Placental abruption dimensions. What is placental abruption during pregnancy and why does it happen? Symptoms of premature placental abruption

Abruption of a normally located placenta is considered one of the most difficult conditions that arise during pregnancy. With this pathology, both the woman and her child are in danger. The most severe consequences occur when placental abruption occurs in late pregnancy.

Causes of placental abruption

Without the placenta, the child simply could not exist in the womb for nine months. It is the fetal place that guarantees the supply of oxygen, nutrients and vitamins to the baby. If for some reason the placenta cannot cope with its functions, it is said to be insufficient. In more severe situations, the fetal site may completely move away from the uterine wall and lead to the death of the fetus.

Under normal conditions, the placenta is born immediately after the baby is born. It happens that the placenta exfoliates much earlier than expected. In the second half of pregnancy, the following factors lead to the occurrence of this pathology:

• severe gestosis;
• kidney disease;
• exacerbation of chronic diseases of the heart and large vessels;
• disorders in the blood coagulation system (thrombophilic complications);
• significant shocks and stress;
• multiple pregnancy.

Hormonal and infectious factors, which were given importance in the early stages, fade into the background in the second half of pregnancy. After 20 weeks, the main cause of placental abruption is pathology of hemostasis. Great importance is also attached to diseases of the cardiovascular system, especially in women over 30 years of age.

Symptoms of placental abruption in late pregnancy

The main sign by which one can suspect the separation of the fetal place from the walls of the uterus is bleeding. The intensity of bloody discharge from the genital tract will depend on the size of the detachment. If the placenta is partially expelled, the discharge will be moderate and even scanty. In late pregnancy, this phenomenon occurs quite rarely. Much more often, complete placental abruption occurs with massive bleeding. This development of events threatens the life of the woman and the fetus and requires immediate assistance from specialists.

It happens that the placenta moves away from the wall of the uterus, but bleeding does not develop. An extensive hematoma forms between the fetal site and the uterus, blood from which gradually seeps into the muscular and serous layers of the organ. If more than 1/3 of the placenta is damaged, the fetus dies. The only sign of placental abruption in this situation will be the absence of fetal movements for a long time.

How can you tell that something is wrong with your baby? A woman feels the first movements at 16-20 weeks. At first these are timid, barely noticeable tremors every few days. The baby is growing up, and fetal movements are becoming more active. Towards the end of pregnancy, the baby kicks the mother's tummy several times a day. Over time, every woman notes that the baby has its own periods of activity. It has been noticed that some babies move more in the morning, while others prefer to stay awake at night.

If there are any deviations from the usual fetal movements, you should consult a doctor. A decrease or increase in a child’s activity does not always indicate placental abruption. This may be a sign of hypoxia, and thus the baby signals to the mother that he is not feeling well. The absence of fetal movements within 24 hours after 30 weeks is an alarming sign and can be regarded as a symptom of placental abruption.

Additional diagnostic methods

If abruption is suspected, all women must undergo an ultrasound examination. During the procedure, the fetal heartbeat is counted. The thickness of the placenta, the presence of calcifications and other changes in it are also assessed. If a hematoma is detected, its size is measured.

After 34 weeks, cardiotocography (CTG) is performed. This method allows you to determine the number of fetal heartbeats per minute, as well as evaluate their rhythm. At the same time, the condition of the muscular layer of the uterus is monitored. The appearance of large Braxton-Hicks waves indicates that the uterus is in increased tone and is ready to get rid of the fetus at any moment.

What are the risks of placental abruption for a woman?

With partial placental abruption, anemia develops. The level of red blood cells in the blood drops, which inevitably leads to a decrease in the amount of iron. All these processes threaten to lead to a lack of oxygen, which negatively affects the child’s condition. Anemia during pregnancy can be a direct cause of fetal hypoxia.

In the later stages of pregnancy, premature passage of the fetal place leads to the development of heavy bleeding. In severe cases, hemorrhagic shock develops. The woman loses consciousness, and only a team of experienced resuscitators can help her.

DIC syndrome often occurs against the background of severe blood loss. At this moment, mechanisms are launched that prevent normal blood clotting. Disseminated intravascular coagulation leads to new episodes of bleeding, which will be quite difficult to stop.

What are the consequences of placental abruption for the fetus?

The placenta is an important organ that connects the baby to the mother’s body. With partial placental abruption, the supply of oxygen and nutrients to the baby is limited. Fetal hypoxia develops, which inevitably affects its development. The brain is the first to suffer from a lack of oxygen, but other internal organs also experience all the consequences of hypoxia. Partial placental abruption almost always leads to the development of placental insufficiency and the birth of a child with various developmental pathologies.

Departure of more than 1/3 of the fetal place leads to fetal death. The baby's oxygen supply stops instantly, and the baby's continued existence in the womb is impossible. You can save the baby only by performing a caesarean section as soon as possible.

A child born after 22 weeks receives all necessary resuscitation measures. Immediately after birth, the baby falls into the hands of neonatologists. A premature newborn is transferred to a specialized unit where he will be cared for by specially trained staff. As soon as the child adapts to the new living conditions, he will be discharged home.

Tactics for placental abruption in late pregnancy

Conservation therapy is carried out only with partial placental abruption. If the fetal heart is beating, doctors try to extend the pregnancy to at least 36 weeks. For this purpose, drugs are prescribed that improve uteroplacental blood flow. Currently, Actovegin and its analogues are very popular. The drug is administered intravenously in a course of 5 to 10 days.

In late pregnancy, placental abruption is often associated with pathology of the blood coagulation system. This is why many expectant mothers are prescribed antiplatelet drugs. Pentoxifylline and other similar drugs affect platelets, reducing their activity. Antiplatelet agents thin the blood, reduce vascular spasm and improve microcirculation in tissues. The course of therapy lasts from 7 to 10 days.

In case of complete placental abruption, an emergency caesarean section is performed.. The duration of pregnancy does not play a role here; we are talking about saving the life of a woman and a child. During the procedure, the vessels are sutured and bleeding is stopped. After the operation, the woman remains in the intensive care unit for several days. Premature babies are transferred to a specialized unit, while babies born after 36 weeks remain with their mother.

Placental abruption can occur not only during pregnancy, but also during childbirth. This often happens at the birth of the first child of twins, as well as in the case of abnormal labor. In this situation, tactics will depend on how far the baby has progressed. If the baby is already at the exit, he is helped to be born using obstetric forceps. In all other cases, an emergency caesarean section is performed.

For prevention If placental abruption occurs in later stages, experts recommend that expectant mothers monitor their health. Timely treatment of chronic diseases allows you to avoid severe pregnancy complications. When the first signs of detachment appear, you should immediately consult a doctor.

Premature abruption of a normally located placenta is a pathological condition in which the placenta is not separated in a timely manner. Placental abruption does not occur after the birth of the fetus, as should be normal, but during pregnancy or during labor. In 1/3 of cases, premature placental abruption is accompanied by heavy bleeding with the development of corresponding complications in the form of hemorrhagic shock and DIC syndrome (disseminated intravascular coagulation).

Causes of premature placental abruption. The reasons leading to premature abruption of a normally located placenta are divided into two groups.

First group– these are factors that directly lead to the development of this complication: prolonged gestosis, the therapy of which was insufficient, or started untimely, or was not carried out at all; diseases accompanied by changes in blood pressure, heart defects, diseases of the urinary system, thyroid gland, adrenal cortex, diabetes mellitus; incompatibility of mother and fetus by Rh factor or blood group; antiphospholipid syndrome; diseases of the blood and connective tissue (systemic lupus erythematosus); changes in the uterus of an inflammatory or cicatricial nature (previous operations), inflammatory diseases of the uterus; operations, malformations of the uterus; location of the placenta in the area of ​​the myomatous node; post-term pregnancy.

Second group of reasons– these are factors leading to premature placental abruption against the background of existing disorders: overstretching of the uterine walls due to a large amount of amniotic fluid, multiple pregnancies, too large a fetus; untimely, rapid discharge of amniotic fluid with polyhydramnios; traumatic damage to the placenta (fall, blow to the stomach); violation of synchrony in the contractile activity of the uterus; inappropriate use of uterotonic drugs during childbirth.

All of the above factors lead to disruption of the connections between the placenta and the wall of the uterus, rupture of blood vessels with the formation of hemorrhage (retroplacental hematoma).

Symptoms of placental abruption, uterine bleeding.

When a small area of ​​the placenta is detached, a retroplacental hematoma can form. In this case, the vessels of the uterus are thrombosed and the progression of placental abruption will stop. In some cases, blood permeates the uterine wall (with significant placental abruption, heavy bleeding, large retroplacental hematoma). In these cases, the contractile activity of the myometrium is disrupted. This pathological condition is called Couveler's uterus. If marginal placental abruption occurs, then blood passes between the fetal membranes and the uterine wall, then symptoms and clinical manifestations of external bleeding are observed, as blood flows into the vagina. The color of blood from the genital tract immediately after placental abruption is scarlet. The dark color of the blood indicates the period of time that has passed from the moment of detachment to the onset of bleeding.

Premature placental abruption can be mild or severe. In a mild form of premature placental abruption, there is a slight bloody discharge from the vagina, the tone of the uterus is unchanged, but some tension is noted, the woman’s condition is satisfactory, the fetal heartbeat is normal.

In severe cases of premature placental abruption, pain with severe bleeding is noted. In the case of accumulation of blood between the wall of the placenta and the uterus, bleeding may be absent; a retroplacental hematoma is formed in this place, a local painful swelling occurs with an increase in pain and spread to all parts of the uterus.

Local pain may not be expressed in cases where the placenta is located on the posterior wall of the uterus, as well as when blood leaks out. In this case, the following signs are noted: rapid pulse and breathing, arterial hypotension, wetness and pallor of the skin, weakness, dizziness, bloating. Tension and soreness of the uterus are noted. The uterus takes on an asymmetrical shape.

With the onset of placental abruption, signs of fetal hypoxia increase. Fetal death can occur as a result of an increase in retroplacental hematoma up to 500 ml, as well as an increase in the area of ​​placental abruption by one third.

Symptoms of bleeding disorders appear, up to a complete absence of blood clotting.

Diagnosis of premature placental abruption. Diagnosis of premature abruption of a normally located placenta is based on clinical manifestations. These include the presence of bloody vaginal discharge against the background of increased uterine tone, changes in the shape of the uterus, and increasing signs of fetal hypoxia. When making a diagnosis, the pregnant woman’s complaints, medical history, clinical course of the complication, as well as the results of objective, instrumental and laboratory studies, in particular ultrasound, which makes it possible to determine the volume and boundaries of the retroplacental hematoma, are taken into account.

Women with gestosis deserve special management tactics.

Delivery with premature placental abruption.

Emergency caesarean section is indicated in cases of progression of placental abruption and impossibility of vaginal delivery. Opening the amniotic sac is contraindicated in the absence of labor, since premature placental abruption may worsen as a result of decreased intrauterine pressure.

Expectant management of labor is possible in a fully operational operating room at a maternity hospital in the case of minor placental abruption, absence of anemia and signs of fetal hypoxia, and the woman’s condition is satisfactory. In this case, careful simultaneous monitoring of the fetus and placenta is carried out through regular Doppler measurements, cardiotocography and ultrasound. The condition of the blood coagulation system is regularly assessed. With the progression of placental abruption, accompanied by repeated bleeding, an emergency cesarean section is performed according to vital indications from both the mother and the fetus.

Delivery through the natural birth canal is possible with a mild form of premature placental abruption, in the case of cephalic presentation of the fetus, with a mature cervix, correspondence of the fetal head to the mother’s pelvis and under normal labor conditions. When giving birth naturally, strict monitoring and control of the condition of the fetus and the contractile activity of the uterus is necessary.

The amniotic sac is opened when regular labor has developed. Opening the amniotic sac leads to a decrease in the tone of the uterus, thereby reducing bleeding. Stimulation of labor in case of premature placental abruption is unacceptable. Increased bleeding volume, progression of placental abruption, uterine hypertonicity and increased fetal hypoxia are indications for cesarean section.

After the birth of the fetus, it is necessary to immediately begin manual separation of the placenta and release of the placenta, after which the cervix and vaginal walls are examined using speculum for damage and their elimination.

Preventive actions. All pregnant women must be examined to identify possible risk factors leading to premature separation of a normally located placenta. Pregnant women are treated if risk factors are identified. Particular attention should be paid to pregnant women with gestosis. If there is no effect from the therapy, the pregnant woman must be hospitalized in a maternity hospital. Pregnant women are subject to mandatory hospitalization at 38 weeks. The issue of timing and method of delivery is decided on an individual basis.

Pregnancy is always associated with some fears and concerns of expectant mothers. Premature placental abruption is a condition that is feared not only by mothers, but also by doctors. What are the signs of this pathology, what to do? And the main question: what are the consequences?

Normal functioning of the placenta

It is important to know and understand how important the placenta is for the normal course of pregnancy and what functions it performs. This unique organ protects the fetus (hemoplacental barrier, immune protection by maternal antibodies), ensures its nutrition and removal of metabolic products, and the normal course of pregnancy, due to the production of certain hormones. Normally, detachment occurs in the final phase of labor; in other cases it is considered premature.
This process is accompanied by damage to the blood vessels, therefore, virtually no oxygen and nutrients reach the child. As a result, a condition such as hypoxia develops, which can become a threat to the health and even life of the child. Therefore, it is important not to miss the first signals of the body and to visit the doctor on time. The results will depend on the speed of medical care.

What are the signs of placental abruption

All symptoms of placental abruption in the 3rd trimester come down to the mechanism of its development and consequences. This is mainly bleeding in varying degrees of severity due to damage to blood vessels. As a result, blood accumulates in the resulting space - a hematoma. Increasing its size only aggravates the situation; the blood clot contributes to the cessation of the functioning of the placenta adjacent to this area.
In medical practice, there are three degrees of severity of placental abruption, which have their own characteristic symptoms:

• light. Often there are no clear symptoms, and it can be diagnosed by ultrasound or by examining the already born placenta.
• average. For the first time, pain and bleeding appear, and a complete absence of discharge is possible. You can feel the tension of the uterus, and when pressing on certain areas there is moderate pain. The first symptoms of impaired fetal heartbeat and symptoms of hypoxia appear.
• Symptoms of placental abruption in the 3rd trimester of severe severity include sudden bursting pain, dizziness, weakness and anxiety. Fainting, a sharp and significant decrease in pressure, and the appearance of dark discharge in moderate quantities are possible.

In addition to bleeding, a pain reaction also becomes a sign of placental abruption in the 3rd trimester. The pain is usually dull, paroxysmal in nature and radiates to the perineum, thigh, etc.
Placental abruption in the 3rd trimester is accompanied by symptoms from the fetal heart. Moreover, there is a direct relationship between this disorder and the degree of detachment and the amount of blood loss in the mother.

It is useful for every pregnant woman to know the triad of signs of premature placental abruption - spotting, pain and increased tone of the uterus, fetal heartbeat disturbances. The pain can be significantly worse if there is internal bleeding.

Due to the fact that this condition poses a particular danger in late pregnancy, immediate delivery is recommended for health reasons.

The detachment is not decreasing - what to do?

Even if the detachment is insignificant, it is necessary to give birth, especially if the PDR is close. The progression of the pathology can occur at any moment, which can cause intrauterine fetal death. Only after dynamic monitoring of the process, no worsening of the situation, and up to 32 weeks of pregnancy, can doctors decide to prolong the pregnancy. If the detachment does not decrease in the third trimester, this will be a direct indication for childbirth, most often a cesarean section.

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

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

What is placental abruption?

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

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

Also, manifestations will depend on such factors:

The detachment continues or it was able to stop;

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

At what stages of pregnancy or even childbirth did this condition develop: placental abruption in the early stages, if a very small section of it has separated from the wall of the uterus, has a mild course and a favorable prognosis, since subsequently the baby’s place will continue to grow and develop, and it is likely that the defect will close and “outgrow”.

Three main signs are considered:

1) Bleeding from the vagina of varying intensity.

2) Pain in the abdomen and its lower parts.

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

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

I. If detachment of the placenta previa occurs from the edge, there is mainly only bleeding, and there is almost no pain. If such a small area peels off, the fetus does not suffer.

II. If the placenta, wherever it is located, detaches in the central area, and the bleeding stops (that is, the detachment is not progressive), then there may be no symptoms. The woman finds out about this case through an ultrasound or then, after the fact, a little brown blood is released.

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

IV. When the central part of the placenta is separated, blood accumulates behind the placenta. This is called a retroplacental hematoma. She on her own, even if the bleeding has stopped, is capable of exfoliating the placenta further. As a result, a significant area, and even the entire placenta, can detach. With such partial detachment, blood does not always come out. Then the symptoms of placental abruption are as follows: weakness, pallor, rapid heartbeat of the woman, she feels pain in the abdomen, tension in the uterus, the baby first moves more often, then may calm down altogether. With further saturation of the uterine walls with blood from the hematoma, the pain intensifies and the uterus does not relax. If the blood finds a way out, it pours out of the vagina.

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

What to do if you think your placenta has separated?

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

Placental abruption during early pregnancy leads to the risk of spontaneous abortion.

With a small area of ​​change, ultrasound examination may not show detachment. But in any case, there will be a noticeable accumulation of blood behind the placenta.

It is also recommended to perform a vaginal examination, since bleeding is not necessarily caused by placental abruption. It is often caused by cervical erosion, infections or benign tumors.

Actions for placental abruption

If the affected area is small and it is possible to maintain the pregnancy, bed rest and drug therapy are recommended. The following groups of drugs are usually used:

• hemostatic agents to stop bleeding;
• antispasmodics to reduce pain;
• drugs that reduce the tone of the uterus, for example, antispasmodics or analogues of the hormone secreted

  Interruption of normal blood supply leads to cardiac arrest.

  Detachment of 1/3 of the placenta causes severe oxygen deficiency.

  The progression of the process is an indication for curettage or artificial childbirth.

  Curettage can be performed up to the 14th week of pregnancy in case of fetal death.

  Thus, the remnants of the membranes and the fruit itself are removed to prevent the infection process.

  For longer periods of pregnancy, drug therapy is prescribed that can cleanse the uterus of the dead fetus.

  To stimulate artificial labor for 3 days, it is recommended to use drugs with estrogen, calcium, glucose and vitamin complexes to create the necessary background.

  After this, labor is induced by the administration of prostaglandins and oxytocin.

  How to prevent placental abruption in the early stages

  To prevent pathology, you need to carefully prepare the body for pregnancy. Before conception, it is necessary to undergo treatment for chronic diseases and conduct an examination of the circulatory system.

  During pregnancy, you should carefully follow your doctor's recommendations, avoid injuries and hypothermia, control blood pressure and not use exotic ingredients in cooking that can cause allergies.

  Only constant monitoring and excellent health can protect a woman from the risk of placental abruption. If trouble does occur, treatment should begin when the first signs appear.