Placental abruption

Detachment of the placenta - premature separation of the normally located placenta in late pregnancy. Signs of this pathology may be bleeding from the vagina, pain and soreness of the uterus, hemorrhagic shock and disseminated intravascular coagulation (DVS). The diagnosis is made on the basis of clinical data and sometimes ultrasonography. Treatment of placental abruption includes bed rest with moderate symptoms and rapid delivery with severe or persistent symptoms.

[1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11]

Causes Placental abruption

What causes placental abruption?

Detachment of the placenta can have any degree, from a few millimeters to a complete separation. This leads to bleeding into the decidual basal membrane behind the placenta (retrocolar). The cause of placental abruption is unknown. The result can be ischemia and intrauterine fetal death, if the process is acute and the volume of uteroplacental blood flow is disturbed; or restriction of fetal growth if the process is chronic and less extensive. Risk factors are: age of the mother over 30, hypertension (caused by pregnancy or chronic), vasculitis, other vascular disorders, previous abruption of the placenta, abdominal trauma, maternal thromboembolic disorders, smoking and, in particular, cocaine use. Detachment of the placenta occurs in 0.4-1.5% of all pregnancies.

Symptoms Placental abruption

Symptoms of placental abruption

With detachment of the normally located placenta, blood can flow through the cervix (external bleeding) or remain behind the placenta (latent bleeding). Severity of symptoms depends on the degree of separation of the placenta and loss of blood. The uterus can be painful, sensitive to palpation. There may be hemorrhagic shock and symptoms of ICE.

Diagnostics Placental abruption

Diagnosis of placental abruption

Placental abruption should be suspected in the presence of vaginal bleeding, pain and soreness of the uterus, fetal condition, hemorrhagic shock or ICE in late pregnancy, especially if the degree of pain or shock seems to be a disproportionate degree of vaginal bleeding. If bleeding occurs later in pregnancy, placental presentation should be ruled out before a pelvic examination is performed. Such a test with placenta previa can increase bleeding.

The evaluation includes fetal heart control, a clinical blood test, a measurement of fibrinogen and fibrin degradation products in serum and abdominal pelvic ultrasonography. Fetal heart rate monitoring can reveal hypoxia or intrauterine death. Ultrasonography can be uninformative; thus, the diagnosis can be made on the basis of clinical data.

[12], [13], [14], [15], [16], [17]

Treatment Placental abruption

Treatment of placental abruption

If bleeding does not threaten the life of the mother or fetus, the fetal heart rate is satisfactory, and if the period of labor has not yet come, hospitalization and bed rest are recommended. These measures can help reduce bleeding. If the bleeding stops, the woman is usually allowed to get up, and she is discharged from the hospital. If the bleeding continues, then a rapid delivery is indicated; the method is selected using criteria similar to those for preeclampsia or eclampsia. Usually, vaginal delivery is performed, accelerated by intravenous administration of oxytocin, or by cesarean delivery, depending on the condition of the mother and fetus. Amniotomy (artificial rupture of membranes) is performed early, as this can speed delivery and prevent ICE. The results of treatment of complications in a condition such as placental abruption (eg, shock, ICE) are positive.