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Placental abruption is a serious diagnosis that complicates the course of pregnancy and directly threatens its favorable outcome. Is it possible to prevent this condition and what to do if detachment does occur?
- What is placental abruption
- Why does placental abruption occur?
Symptoms of detachment
- Diagnosis of placental abruption
- Treatment of placental abruption
- Video - behavior of a pregnant woman when there is a threat of miscarriage
Causes of placental abruption
The placenta, or fetal place, is the organ that connects the fetus to the mother’s body. Through the placenta, nutrients and oxygen are supplied to the fetus, and carbon dioxide is constantly removed. At the same time, the fetal place performs a protective function, preventing the penetration of dangerous infectious agents, chemicals and antibodies to the baby.
The placenta is finally formed by 14-16 weeks. Until this time, the chorion takes over its functions. The outer membrane of the fertilized egg is attached to the wall of the uterus and transports oxygen and nutrients. Normally, the placenta exists until the end of pregnancy and comes out only after the birth of the child.
It happens that the fetal place moves away from the wall of the uterus before the due date. After 16 weeks, this condition is called premature placental abruption. Up to 16 weeks we are talking about detachment of the chorion (fetal egg). Why does this situation arise?
Causes of placental and chorion abruption in early pregnancy:
- fetal chromosomal abnormalities;
- infectious processes in the pelvic cavity;
- thrombophilia (congenital and acquired);
- malformations of the uterus that interfere with the attachment of the chorion;
- heavy physical activity;
- stress;
- exacerbation of maternal chronic diseases;
- abdominal injuries during pregnancy.
Under the influence of any of these factors, placental vasospasm occurs. The uterus becomes toned, and the fetal place begins to gradually move away from the wall of the organ. A hematoma is formed, blood from which can come out or accumulate in the muscle layer of the uterus. When more than 1/3 of the surface of the placenta is detached, the supply of oxygen to the fetus is cut off, and the child dies in the womb.
Causes of pathology
Placental abruption is a multifactorial pathology - its appearance is caused by a combination of several factors. Among the main causes of placental abruption are vascular pathologies, serious illnesses of the mother, and degenerative changes in the mucous membrane.
Other causes of placental abruption:
- High blood pressure in the mother.
- Fluctuations in blood pressure caused by stress or health problems.
- Degenerative changes in the mucous membrane caused by frequent or multiple births.
- Post-term pregnancy.
- Age after 35.
- Pregnancy that occurs after prolonged infertility.
- Anomalies of the uterus - bicornuate, saddle-shaped.
- Anomalies in the location and development of a child's place.
- Pregnancy after caesarean section.
- Toxicoses, preeclampsia, especially in the 1st trimester.
- Pathologies of the structure of the uterus.
- External abdominal injuries (fall, blow).
- Drinking alcohol and smoking.
- Poor nutrition.
- Allergic reactions to medications.
- Severe chronic, endocrine and infectious diseases.
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Symptoms of placental abruption
In the first half of pregnancy, the main symptom of abruption is bleeding from the genital tract. They can be very moderate or very abundant - it all depends on the severity of the pathology. Bleeding is always accompanied by pain in the lower abdomen. If the placenta is located on the posterior wall of the uterus, pain will be localized in the sacrum and lumbar region. In some cases, the pain may not be too pronounced and may even be mistaken for an exacerbation of osteochondrosis.
The woman's general condition will depend on the degree of blood loss. With minor discharge, the expectant mother will not notice any special changes in her well-being. Heavy bleeding can lead to weakness, dizziness, and a feeling of shortness of breath. In severe cases, loss of consciousness is possible.
Signs of pathology
The patient may experience heavy bleeding, but there may be no external signs. Another symptom is that the fetus stops moving. In almost all cases, lower back pain is observed.
Other symptoms of placental abruption:
- The mild form is not associated with pronounced symptoms. It is detected by ultrasound or during childbirth, when a small depression with blood clots is found in the child’s place.
- A moderate anomaly is accompanied by pain and mild bleeding. There may not be any bleeding. Palpation of the uterus reveals tension and mild local pain. When listening to the fetal heartbeat, hypoxia is detected.
- Premature placental abruption in severe form is manifested by severe pain, attacks of weakness, and anxiety. Sweating, shortness of breath, decreased blood pressure and temperature may occur. The uterus is tense and has asymmetrical contours. The fetal heartbeat cannot be heard.
The main symptoms of pathology in the first trimester:
- Placental abruption in the first trimester is accompanied by mild bleeding.
- There is pain and a feeling of heaviness in the lower abdomen.
- Fetal hypoxia.
Symptoms of pathology in the second trimester:
- Weakness.
- Dizziness.
- In addition to pain and possible bleeding, the tone of the uterus and noticeable pain on palpation are added.
Symptoms of pathology in the third trimester and during childbirth:
- Severe abdominal pain.
- Bleeding.
- Uterine tension.
- Detachment of the baby's place during childbirth is accompanied by the baby's meconium and the appearance of blood in the amniotic fluid.
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Diagnostics
If you experience bloody discharge from the genital tract, you should definitely see a doctor. Already during the examination, the doctor can give an approximate prognosis of the disease. A closed or slightly open cervix is considered a good sign. If the internal pharynx has opened more than one centimeter, this indicates an imminent miscarriage.
After the examination, an ultrasound examination is required. The doctor's further tactics will depend on whether the fetal heartbeat is detected. If the heart is beating, conservation therapy is carried out. In a situation where the heartbeat is not heard, all attempts to prolong the pregnancy stop.
Diagnosis of pathology
Diagnosis is made based on clinical manifestations. The problem is indicated by bloody discharge, the uterus in good shape, and a change in its shape. Detachment is usually accompanied by abdominal pain and signs of increasing fetal oxygen deficiency. The mother's medical history, her complaints, and the results of laboratory and clinical examinations are taken into account.
After examining the patient, the doctor decides how to determine the detachment of the child’s place and what examination methods to use. In the absence of pronounced symptoms, ultrasound is used.
Using ultrasound, the size of the area of the separated child's place and the size of the hematoma are determined. A blood test is required to detect signs of anemia. The presence of anemia may indicate hidden or chronic blood loss.
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Consequences of placental abruption in early pregnancy
What is the threat to the fetus when the placenta leaves the uterine wall? First of all, because at this moment the oxygen supply to the baby is disrupted or completely stopped. Without oxygen, the fetus can live no more than 5 minutes, after which brain activity stops. When the placenta is completely detached (or more than a third of its surface is separated), immediate fetal death occurs.
With partial placental abruption, there is still a chance for a successful outcome. In this case, a hematoma forms under the damaged part of the fetal place. Over time, the hematoma can completely resolve, and in the future there will be nothing to remind you of placental abruption. In this situation, it is possible to prolong pregnancy until the due date.
What are the risks of placental abruption for a pregnant woman? When the fetus is expelled, heavy bleeding develops. The longer the pregnancy, the higher the blood loss, and therefore, the more likely the development of serious complications, including loss of consciousness and coma.
Diagnosis of premature detachment
There are usually no difficulties in diagnosing this pathology. The clinical manifestations are quite characteristic, in addition, every pregnant woman should undergo periodic examinations and ultrasound diagnostics.
In order to determine the maturity of the placenta, its possible detachment, as well as the presence of umbilical cord nodes, a routine ultrasound examination is required at the 33rd week of pregnancy.
Until the end of pregnancy, fetal cardiac activity must be monitored.
If a pregnant woman has complaints about bleeding, in addition to ultrasound diagnostics, the doctor must examine the woman in a chair to rule out other causes of bleeding. These could be polyps, cervical ruptures or infectious diseases. In addition, the doctor evaluates the condition of the uterine pharynx, as well as possible dilatation of the cervix.
Treatment of partial placental abruption in early pregnancy
Treatment of the disease will depend on the duration of pregnancy and the severity of the pathological process. With partial placental abruption, doctors try to prolong the pregnancy to the maximum possible date. For this purpose, medications are prescribed that reduce the tone of the uterus and prevent miscarriage. Drotaverine has a good effect. This drug eliminates hypertension, relieves pain and makes it possible to maintain pregnancy. At the initial stages of therapy, antispasmodics are prescribed intravenously. If the patient’s condition improves, the patient is transferred to the tablet form of the drug.
The duration of treatment with antispasmodics is determined individually in each specific case. Typically, drotaverine and its analogues are prescribed until the pain syndrome completely subsides. With pronounced toning of the uterus, drugs can be used up to 16 weeks of pregnancy.
After 14-16 weeks, drotaverine and its analogues are not used. In the second half of pregnancy, uterine receptors stop responding to antispasmodic drugs. They are being replaced by ginipral, a drug that effectively relieves uterine hypertonicity and reduces the likelihood of placental abruption.
In the early stages of pregnancy, with partial detachment of the placenta (chorion), hormonal drugs are prescribed. Synthetic analogues of progesterone (Duphaston, Utrozhestan) keep the body in good shape and prevent the fetal site from moving away from the uterine wall. At 14-16 weeks these drugs are discontinued. At this stage, the placenta is fully formed and begins to independently produce progesterone.
In some cases, hormonal drugs are prescribed until birth. This is possible during pregnancy after IVF, as well as with some ovarian diseases. In such a situation, the question of extending hormonal support is decided by the doctor monitoring the pregnant woman.
Treatment of placenta abruption
When premature detachment is diagnosed, the doctor must decide further tactics for managing the pregnancy.
How to treat placental abruption depends on the following points:
- gestational age;
- the condition of the pregnant woman and the vital signs of the child;
- symptoms of bleeding and volume of blood loss.
Most often, it is recommended that a pregnant woman give birth as soon as possible. In addition, therapy should be aimed at improving blood clotting and combating shock.
If the condition of the pregnant woman and child allows, treatment of this condition can be conservative with mandatory bed rest in a hospital setting.
In the early stages, placental abruption can be prevented using tocolytic therapy:
- magnesium sulfate;
- no-shpa;
- papaverine;
- other antispasmodics.
In addition to antispasmodics, complex treatment also includes:
- hemostatic drugs (tranexam, dicinone, etc.);
- antianemic drugs (iron supplements, vitamins).
During therapy, monitoring of blood pressure, blood clotting, ultrasound examinations, cardiotocography, and Dopplerometry is mandatory. Those. the expectant mother and her baby must be constantly under medical supervision.
To avoid placental insufficiency and fetal hypoxia, pregnant women are prescribed Curantil for preventive purposes, which quite gently dilates blood vessels and also induces the production of interferon, i.e. increases immunity. However, if detachment is suspected, Curantil should be immediately discontinued, otherwise it may provoke even greater blood loss.
Tactics for complete placental abruption in early pregnancy
With complete detachment, we are talking about preventing large blood loss and preserving the woman’s life. In this case, it is not possible to save the child. Until 22 weeks, the fetus is too weak and is not able to exist outside the mother’s body. His internal organs are not yet developed enough for such a child to survive even in intensive care conditions. All resuscitation measures are carried out only after 22 weeks of pregnancy.
The choice of surgery will depend on the stage of pregnancy. When chorionic detachment occurs before 12-16 weeks, vacuum aspiration of the fertilized egg is performed, followed by curettage of the uterine cavity. After such a procedure, preventive antibiotic therapy is mandatory. Planning a new pregnancy is recommended after 3-6 months.
After 16 weeks, a caesarean section is performed. In this case, the fetus and placenta are removed from the uterus, and all vessels are carefully sutured. If massive internal bleeding develops, a transfusion of blood or other components is performed to replenish the lost volume. Recovery after such an operation takes place in intensive care wards. After a caesarean section, it is recommended to plan a new pregnancy no earlier than 12 months later.
Prevention of placental abruption in early pregnancy has not been developed. No one can predict in advance which factor will be decisive in the development of this pathology. Experts recommend avoiding harmful effects during pregnancy, not overexerting yourself and not using any medications unless absolutely necessary. When the first signs of placental abruption appear, you should immediately contact a gynecologist or call an ambulance.
What is placenta
To understand the essence of this problem, you need to understand what the placenta is and what it is. This is an organ that functions and exists in the female body only during pregnancy, and after the birth of the child it exfoliates and leaves the birth canal along with the membranes of the fetus.
It performs a number of important functions:
- during pregnancy, it takes on the role of an internal secretion organ, synthesizing the hormones necessary for the preservation and growth of the fetus, as well as stimulating lactation (hCG, progesterone, estrogen, lactogen, prolactin, etc.);
- carries out the process of gas exchange between the body of mother and child;
- All necessary nutrients are supplied through the placenta, thanks to which the baby grows and develops normally;
- carries out a complex mechanism of immune defense of the fetus, preventing the cells of the mother's body from recognizing a foreign object in the child, and preventing its rejection.
But at the same time, mother’s antibodies easily penetrate through it, protecting the baby from possible infections.
Diagnosis of the problem
Diagnosing the pathological condition is easy. If symptoms are present, the doctor will already make a preliminary diagnosis. An external examination is carried out: the abdomen is palpated, the fetal heartbeat is listened to with a stethoscope, and an anamnesis is collected.
According to the data received, after an obstetric examination, the doctor is almost sure of the diagnosis. The hardness of the uterus, its altered shape, and the fetal heartbeat that is difficult to hear speak volumes.
Afterwards the pregnant woman is referred to:
- Ultrasound diagnostics;
- cardiotocography;
- Dopplerometry;
- blood and urine tests.
Based on all the data, we can clearly say whether there is a detachment and what complications it caused.
Often, detachment is detected during a routine ultrasound. This study is enough to establish a clear diagnosis and begin effective treatment.
