state is very important, because this organ performs the functions of the lungs, digestive organs, kidneys, and skin for the child. A complete placenta is formed by the end of the first month of pregnancy. For this, the chorionic villi grow, and the uterine mucosa changes.

So, we said above that the uterus tends to contract from time to time. At the same time, the placenta does not have muscle fibers and is not capable of contraction. That is why, with intense contractions of the uterus on early stages During pregnancy, partial or complete detachment of the ovum may occur. It happens that placental abruption occurs due to insufficient blood supply and specific immune reactions (for example, allergies).

We can say that partial detachment is a threat, and large or complete detachment is a spontaneous abortion. In some women, the detachment is asymptomatic and is detected during the next ultrasound. Others, on the contrary, experience painful, often cramping, sensations in the lower abdomen and bloody, less often watery, discharge.

At the stage of beginning detachment of the ovum, even if a small one occurs, the pregnancy can still be maintained. To do this, the main thing is to seek medical help in time. Before calling a doctor, you should take a horizontal position and not take any medications yourself. In most cases, the woman is sent for hospitalization - preservation. Sometimes they leave you at home, but under strict bed rest.

It is very important to identify all possible premature placental abruption and, if necessary, conduct a thorough examination and treatment.

Especially for- Olga Pavlova

Pregnancy is a difficult period for the female body, when you need to be careful not to harm the baby. Placental abruption in the early stages is dangerous and can lead to spontaneous abortion. Pathology can occur at any time during pregnancy. When diagnosing an illness, the consequences for the child can be most undesirable.

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Organ structure

The placenta is a special organ, in which optimal conditions are created for the growth and development of the baby.

Consists of connective tissue that is used for embryo maturation. The organ must occupy a special place in the uterus.

Only in this case will the fetus be able to grow and develop properly.

The structure of this organ is very complex. It supplies the child with all the necessary minerals and trace elements. Additionally protects the fetus from negative impact external environment.

We figured out what it is. You should also know the functions of this organ.

It ensures the normal course of processes such as:

• nutrition;
• removal of residual decomposition products;
• gas exchange;
• protection from negative external influences.
• hormonal regulation of development.

The placenta fits tightly to the walls of the uterus. At the same time, pressure is exerted on her from both sides. If it is not uniform, then placental abruption is diagnosed in the early stages of pregnancy. Treatment depends qualitatively on the degree and nature of the disease.

Important! Signs of placental abruption can be characteristic of any period of gestation.

This pathological manifestation cannot be left to chance. Otherwise it is created dangerous situation for both organisms.

Reasons for the development of the disease

Treatment is selected only after identifying factors that negatively affect the woman and fetus.

In medical practice there are following reasons placental abruption:

1. Excessive fragility of capillaries.
2. Incorrect size of the female organ.
3. Negative changes in the functioning of the heart.
4. in early or late pregnancy.
5. The presence of pathologies in the functioning of internal organs.
6. Serious diseases of the genitourinary system that have become chronic.
7. Multiple pregnancy.
8. Autoimmune or allergic reaction.

Premature placental abruption can occur under the influence of any of the above reasons. It is important for the patient to recognize the first manifestations of the disease and promptly seek medical help.

Manifestations of the disease

Symptoms of placental abruption include bleeding, which occurs against the background of capillary rupture.

This situation occurs when the organ is separated from the uterine cavity. Blood may accumulate, forming a hematoma.

Such manifestations are not always present, even if placental abruption has already been diagnosed in the early stages of pregnancy.

Treatment must be carried out without fail.

In addition to bleeding, a woman may feel. At the same time, the fetus begins to behave very mobile.

Important! The woman will also be able to feel unpleasant pain in the abdomen and excessive tension in the uterus.

A detailed examination may reveal an increase in the fetal heart rate.

The nature of uterine bleeding

We have already figured out what detachment looks like. However, the most common manifestation of the disease is uterine bleeding, which is diagnosed in 80% of cases. The rate of blood absorption plays an important role. Depending on this, bleeding can be scanty or profuse.

The absence of blood is typical for the situation if it accumulates inside the uterus. Most often, the manifestation is observed in its central part. Such a manifestation is considered dangerous, because the release of blood does not stop. It accumulates inside. In this case, retroplacental hematoma is diagnosed in medical practice. As the amount of fluid increases, the area of ​​the detachment itself begins to gradually increase. As a result, the uterus is completely saturated with blood. The situation is dangerous and threatens the woman's life. As a rule, the fetus dies.

Marginal premature detachment is less dangerous. In this case, blood does not accumulate in abdominal cavity, but is brought out.

If the liquid is scarlet in color, then most likely the detachment occurred recently. The darker the shade, the more time ago the separation of this organ from the walls of the uterus occurred.

Based on these characteristics, the woman is diagnosed and measures are taken to preserve the fetus.

Often enough doctors face with a mixed type of illness. In this case, it is quite difficult to understand the amount of blood lost based only on its external secretion. In this case, the general well-being of the woman who is carrying the baby is taken into account.

Important! Even if blood discharge is completely absent, it cannot be said unequivocally that the pathology is in this moment does not develop in the body.

Pregnant women need to be extremely careful to your well-being.

Hypertonicity and pain

Severe abdominal pain is not always present when placental abruption was previously diagnosed in the early stages of pregnancy. Treatment in this situation should be provided in a timely manner. Otherwise, the risk of spontaneous miscarriage increases. With placental abruption, a woman is in severe pain. It is characterized by dullness and comes in fits and starts. It is difficult to unambiguously determine where exactly its source is. Pregnant women note that it can radiate to the perineum or lower back.

Important! With detailed palpation it is difficult to determine the location of the lesion.

Pain with pressure becomes acute only if the bleeding goes inside the abdominal cavity. The gynecologist most often additionally diagnoses excessive density of the uterus and its increased tone.

Danger to the fetus

We already know why placental abruption occurs. Additionally, it should be noted that the amount of blood lost directly depends on the area of ​​the lesion. This situation negatively affects the functioning of the fetal heart. He begins to develop hypoxia. As a rule, this situation is typical only for the second stage of development of the disease. Death cannot be avoided if the membrane has moved away from the walls of the uterus by more than half.

A tragic situation can only be avoided if you consult a doctor in a timely manner.

Diagnostics

Placental abruption is easy to detect on any stage of development of the disease. It can be detected even during the first examination of a woman. To do this, you will need to collect anamnesis and ask the pregnant woman about her health.

If necessary, your doctor will order a series of tests. Thanks to this, the cause of the bleeding is identified.

The patient may also have increased uterine tone and regular aching pain in this area.

In this case, the fetus begins to suffer from insufficient oxygen supply.

To confirm the diagnosis you will need to undergo. Thanks to this device, it is possible to detect bleeding that is located in the abdominal cavity. The area and volume of the hematoma is of no small importance.

Discharge with blood in a pregnant woman occurs not only in the case of placental abruption. This clinical picture is observed in the presence of infectious diseases or benign formations. In some cases, the manifestation is accompanied by the opening of the cervix.

Treatment

The choice of therapy directly depends on the nature and degree of damage to the placenta. Additionally, the symptoms of a pregnant woman are also taken into account. Treatment should be gentle and be accompanied by stopping bleeding.

To quickly and effectively get rid of the disease, you must adhere to the following recommendations:

• observe bed rest and complete rest;
• eliminate any stress on the body;
• take specially selected;
• relieve increased uterine tone;
• take various antispasmodic drugs;
• use medications that will help quickly stop bleeding;
• take medications high in iron.

Important! During treatment, it is necessary to monitor the functioning of the cardiovascular system.

If the disease is severe, then a decision on the need for surgical intervention is considered. Thanks to this, the mother's life is saved. That is why you should consult a doctor if you have any symptoms of the disease.

Preventive actions

It is easier to try to avoid an illness than to deal with dangerous consequences later.

1. If diseases of the genitourinary system occur, they must be eliminated immediately.
2. A systematic approach to treating the whole body.
3. Pregnancy with Rh-conflict should be monitored by doctors at all times.
4. A woman should take changes in her blood pressure into account.
5. Completely remove from your life bad habits.
6. Minimize the risk of injury.
7. Regularly undergo examination of the circulatory system.
8. A pregnant woman should visit the doctor's office regularly for preventive examinations.
9. Allergy control.
10. Minimizing stressful situations.

A woman during pregnancy should be attentive to her health. If you notice the first symptoms of bleeding, you should immediately consult a doctor. Find out how long sperm lives by following the link.

Useful video: what causes placental abruption in the early stages

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Throughout pregnancy, women face many dangers that can harm their health. expectant mother and fruit. And in fact worst case may become a prerequisite for spontaneous abortion. Placental abruption is one of the pathologies that occurs in pregnant women at any stage.

Placental abruption in the early stages is its mildest manifestation and causes less harm to the developing fetus.

What is the placenta and its role for the fetus

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

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

Functions of the placenta:

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

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

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

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

Placental abruption has three forms of manifestation:

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

Causes of placental abruption in early pregnancy

The following groups of causes and factors influencing premature placental abruption can be distinguished:

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

Etiological factors:

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

Risk factors that can trigger the occurrence of premature placental abruption:

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

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

Symptoms of placental abruption

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

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

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

Uterine bleeding

Bleeding is the most common symptom of placental abruption. On average, in four out of five cases there are bloody issues from the vagina. Depending on the size of the detachment and the general state of blood coagulation of the pregnant woman, uterine bleeding can be minor or heavy.

• However, visible bleeding may not be observed. Blood can accumulate in the area where the placenta has separated from the walls of the uterus, this is especially common in cases of separation in the central part of the placenta. This is a particularly dangerous manifestation of the pathology, since bleeding from the vessels and capillaries does not stop, but it has an internal manifestation. The scientific name for this manifestation of placental abruption is retroplacental hematoma. With central placental abruption, blood accumulates more and more in the resulting space, which leads to an increase in the area of ​​the abruption. As a result, the walls of the uterus become saturated with blood. In this case, we will be talking about saving the life of the mother, but the fetus faces death in 100% of cases.
• Marginal bleeding is less dangerous because the blood does not accumulate in the uterus, but comes out, causing visible or external bleeding. If the blood is scarlet in color, the detachment has just occurred; if the color of the bloody discharge is darker, some time has passed between the detachment and the bloody discharge.
• Mixed bleeding may occur. In this case, it is impossible to accurately estimate the amount of blood loss, referring only to external secretions. Here you need to take into account the general condition of the pregnant woman.

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

Abdominal pain and uterine tension

In the absence of visible bleeding, pain may be a symptom of placental abruption. Most often, this pain appears in peculiar attacks and is characterized as dull. There is also no clear localization of this pain. In most cases, it can radiate to the lower back, perineum or thigh.

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

Cardiac dysfunction in the fetus

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

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

Diagnosis of placental abruption

Diagnosis of this pathology usually never causes difficulties. Placental abruption can be diagnosed during the initial examination and history taking of the pregnant woman. Doctors carefully study the patient’s complaints, medical records and conduct all necessary laboratory tests. The presence of bloody discharge, increased uterine tone and the presence of pain. Also, the state of detachment is characterized by oxygen starvation of the fetus.

Diagnosis using ultrasound provides complete confirmation of the diagnosis. By using ultrasound examination, it becomes possible to find out the presence of internal bleeding, the area of ​​placental abruption, and the volume of retroplacental hematoma.

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

Treatment of premature placental abruption

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

In case of minor placental abruption, the following measures are taken:

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

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

If the placental abruption is severe, we may already be talking about terminating the pregnancy and saving the life of the mother.

Therefore, for a successful outcome, you must consult a doctor at the slightest symptoms.

Prevention of placental abruption in the early stages

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

A set of preventive measures:

• timely treatment of all diseases of the genitourinary organs of a pregnant woman;
• treatment of diseases of other body systems;
• maximum attention to your condition in the presence of Rh conflict;
• constant monitoring of your blood pressure;
• elimination of all bad habits;
• avoiding all kinds of injuries;
• monitoring the state of the circulatory system;
• routine examinations by a doctor;
• if there are allergies, timely control;
• complete exclusion of stressful situations.

The health of a pregnant woman is a value that must be protected and protected. After all, the life and condition of the child directly depends on her health. Be careful, pay attention to every little thing and any change in the body. In this way, you will help yourself and your child in time.

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

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

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

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

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

Afterbirth and its meaning

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

What functions does the placenta perform?

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

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

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

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

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

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

Prognosis in early gestation

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

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

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

Forecast for the last stages of gestation

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

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

Forms of placental abruption

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

If the location of the placenta is normal

Premature detachment normal placenta available in three options:

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

If presentation is diagnosed

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

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

When the placenta is located in the uterine os

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

Clinical manifestations at different stages

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

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

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

How does a woman feel in the early stages?

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

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

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

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

Ultrasound reveals a small compaction or depression.

The nature of pain in pathology

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

Detachment during delivery

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

How does placental abruption manifest during childbirth?

• cramping severe pain;
• intense blood loss;

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

What is the diagnosis based on?

Pathology is diagnosed based on the patient’s complaints, objective examination, data special methods research.

Hardware surveillance

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

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

Clinical observation and tests

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

Objective examination

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

When is emergency care provided?

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

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

Risk table for different pathology options

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

Gestational age	Types of premature placental abruption	Exodus
Up to 6 weeks	partial non-growing	Recovery after detachment is easy and can go away without treatment
	partial increasing	Required conservative treatment at home
6–12 weeks	partial	Small area, needs drug treatment, childbirth takes place naturally
Up to 36 weeks	partial	Treatment in hospital
37 weeks and later	partial	To prevent the death of the baby, surgical delivery is performed

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

Therapeutic measures

Bleeding and hematoma due to placental abruption require medical intervention.

Principles of treatment for placental abruption during pregnancy

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

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

What drugs are used for treatment

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

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

Delivery options

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

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

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

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

Is there prevention?

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

• identification of risk groups;
• systematic examination;
• prophylactic appointment medicines(disaggregants, multivitamins);
• timely treatment in a hospital setting.

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

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

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

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

A serious complication that a pregnant woman may encounter is placental abruption during pregnancy.

This condition requires urgent medical attention, as delay can cost the life of an unborn baby.

An organ that arises during pregnancy in the uterus and connects mother and fetus is connected by the placenta (baby place). Its significance is very great. The organ is responsible for the biological processes due to which the baby develops normally in the tummy. The life of a child depends on the placenta. Deviations and pathologies associated with it can lead to his death.

The following functions of the placenta can be distinguished:

• gas exchange. The baby in the womb needs oxygen: it enters the fetal blood from the maternal blood through the placenta. Through it, carbon dioxide is also transferred from the child to the mother. A small placental abruption can disrupt gas exchange;
• nutritional and excretory. For the normal development of a baby, vitamins, nutrients, and water are required. He receives all this through the placenta. Through it, waste products are removed;
• hormonal. The placenta can be compared to an endocrine gland. It produces very important hormones ( human chorionic gonadotropin, placental lactogen, prolactin, progesterone, etc.), without which the normal course of pregnancy is impossible;
• protective. The placenta provides the fetus with immunological protection. Mother's antibodies passing through the baby's place protect the baby from various diseases.

Placental abruption: what is it, what does it look like and what happens?

Placental abruption is its separation (partial or complete) from the lining of the uterus. In this case, blood accumulates between the baby's place and the wall of the uterus, which pushes the placenta away from the uterus. The placenta should not be expelled during pregnancy. Its separation from the uterus should occur in the third labor period. However, there are cases when the placenta leaves prematurely.

What are the risks of placental abruption during childbirth? This process is dangerous for the baby, as it can deprive him of oxygen and nutrients.

Causes of premature abruption of a normally located placenta

Women experience premature expulsion of the placenta in 0.4-1.4% of cases. It can occur both during pregnancy and during childbirth in the first or second stage. Why does placental abruption occur? The reasons for this process are various.

Branch children's place may be caused disorders in the vascular system. The capillaries of the uterus and placenta may become more fragile and brittle. Because of this, blood flow may be impaired. Similar changes in female body may occur when They are also observed in the presence of certain diseases: cardiovascular pathology, hypertension, kidney disease, obesity, diabetes mellitus and etc.

The threat of placental abruption can come from inflammatory, degenerative and other pathological processes , occurring in the child's place and uterus. Disturbances can be observed with uterine fibroids, malformations, and post-maturity.

Predisposes to premature expulsion of the placenta bad habits: excessive consumption of drinks containing alcohol, addiction to cigarettes, drugs. The situation may worsen with anemia (anemia, decreased number of red blood cells, low hemoglobin).

Most often, symptoms of placental abruption in early pregnancy or later are observed in women for whom the upcoming not the first birth. The reason for this lies in changes in the uterine mucosa.

The most rare cases of placental abruption are due to autoimmune conditions, in which the female body produces antibodies to its own cells. This can be observed with a disease such as lupus erythematosus.

Allergy to drug therapy is another reason for placental abruption in late or early stages. Typically, pregnant women experience an allergic reaction when transfusion of donor blood and its components, or administration of protein solutions.

Complications can result from abdominal trauma caused by a fall, blow, or accident. Placental abruption may also be caused by sudden changes blood pressure arising from stress and other neuropsychic influences.

Symptoms of placental abruption

In the early stages of pregnancy and in the later stages, symptoms of placental abruption may be as follows:

• bleeding;
• uterine tension and pain during placental abruption;
• cardiac dysfunction in a baby.

Bleeding can be external (visible), internal (hidden) or mixed. External bleeding is easy to notice, as it appears from the vagina during placental abruption brown discharge. It is observed when the edges of the placenta are detached. If the baby's place is disconnected from the uterus in the center, and the edges remain attached to its wall, then the bleeding in this case will be called internal. Fluid will accumulate between the uterus and placenta.

When a child's place is detached, it is felt uterine tension. When palpated it is felt pain. It can be dull and parsimonious. Sometimes the pain radiates to the hip and pubic area, as well as to the lumbar region. It is felt most strongly with internal bleeding.

A fetus with premature placental abruption may have cardiac dysfunction. Its condition depends on the volume of blood that the woman has lost and the size of the placental abruption. Signs of intrauterine suffering begin to appear when 1/4 of the placenta is separated. If 1/3 of it leaves, the child begins to experience severe oxygen deficiency. His death occurs when 1/3-1/2 of the placenta is detached.

Placental abruption at different stages of pregnancy

The separation of the baby's place from the uterus manifests itself differently depending on the stage of pregnancy. Quite often, doctors encounter premature placental abruption in the first trimester. With timely diagnosis and proper treatment, you can avoid dire consequences. Pregnancy may continue, but there will be no discharge. In the future, the lost area of ​​contact between the placenta and the wall of the uterus can be compensated by the growth of the placenta (its increased area).

Placental abruption in the second trimester characterized by such signs as high muscle tone and tension. Actions medical workers are directly dependent on the duration of pregnancy. For example, the placenta may continue to grow until the middle of the second trimester and compensate for previously lost space.

The most dangerous thing is separating a child's seat in 3rd trimester, because all her compensatory capabilities are completely exhausted, and she can no longer grow. Signs of placental abruption in the later stages are typical: abdominal pain, tension and soreness of the uterus, bleeding, fetal suffering.

The only way out is delivery. However, it is worth noting that if the area of ​​the detachment is not large, there is no bleeding and the process does not progress, then it is possible to carry the child to the term prescribed by nature, while being in a hospital under close medical supervision.

Premature placental abruption during childbirth- a fairly common occurrence. Ideally, this should happen in the third stage of this natural process. However, it also happens that detachment occurs at the first or second stage. In such a situation, doctors either induce labor or begin surgery. caesarean section.

Diagnosis of premature placental abruption

If you have pronounced symptoms, it is not at all difficult to find out that the placenta is detached. If the symptoms are not fully manifested, for example, there is no pain factor, external bleeding is not observed, then the diagnosis is made, excluding the presence of other diseases that can cause similar symptoms. Ultrasound assists in diagnosing placental abruption. Thanks to it, it is possible to determine the area of ​​the placenta that has moved away from the uterine wall and the size of the retroplacental hematoma.

During the examination, one of three possible diagnoses of the separation of a child’s place can be made:

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

The placenta may partially detach from the wall of the uterus in a small area. In such situations, damaged blood vessels quite often become clogged. The bleeding stops and further detachment does not occur. Pregnancy can proceed completely without any complications, and the child will be born healthy.

Progressive partial detachment placenta poses a danger to the fetus. The size of the hematoma increases. If most of the placenta leaves the uterine wall, the fetus will die. In such a situation, the fair sex who is carrying the baby suffers greatly, because she loses a large amount of blood. Blood loss can lead to hemorrhagic shock. This situation can be dealt with through emergency delivery.

It may also be observed total(complete) detachment of the child's place. This happens in very rare cases. The fetus dies almost immediately, as gas exchange between it and the mother stops.

Treatment of placental abruption

The question of how to treat placental abruption causes a lot of anxiety. When diagnosing premature separation of a child's place, the doctor faces a difficult task - to choose a method of gentle and quick delivery. You also need to take additional actions aimed at increasing blood clotting, combating shock and blood loss.

The choice of treatment method for placental abruption in the early stages of pregnancy and later depends on several parameters:

1. The moment of detachment (during pregnancy or childbirth);
2. The volume of blood loss and the severity of bleeding;
3. General condition of the expectant mother and fetus.

Doctors may refuse the option of early delivery if:

• the placenta has separated in a small area, and this condition does not progress;
• pregnancy period is no more than 36 weeks;
• discharge has stopped due to placental abruption and the amount of blood loss is small;
• there are no signs of oxygen starvation in the fetus;
• The pregnant woman feels well and will be in the hospital under the supervision of doctors.

The patient must comply bed rest. The condition of the expectant mother and baby should be monitored. Need to be taken regularly ultrasound examination, cardiotocography, Dopplerometry, monitor blood clotting (it is determined on the basis of special laboratory tests).

For placental abruption, the following drugs can be used:

• medicines that have a relaxing effect on the uterus;
• antispasmodics;
• hemostatic agents;
• medications to combat anemia.

If there are any concomitant diseases and complications, then appropriate therapy must be carried out.

You will have to abandon wait-and-see tactics if, during your hospital stay, bleeding begins to appear after placental abruption. They may indicate that the detachment is progressing. In such cases, a decision is most often made to carry out. Childbirth can also be carried out through natural ways. This depends on the condition of the pregnant woman and the fetus.

In any case, childbirth should take place under the close supervision of medical workers over the child’s cardiac activity. If a woman gives birth naturally, then after the baby is born, a manual examination of the uterine cavity is required.

After a cesarean section, the uterus is also examined to assess the condition of its muscle layer. If it is soaked in blood, then the uterus is removed, since in the future it can become a source of bleeding.