Signs and causes of placental abruption, consequences for the fetus

Placental abruption is a serious complication of pregnancy and childbirth. Detachment of the "baby seat" from the uterine wall can be fatal for the baby and his mother. According to statistics, such a violation occurs in 1.5% of all pregnancies. Why this happens, if there are any chances of saving the baby, and what the consequences may be at different times, will be discussed in this article.

What it is?

Placental abruption is considered normal only if it occurs after childbirth, after the baby is born. The “child's place”, having exhausted its resources and has become unnecessary, is rejected and born. During pregnancy, first the chorion, and then the placenta, formed on its basis, nourishes and supports the baby, supplies him with oxygen and all the substances necessary for growth and development.

Premature detachment is a partial or complete detachment of the placenta from the uterine wall with vascular damage. The mechanism of the detachment development until the end is not clear to medicine, but the processes that follow such detachment are obvious - bleeding of varying intensity develops, comparable to the size of the detachment.

Most often, pathology occurs in women who decide to become mothers for the first time. In addition, women during preterm birth are 3 times more likely to experience detachment of the "baby's place" than women who give birth on time.

The state and vitality of the baby, its development largely depends on the state of the placenta. The placenta not only participates in gas exchange (supplies the baby with oxygen and removes carbon dioxide), it also nourishes it, protects and participates in the production of many hormones necessary for the successful bearing of a child. The “baby's place” usually fits quite tightly to the wall of the uterus: the fetus and water are pressed on it from above, and the walls of the uterus from below. It is this double pressure that prevents the placenta from leaving its place prematurely.

Detachment of a severe degree, total detachment before the birth of a child leads to acute hypoxia - the baby is deprived of oxygen and nutrients. The hormonal background is disturbed in the body of a pregnant woman. If no emergency medical care is provided, the child will die. If the baby is very premature at the time of the detachment, he will most likely also die.

With marginal, partial detachment, oxygen delivery will not completely stop, but will be insufficient. The consequences for the child will not be long in coming: the baby will not receive enough nutrients, will experience chronic hypoxia, and may slow down in development and growth. The state of chronic hypoxia adversely affects all organs and systems of the child, but to a greater extent - on the nervous system and the work of the brain and spinal cord, as well as the musculoskeletal system.

For a woman, detachment is dangerous due to the occurrence of bleeding. With prolonged bleeding, anemia sets in, the condition of the expectant mother deteriorates significantly. With profuse bleeding, characteristic of a total detachment of a large area, the death of a woman from massive blood loss is possible. Even a small placental abruption that occurs at different times creates huge risks of miscarriage or premature birth.

Causes

The exact reasons that lead to the departure of the "child's place" from the wall of the uterus are still unknown to science. Doctors tend to believe that in each case, not even one, but a combination of several risk factors plays a role.

Pressure. High blood pressure can cause the placenta to pass. Half of the women who survived the detachment had hypertension. In about 10%, the detachment occurred against the background of a spontaneous jump in blood pressure up or down. Often, blood pressure begins to "jump" under severe stress, in a threatening and unfavorable psychological situation. Long lying on your back leads to a violation of the pressure in the inferior vena cava, which can also lead to the detachment of the placenta from the uterine wall.
Repeated pathology. If a woman has already had a detachment before, the probability that it will recur is higher than 70%.
Multiple pregnancies and many children. Women who carry two or three babies are more susceptible to pathology than women who carry one child. Often, detachment is recorded in women who have given birth a lot and often - the walls of the uterus are more flabby and stretched.

Pregnant age. In expectant mothers over 30 years old, the risks of premature detachment are several times higher than in women 18-28 years old. If the expectant mother is more than 35 years old, then quite often her placenta "acquires" an additional lobule, and it is this lobule that breaks off during childbirth, causing the automatic disconnection of the entire "child's place".
Pregnancy after infertility, IVF. If pregnancy occurs after a long period of infertility, naturally or as a result of assisted reproductive methods, for example, IVF, then the likelihood of placental abruption increases, the risk is estimated at about 25%.
Gestosis and toxicosis. In the early stages, severe, painful toxicosis is considered a risk factor. Vomiting, nausea, metabolic disorders, pressure drops often lead to exfoliation to one degree or another. In the later stages, gestosis is dangerous.

With edema, excess weight, leaching of protein from the body with urine and hypertension, the vessels suffer, which can also lead to the detachment of the placenta from its place.

Features of the uterus and blood vessels. Some anomalies in the structure of the main female reproductive organ, for example, a two-horned or saddle uterus, as well as anomalies in the structure of the vessels of the uterus, can lead to recurrent miscarriage due to constant detachments.
Placenta previa or low placentation. If, for some reason, the ovum is fixed in the lower segment of the uterus, and subsequently the chorion, and behind it the placenta, did not migrate higher, then detachment becomes the main threat of this condition. Particularly dangerous is the full central presentation of the placenta, when the child's place closes the entrance to the cervical canal completely or almost completely.
Hemostasis disorders... In women with blood clotting disorders, detachment of the "child's place" during pregnancy and childbirth occurs quite often. Usually, violations of hemostasis are accompanied by other pathologies of pregnancy.

Labor problems. Often, a dangerous condition occurs directly in childbirth - due to a pressure drop, during rapid, rapid childbirth, after the birth of the first child from twins, with an untimely rupture of the amniotic membranes, as well as with a short umbilical cord.
Injury. Unfortunately, this is also a common cause of severe complications. A woman can get a blunt trauma to the abdomen, fall on her stomach, get into an accident and hit her stomach. With such an injury, detachment of the "child's place" occurs in about 60% of cases.
Bad habits. If the expectant mother cannot part with the habit of smoking or taking alcohol and drugs even while carrying her baby, then the likelihood of spontaneous sudden detachment increases tenfold.

Autoimmune processes. The immunity of a pregnant woman can begin to produce specific antibodies to her own tissues. This happens with severe allergies, for example, to medications or incorrectly performed blood transfusions, as well as in severe systemic ailments - lupus erythematosus, rheumatism.
Mom's diseases. From the point of view of the likelihood of detachment, all chronic diseases of a pregnant woman are dangerous, but the greatest risks are caused by diabetes mellitus, pyelonephritis, thyroid problems, as well as obesity of a woman.

If, upon registration, after examining the woman's anamnesis, the doctor decides that this pregnant woman belongs to a risk group for the possible development of detachment, he will more closely monitor such a pregnancy. A woman will have to visit a doctor more often, take tests, do an ultrasound, and she may also be recommended a preventive stay in a day hospital several times during pregnancy.

Symptoms and Signs

All signs of premature separation of the "child's place" are reduced to one manifestation - bleeding. The degree and severity of it depends on how extensive the detachment is. Even a small detachment can lead to a large hematoma. It is an accumulation of blood that has come out of damaged vessels and accumulates between the wall of the uterus and the "child's place" itself. If there is no blood outlet, the hematoma grows and increases, contributing to the detachment and death of all new areas of the placenta.

Symptoms may not be only with a mild degree of pathology. Only a very attentive ultrasound doctor, as well as an obstetrician who will take delivery, can notice a small detachment - there will be small depressions on the placenta on the side with which it was adjacent to the uterus, and, possibly, blood clots.

If a woman feels small pulling pains in the abdomen, accompanied by slight brown or pink discharge, this is already a moderate severity of the pathology. When bloody "smears" appear, the state of the placenta is necessarily examined at any time in any woman.

A moderate detachment is much more dangerous than pregnant women themselves are used to thinking. It threatens with hypoxia for the baby, and is often manifested by a violation of the fetal heart rhythm.

A severe form of pathology is always characterized by an acute onset. A pregnant woman has a sharp, sudden, severe pain in the abdomen, a feeling of fullness from the inside, dizziness. Loss of consciousness is not excluded. With this form of detachment, bleeding is severe, intense. Moderate bleeding is also possible. A distinctive feature of the form is the color of blood. It is scarlet, bright with severe detachment. The woman almost immediately develops shortness of breath, the skin becomes pale, she sweats intensely.

In severe and moderate forms, there is always a tension of the smooth muscles of the uterus, an increased tone, upon examination, the doctor states the asymmetry of the reproductive female organ. By the nature of the bleeding, an experienced doctor can easily determine the type of detachment.

No or minor bleeding - Central placental abruption is not excluded, in which all blood accumulates between the wall of the uterus and the central part of the "child's place". This is the most dangerous form.
Moderate vaginal bleeding - marginal or partial detachment is not excluded, in which blood quickly leaves the space between the uterus and the "baby's place". Pathology of this kind has more favorable prognosis, since the discharge of blood increases the likelihood of thrombosis of damaged vessels and healing of the site.
No bleeding against the background of a noticeable deterioration in the condition of the pregnant woman and the soreness of the uterus, the bleeding is hidden, and this is a rather dangerous condition that can lead to total detachment.

The pain usually has a dull and aching character, but with an acute and severe detachment, it can be sharp, radiating to the lower back, thigh. When the doctor palpates the uterus, the woman will experience severe pain. The baby's heartbeat is disturbed due to oxygen deficiency, which develops against the background of the discharge of the placenta.

The first signs of fetal disruption make themselves felt if the "child's place" has moved away by about a quarter of its total area, with a threatening condition, which is manifested by a violation of the baby's motor activity, they say about detachment of about 30% of the placenta. When the organ leaves 50% of its own area, the child usually dies.

When diagnosing, the doctor will definitely take into account the gestational age, because in different trimesters the symptoms and manifestations of pathology may be different.

Detachment at different times

In the early stages, placenta discharge occurs most often, but you should not be upset, because with timely access to a doctor, there are many ways to maintain a pregnancy and prevent negative consequences for a mother and her baby. Usually in the first trimester, such a detachment is manifested by a retrochorial hematoma, which is confirmed by ultrasound results. Allocations may or may not appear at all.

In most cases, competent treatment at this stage allows the placenta to fully compensate for the loss of contact of a part of the area with the uterus in the future, and pregnancy will develop quite normally.

If the detachment occurs in the second trimester up to 27 weeks inclusive, then this is a more dangerous condition that threatens the baby with hypoxia. The baby at the initial stage of oxygen starvation becomes more active, he tries with all his might to get himself additional oxygen.

If hypoxia becomes chronic, the child's movements, on the contrary, slow down. Until the middle of the second trimester, the placenta can grow, then it loses this ability and can no longer compensate for the lost areas. Therefore, the forecasts are more favorable if the detachment occurred before 20-21 weeks. After this period, the forecasts are not so rosy.

In the later stages, pathology is the greatest danger. The “child's place” can no longer grow, and it is physically impossible to compensate for some of the lost functions. Fetal hypoxia will only progress, the child's condition may become critical. If the detachment continues to grow and grow in size, the woman is given a caesarean section to save the baby.

It is not always possible to save, since children can be deeply premature, and then death can occur as a result of acute respiratory failure due to immaturity of the lung tissue or due to the inability of the baby to maintain body temperature.

Only if the detachment in the third trimester does not progress, there is a chance to preserve the pregnancy with strict bed rest under round-the-clock supervision in a gynecological hospital. It is impossible for a woman to stay at home.

Placental abruption during childbirth can occur for a variety of reasons, most often this occurs in pregnant twins or women in labor with diagnosed polyhydramnios. The walls of the uterus may lose contractility due to profuse blood flow. At any stage of the birth process in this situation, doctors use stimulation of contractions, if this turns out to be ineffective, then an emergency cesarean section is performed.

Treatment

If there is very little left before the date of birth, then the treatment of detachment is inappropriate. Doctors recommend giving birth - to stimulate natural childbirth or to have a caesarean section (depending on the time and situation). There is no point in waiting and hesitating - delay can lead to tragedy.

But if the child is not yet considered viable, then doctors will try to do everything to prolong the pregnancy if the detachment does not progress. There is no single, ready-made solution - in each specific situation, the doctor and the patient must carefully weigh the risks: to give birth to a premature baby who may not survive, or to risk and, possibly, face a critical condition of the baby due to detachment and hypoxia.

Detachment is always treated in stationary conditions. Therapy, which will include drugs - hemostatics that stop bleeding, as well as drugs of other groups at the discretion of the doctor, is carried out only when the detachment is partial, the gestational age is less than 36 weeks, vaginal bleeding is absent or moderate, and there are no signs of severe fetal hypoxia and the progression of detachment of the "child's place".

To remove the threat, antispasmodics are prescribed, which must maintain the muscles of the uterus in a relaxed state, preventing even a short-term tone. The woman will be injected with drugs that will make up for the baby's nutritional deficiencies and improve blood circulation between the uterus and the placenta. And also sedatives and iron preparations may be recommended to her, which will help get rid of the symptoms of anemia.

In a hospital setting, a woman will have an ultrasound scan with a Doppler almost daily, as well as CTG to find out how the baby is feeling. Doctors will monitor the laboratory tests of the pregnant woman, paying special attention to blood clotting factors. All measures will be aimed at avoiding re-bleeding.

When even the slightest signs of progression of detachment of the "child's place" appear, a decision is made to terminate expectant tactics and preserving therapy in favor of emergency delivery.

Prevention

Any pregnant woman should do everything possible to prevent such a pathology. If there is at least a minimal chance of detachment, the doctor will definitely inform you about it and give a number of important recommendations that will help protect your baby and your own health.

So, for women who have previously encountered this unpleasant complication, no one can offer any preventive treatment, since it does not exist in nature. But for the prevention of recurrence of the problem of a pregnant woman, it is recommended to contact the antenatal clinic as early as possible for registration.

Women with low placenta or placenta previa, as well as with the threat of termination of pregnancy due to malformations of the "child's place" itself, are not recommended sex, excessive physical activity and stress. You cannot neglect visiting a doctor, passing mandatory and additional tests while carrying a child.

If a woman suffers from high blood pressure, she must definitely control its level and, if necessary, take medications as prescribed by a doctor that will effectively reduce pressure without harm to the child's body. Women with a negative Rh factor during pregnancy from a Rh-positive man require the introduction of anti-Rh immunoglobulin in the second trimester of pregnancy.

If a woman is at risk for detachment (and even if she is not included in it), you should quit smoking during the period of gestation, and avoid even small doses of alcohol. Women should always wear a seat belt when traveling by car, with the belt above or below the level of the abdomen. In winter, when the abdomen becomes quite large, you should move very carefully, since your own legs become invisible and the likelihood of falling and getting a blunt abdominal injury increases.

A woman should avoid contact with allergenic substances, do not take medications without a doctor's prescription, since many drugs can provoke placental abruption and bleeding. In the presence of chronic diseases, two specialists should lead a pregnancy in a woman - an obstetrician-gynecologist and a doctor of the specialty who is in charge of the disease of the expectant mother. Only a joint medical tandem will help avoid complications.

When signs of gestosis appear (the appearance of protein in the urine, increased pressure, edema and pathological weight gain), the expectant mother must follow all the doctor's prescriptions, if necessary, go to the hospital to be under the supervision of doctors and receive the necessary treatment.

Forecasts

Forecasts are more favorable if a woman seeks a doctor as early as possible. With the appearance of bloody discharge, with pain in the abdomen, a deterioration in general well-being, one cannot look for an answer to the question of what is happening on the Internet or from friends and acquaintances. It is important to call an ambulance as soon as possible. Bloody discharge cannot be considered normal during pregnancy, and in most cases it is an unambiguous sign of problems with the integrity of the "child's place".

Every day, every hour is of great importance in predicting the outcome and consequences of placental abruption. The longer the pregnancy, the more unfavorable the prognosis will be. The size of the detachment and the presence of its progression also affect the prognosis.

Reviews

Many women describe in their reviews on thematic forums that the placental abruption was not preceded by any difficulties, diseases, problems with gestation. It all happened suddenly. In the early stages, most of the stories have a good ending - after a course of treatment in a gynecological hospital, the symptoms subsided, and the pregnancy was managed to be brought to term. Unfortunately, in later stages, women often lose babies due to a sudden detachment of the "child's place".

In severe cases, when the walls of the uterus are soaked with blood, it is not possible to save either the child or the woman's reproductive health - the uterus must be removed completely. After the death of a child due to the detachment of the "child's place", it is especially difficult for women to plan their next pregnancy, both in terms of gynecological problems and psychologically.

There are groups on the Internet in which women who have experienced a similar experience, but do not lose hope of having children in the future, help each other with kind advice and supportive words. It is very important to overcome the fear of a new pregnancy.