Premature placental abruption

Premature placental abruption is a complication of pregnancy. The placenta is a flat tissue that forms during pregnancy and supplies the baby with all the necessary substances - food and oxygen. During a healthy pregnancy, the placenta is securely fixed to the inner wall of the uterus until the baby is born. But in the case of premature placental abruption, the placenta separates early from the walls of the uterus, resulting in:

• the baby is born prematurely and has insufficient weight;
• The mother loses a lot of blood.

Premature placental abruption is harmful to both mother and baby, and in rare cases, can be fatal. It occurs in 9 out of 1,000 cases and typically develops in the third trimester, but can also occur at any time after 20 weeks of pregnancy.

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Causes of premature placental abruption and its prevention

It is not known exactly what causes premature placental abruption, but there are factors that increase the risk of developing the pathology.

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Risk factors

• high blood pressure (140/90 and above) is the most common cause of premature placental abruption, regardless of whether a woman had hypertension before conception or her blood pressure increased during pregnancy;
• premature detachment of the placenta during a previous pregnancy;
• smoking;
• cocaine use;
• a suture on the uterus as a result of the removal of a uterine fibroid (the placenta may attach precisely in the area of the suture);
• uterine trauma;
• premature rupture of the membranes over a period of 24 hours or more, especially in the case of an inflammatory process in the uterus.

Symptoms of premature placental abruption

Not every woman who experiences placental abruption experiences warning symptoms.

If you have premature placental abruption, you may experience the following symptoms:

• Vaginal bleeding. Depending on the location of the detachment and its size, vaginal bleeding varies in amount (from slight to heavy) and color (from bright to dark red). Minor vaginal bleeding does not always indicate no cause for concern. In some cases, a large amount of blood can accumulate between the placenta and the uterine wall, resulting in little or no bleeding.
• Pain or hardness of the uterus.
• Signs of Preterm Labor. In many cases of premature placental abruption, the symptoms of preterm labor are a cause for concern, namely:
  • regular contractions
  • sharp or aching pain in the abdomen or back

In rare cases, only a state of shock indicates premature placental abruption, since blood is retained in the uterus. The first signs of a state of shock are:

• dizziness or loss of consciousness;
• anxiety, confusion, or fear;
• shallow or rapid breathing;
• damp, cold skin or increased sweating;
• weakness;
• thirst, nausea or vomiting.

Arterial hypertension often provokes premature placental abruption.

If you experience any of the symptoms listed below, contact your doctor immediately.

• Light to moderate vaginal bleeding: The amount of bleeding caused by detachment depends on the location of the detachment and the duration of bleeding.
• Pain and hardness of the uterus.

Signs of preterm labor include regular contractions and lower back and abdominal pain. Call 911 immediately if:

• sudden sharp pain in the abdominal cavity;
• heavy vaginal bleeding;
• shock: dizziness or feeling like you are going to lose consciousness, weakness, anxiety, difficulty breathing, nausea and vomiting.

The amount of vaginal bleeding does not indicate the severity of placental abruption, as even mild bleeding can cause serious problems. Sometimes blood is trapped between the placenta and the uterine wall. In rare cases, signs of shock indicate that the pregnant woman is in a serious condition.

Diagnosis of premature placental abruption

Your doctor will ask about your symptoms and check your baby's heartbeat, as well as order an ultrasound and blood tests for hemoglobin. If your doctor suspects placental abruption, you will be hospitalized to determine the severity of the problem.

Premature placental abruption can be difficult to diagnose immediately. Diagnosis is based on a pelvic exam, medical history, and the elimination process. Testing includes:

• fetal heart rate monitoring to determine the baby's condition and check uterine contractions;
• Ultrasound (in 50% of cases, placental abruption is diagnosed during an ultrasound examination);
• blood test for hemoglobin (as a result of large blood loss, hemoglobin can drop rapidly).

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Treatment of premature placental abruption

Treatment depends on:

• severity of placental abruption;
• the child's condition;
• pregnancy period.

A mild placental abruption is not a serious problem and usually only requires careful monitoring throughout the rest of the pregnancy. A moderate or severe placental abruption means you will be hospitalized and, in rare cases, a cesarean section may be needed to save the lives of both mother and baby.

Premature placental abruption cannot be stopped. A pregnant woman with suspected premature placental abruption must be hospitalized immediately, as this condition poses a threat to her life and the life of the baby. Only a doctor can determine the seriousness of the problem and take certain measures.

If the Rh factor is negative, an Rh antibody shot should be given, since the fetus may be Rh positive, and when the blood is mixed, the woman's immune system may begin to reject the fetus.

Minor placental abruption

With a minor placental abruption, bleeding is not severe, the fetus may not be in danger, but the woman will be hospitalized for some time for observation. In the future, the doctor will advise avoiding physical activity and regularly monitoring the condition of the fetus. If signs of premature labor are observed long before the expected date of birth, while the placental abruption is minor, tocolytic drugs are prescribed that reduce labor activity.

Moderate to severe placental abruption

If placental abruption is moderate or severe, or if there is a threat to life due to generalized thrombohemorrhagic syndrome, immediate extraction of the fetus is required. In some cases, vaginal delivery is possible, but a cesarean section is often used. If bleeding cannot be stopped, a hysterectomy is performed - removal of the uterus. Depending on the severity of the woman's condition (large blood loss and generalized thrombohemorrhagic syndrome), a blood transfusion may be necessary. The condition of the child after placental abruption depends on the gestational age at which it was born, as well as on the prenatal functioning of the placenta (supply of oxygen and nutrients to the fetus).

After birth, the baby may spend some time in intensive care (for days or even weeks) depending on the severity of the condition. A neonatologist is responsible for treating the newborn.

Pregnancy in the future

Once placental abruption has occurred, there is a high chance of it happening again. After two or more, the risk is 1 in 4. Although there is no way to prevent another placental abruption, your doctor will recommend taking certain steps:

• do not smoke or take drugs;
• normalize blood pressure;
• take vitamins containing folic acid, since insufficient amounts of it provoke premature detachment of the placenta;
• visit your doctor regularly.

Premature Placental Abruption: Home Treatment

Call an ambulance immediately if:

• sudden sharp pain in the abdominal cavity;
• heavy vaginal bleeding;
• signs of shock due to major blood loss: dizziness, weakness, confusion, anxiety, shallow or rapid breathing.

During pregnancy, you should be closely monitored for any new symptoms or injuries that could lead to premature placental abruption. Contact your doctor if:

• minor to moderate vaginal bleeding;
• sudden but moderate pain in the abdominal cavity, while the uterus is in tone;
• a blow to the abdomen as a result of a fall or physical attack;
• car accident;
• signs of preterm labor, including regular contractions and sharp or aching pain in the abdomen or lower back.

How to survive the bitterness of loss

It is possible that you may lose your baby as a result of premature placental abruption. In this case, allow yourself to grieve and realize the bitterness of the loss. Remember that it is not only you who are suffering - your husband, children and other family members are also suffering because of this loss. Experts recommend attending psychological support groups, talking to other women who have experienced the grief of such a loss.

Talk to your doctor, friends, or a counselor. Before you try to get pregnant again, you should talk to your doctor about reducing your risk of another placental abruption.

Prevention

Premature placental abruption cannot be prevented, but it is important to be aware of the risk factors that provoke it. During pregnancy:

• do not smoke;
• do not use drugs or methamphetamines;
• Visit your doctor regularly for scheduled check-ups;
• If you have hypertension, follow your doctor's recommendations to normalize your blood pressure;
• Take prenatal vitamins containing folic acid, as its deficiency can cause premature placental abruption.

Even if pregnancy proceeds normally, complications are possible. Therefore, a pregnant woman should lead a healthy lifestyle and regularly visit her doctor for a scheduled examination.