Premature detachment of the placenta

Premature detachment of the placenta is a complication during pregnancy. The placenta is a flat tissue that forms during pregnancy and supplies the child with all the necessary substances - food and oxygen. During a healthy pregnancy, the placenta is firmly fixed on the inner wall of the uterus until the birth of the child. But in case of premature detachment, the placenta is separated early from the walls of the uterus, resulting in:

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

Premature detachment of the placenta harms both mother and child, and in rare cases - leads to death. This pathology occurs in 9 cases out of 1000, and usually develops in the third trimester, but it can also happen at any time after 20 weeks of pregnancy.

[1], [2], [3], [4], [5], [6]

Causes of premature placental abruption and its prevention

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

[7], [8], [9], [10], [11]

Risk factors

• high blood pressure (140/90 and above) is the most common cause of premature placental abruption, regardless of whether the woman had hypertension before conception or if the pressure increased during pregnancy;
• premature placental abruption during a previous pregnancy;
• smoking;
• cocaine use;
• suture on the uterus as a result of the removal of uterine fibroids (the placenta can be attached in the seam region);
• trauma of the uterus;
• premature rupture of the bladder 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 whose placental detachment experiences warning signs.

If you have a premature detachment of the placenta, you can observe the following symptoms:

• Vaginal bleeding. Depending on the site of exfoliation and its magnitude, vaginal bleeding differs in quantity (from insignificant to abundant) and in color (from bright to dark red). Minor vaginal bleeding does not always indicate a lack of cause for concern. In some cases, a large amount of blood can accumulate between the placenta and the uterine wall, resulting in bleeding may be minor or completely absent.
• Soreness or hardness of the uterus.
• Signs of premature birth. In many cases of premature placental abruption, the cause for concern is the symptoms of premature birth, namely:
  • regular bouts
  • Acute or aching pain in abdominal or back

In rare cases, only a shock condition indicates a premature detachment of the placenta, as the blood lingers in the uterus. The first signs of a shock state are:

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

Arterial hypertension often provokes premature detachment of the placenta.

If any of the following symptoms occur, contact your doctor immediately.

• Minor or moderate vaginal bleeding: the intensity of bleeding caused by exfoliation depends on the site of detachment and the duration of bleeding.
• Soreness and hardness of the uterus.

Signs of premature birth, including regular contractions and pain in the lower back and abdomen. Call an ambulance immediately if:

• sudden acute pain in the abdominal cavity;
• severe vaginal bleeding;
• shock state: dizziness or feelings that lose consciousness, weakness, anxiety, difficulty breathing, nausea and vomiting.

The amount of vaginal bleeding does not indicate the severity of the placenta detachment, since even mild bleeding can cause serious problems. Sometimes the blood lingers between the placenta and the wall of the uterus. In rare cases, signs of a shock state indicate a serious condition of a pregnant woman.

Diagnosis of premature placental abruption

The attending physician will ask about the symptoms and check the child's palpitations, and also appoint ultrasound and blood tests for hemoglobin. If the doctor suspects a detachment of the placenta, you are hospitalized to determine the severity of the problem.

Sometimes it is difficult to immediately determine premature detachment of the placenta. Diagnosis is based on gynecological examination, medical history and elimination process. Testing includes:

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

[12], [13]

Treatment of premature placental abruption

Treatment depends on:

• severity of placental abruption;
• state of the child;
• term of pregnancy.

Slight detachment of the placenta is not a serious problem and, as a rule, requires only careful monitoring throughout the subsequent pregnancy. The average or severe degree of placental abruption means that you are hospitalized and, in rare cases, require a cesarean section to save the life of the mother and child.

Premature detachment of the placenta can not be stopped. A pregnant woman with suspected premature abruption of the placenta should be immediately hospitalized, since this condition is a threat to her life and the life of the child. Only a doctor can determine the seriousness of the problem and take certain measures.

If the Rh factor is negative, Rh-vaccine should be given, as the fetus can have a positive Rh, and when the blood is mixed, the immune system of the woman can begin to reject the fetus.

Slight placental abruption

With insignificant placental abruption, the bleeding is not strong, the fetus may not be endangered, but the woman is hospitalized for a while for observation. In the future, the doctor advises to avoid physical exertion and regularly monitor the condition of the fetus. Long before the expected date of birth, there are signs of premature birth, while the detachment of the placenta is insignificant, tocolytic drugs are prescribed that reduce the activity of the mother.

Medium or severe placental abruption

If the placental abruption is moderate or severe, or if there is a life threat in the generalized thrombohemorrhagic syndrome, immediate extraction of the fetus is required. In some cases, vaginal births are possible, but often resort to a cesarean section. If it is impossible to stop bleeding, 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 detachment of the placenta depends on the gestational age when he was born, as well as on the prenatal functioning of the placenta (supply of the fetus with oxygen and nutrients).

After childbirth, the child may be in intensive care for some time (for days or even weeks), depending on the severity of the condition. Neonatologist deals with the treatment of the newborn.

Pregnancy in the future

If the detachment of the placenta occurs once, the probability of its recurrence is great next time. After two or more, the risk is 1 out of 4. Although there is no method to prevent another placental abruption, the attending physician will advise taking certain measures:

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

Premature detachment of the placenta: Treatment at home

Call an ambulance immediately if:

• sudden acute pain in the abdominal cavity;
• severe vaginal bleeding;
• signs of a shock condition as a result of a large loss of blood: dizziness, weakness, confusion, anxiety, superficial or rapid breathing.

During pregnancy, you should closely monitor the manifestation of any new symptoms or injuries that can lead to premature detachment of the placenta. Contact your doctor if:

• minor or moderate vaginal bleeding;
• sudden but moderate pain in the abdominal cavity, while the uterus is in a tonus;
• shock in the abdomen as a result of a fall or physical attack;
• car accident;
• signs of premature birth, including regular contractions and acute or aching pain in the abdominal or lower back.

How to survive the bitterness of loss

It is possible that you can lose a child as a result of premature detachment of the placenta. In this case, allow yourself to grieve and realize the bitterness of loss. Remember that not only is it hard for you - the husband, children and other family members also suffer from this loss. Experts recommend visiting psychological support groups, socialize with other women who have experienced the grief of such a loss.

Talk with your doctor, friends, or a psychologist. Before again planning a pregnancy, you need to consult a doctor about reducing the risk of repeated detachment of the placenta.

Prevention

Premature detachment of the placenta can not be prevented, but remember the risk factors that provoke it. During pregnancy:

• do not smoke;
• Do not take drugs and methamphetamines;
• visit the doctor regularly for a scheduled examination;
• when hypertension follow the doctor's recommendations for normalizing blood pressure;
• take vitamins for pregnant women containing folic acid, because its deficiency provokes premature placental abruption.

Even with a normal course of pregnancy, complications are possible. Therefore, a pregnant woman should lead a healthy lifestyle and regularly visit the attending physician for a planned examination.