A dangerous condition that can happen during pregnancy is placental abruption. It occurs when the placenta, which gives the unborn child oxygen and nourishment, separates from the uterus prior to childbirth. To ensure the safety of mother and child, it is imperative to comprehend the symptoms and underlying causes of this condition.
It is important to not disregard symptoms that women may experience, such as contractions, bleeding, and stomach pain. These symptoms may suggest that something is wrong and that you need to get help right away. It’s critical to be aware of potential hazards.
Placental abruption can have a variety of effects, but the fetus is at serious risk. The outcome can be altered, protecting the health and wellbeing of the unborn child, with early detection and prompt medical attention.
- What is it?
- Causes
- Symptoms and signs
- Detachment at different times
- Treatment
- Prevention
- Forecasts
- Video on the topic
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What is it?
Only when placental abruption happens after childbirth, after the baby is born, is it accepted as normal. The "child’s place," having run out of resources and grown superfluous, is abandoned and gives birth. The placenta, which forms on the chorion during pregnancy, provides the baby with all the nutrients and support it needs to grow and develop, including oxygen.
Partial or total detachment of the placenta from the uterine wall accompanied by blood vessel damage is referred to as premature detachment. Medicine does not fully understand the mechanism of detachment development, but the processes that follow are evident: bleeding that varies in intensity and is proportionate to the size of the detachment occurs.
The pathology most frequently affects women who have made the decision to become mothers for the first time. Moreover, placental abruption is three times more common in women who give birth prematurely than in those who do so on schedule.
The condition of the placenta largely determines the condition and viability of the baby, its development. The placenta not only participates in gas exchange (supplies the baby with oxygen and removes carbon dioxide), it also nourishes it, protects it and participates in the production of many hormones necessary for the successful bearing of the child. The placenta usually fits quite tightly to the wall of the uterus: the fetus and water press 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. Severe placental abruption, total placental abruption before the birth of the child leads to acute hypoxia – the baby is deprived of oxygen, nutrients. The hormonal background in the pregnant woman"s body is disrupted. If emergency medical care is not provided, the child will die. If the baby is very premature at the time of detachment, he or she will most likely also die.
With marginal, partial detachment, oxygen supply will not stop completely, but will be insufficient. The consequences for the child will not take long to appear: the baby will not receive enough nutrients, will experience chronic hypoxia, and may slow down in development and growth. The state of chronic hypoxia has a detrimental effect on all organs and systems of the child, but to a greater extent – on the nervous system and the functioning 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 occurs, the condition of the expectant mother significantly worsens. With heavy bleeding, characteristic of a total, large-area detachment, the woman may die from massive blood loss. Even a small placental abruption that occurs at different stages creates a huge risk of miscarriage or premature birth.
Causes
- Pressure. High blood pressure can provoke placental abruption. Half of the women who experienced placental abruption had hypertension. About 10% of the cases, placental abruption 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. Lying on your back for a long time leads to a violation of pressure in the inferior vena cava, which can also lead to detachment of the placenta from the uterine wall.
- Repeated pathology. If a woman has previously experienced placental abruption, the probability that it will happen again is higher than 70%.
- Multiple pregnancies and having many children. Women who are carrying two or three babies are more susceptible to pathology than women who are carrying one child. Often, placental abruption is recorded in women who have given birth many times and often – their uterine walls are more flabby and stretched.
- Age of the pregnant woman. For expectant mothers over 30 years old, the risk of premature detachment is several times higher than for women aged 18-28. If the expectant mother is over 35 years old, then quite often her placenta "acquires" an additional lobe, and it is this lobe that breaks off during childbirth, causing automatic detachment of the entire "baby"s place".
- Pregnancy after infertility, IVF. If pregnancy occurs after a long period of infertility, naturally or as a result of assisted reproductive methods, such as 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. Voming, nausea, metabolic disorders, pressure drops often lead to detachment to one degree or another. In the later stages, gestosis is dangerous.
Blood vessels suffer from edema, obesity, protein evaporating from the body through urine, and hypertension; these conditions can also cause the placenta to separate from its intended location.
- Features of the uterus and blood vessels. Some anomalies in the structure of the main female reproductive organ, for example, a bicornuate or saddle-shaped uterus, as well as anomalies in the structure of the uterine vessels can lead to habitual miscarriage due to constant detachments.
- Placenta previa or low placentation. If for some reason the fertilized egg has become fixed in the lower segment of the uterus, and subsequently the chorion, and then the placenta, do not migrate higher, then detachment becomes the main threat of such a condition. Particularly dangerous is complete central placenta previa, when the baby"s place closes the entrance to the cervical canal completely or almost completely.
- Hemostasis disorders. In women with blood clotting disorders, detachment of the "baby"s place" during pregnancy and childbirth often occurs. Usually, hemostasis disorders are accompanied by other pregnancy pathologies.
- Problems of labor. Often, a dangerous condition occurs directly during labor – due to a pressure drop, during rapid, precipitous labor, after the birth of the first child of twins, during untimely rupture of the amniotic membranes, as well as with a short umbilical cord.
- Trauma. Unfortunately, this is also a common cause of severe complications. A woman can receive a blunt abdominal injury, fall on her stomach, get into an accident and hit her stomach. With such an injury, detachment of the "baby"s place" occurs in about 60% of cases.
- Bad habits. If the expectant mother cannot give up 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 pregnant woman"s immune system can begin to produce specific antibodies to her own tissues. This happens with severe allergies, for example, to medications or with an improperly performed blood transfusion, as well as with severe systemic diseases – lupus, rheumatism.
- Mother"s diseases. From the point of view of the likelihood of detachment, all chronic diseases of the pregnant woman are dangerous, but the greatest risks are created by diabetes mellitus, pyelonephritis, problems with the thyroid gland, as well as obesity of the woman.
Upon registration and after reviewing the patient’s medical history, if the physician determines that the expectant mother is at risk for developing detachment, he will closely monitor the pregnancy. In addition to having to undergo tests, an ultrasound, and more frequent doctor visits, the woman may be advised to spend multiple days in a day hospital as a preventative measure throughout her pregnancy.
Symptoms and signs
Bleeding is the singular manifestation of premature separation of the "baby’s place." The extent of the detachment determines the degree and severity of it. A large hematoma may develop from even a minor detachment. It is a build-up of blood that forms between the uterine wall and the actual "baby’s place" after spilling out of damaged vessels. More and more sections of the placenta separate and die as a result of the hematoma growing larger and larger if there is nowhere for the blood to go.
If the pathology is only mild, there might not be any symptoms. Only a very keen ultrasound diagnostician and the obstetrician who will deliver the baby will be able to detect a small detachment; there will be tiny indentations and possibly blood clots on the placenta’s side where it was next to the uterus.
A woman is already experiencing a moderate degree of pathology if she has a small amount of abdominal pain that bothers her and is accompanied by a negligible brown or pink discharge. At every stage in any woman, the placenta’s health must be assessed when bloody "smears" appear.
Pregnant women themselves are not used to realizing how dangerous moderate detachment is. It frequently presents as a disruption of the fetal heart rhythm and poses a risk of hypoxia for the unborn child.
An acute onset is a hallmark of all severe forms of pathology. A sharp, sudden, intense abdominal pain, dizziness, and an internal sensation of distension are experienced by the pregnant woman. Consciousness loss is possible. This type of detachment causes severe, intense bleeding. However, mild bleeding can also occur. The blood’s color is one of the form’s defining characteristics. It is bright and scarlet with a severe detachment. The woman experiences severe perspiration, pale skin, and dyspnea almost instantly.
In the severe and medium forms, the doctor notes asymmetry of the female reproductive organ during examination and notes constant tension and increased tone in the uterine smooth muscles. By examining the type of bleeding, a skilled physician can quickly ascertain the type of detachment.
- There is no bleeding or it is insignificant — central placental abruption is possible, in which all the blood accumulates between the wall of the uterus and the central part of the "baby"s place". This is the most dangerous form.
- Moderate vaginal bleeding — marginal or partial detachment is possible, in which the blood leaves the space between the uterus and the "baby"s place" faster. Pathology of this kind has a more favorable prognosis, since the outflow of blood increases the likelihood of thrombosis of damaged vessels and healing of the area.
- There is no bleeding against the background of a noticeable deterioration in the condition of the pregnant woman and soreness of the uterus—the bleeding is hidden, and this is a rather dangerous condition that can lead to total detachment.
Usually dull and aching, the pain can become sharp and refer to the lower back when there is severe and heavy detachment. She will hurt herself terribly when the doctor palpates her uterus. The oxygen shortage that develops against the backdrop of placental abruption causes the baby’s heartbeat to become irregular.
The earliest indications of a problem with the fetus’s condition appear if the "baby’s place" has moved away by roughly 25% of its total area. In a condition that is considered dangerous and is characterized by a disruption in the baby’s motor activity, about 30% of the placenta may separate. Usually, the child passes away when the organ travels 50% outside of its original region.
The doctor will undoubtedly consider the gestational age when making a diagnosis because the pathology’s symptoms and manifestations may vary depending on the trimester.
Detachment at different times
Placenta abruption most frequently happens in the early stages of pregnancy, but don’t worry—there are plenty of ways to keep the pregnancy going and avoid harmful outcomes for both the mother and the unborn child if you see a doctor in a timely manner. Typically, during the first trimester, this type of detachment shows up as a retrochorial hematoma, which can be verified through ultrasound findings. There could be a discharge or none at all.
When this stage of the pregnancy is treated competently, the placenta can usually fully compensate for the loss of uterine contact, and the pregnancy will progress normally.
Detachment is a more serious condition that puts the baby at risk of hypoxia if it happens during the second trimester up until and including the 27th week. When a baby is first experiencing oxygen starvation, he becomes more energetic and makes every effort to obtain more oxygen.
The baby’s movements, on the other hand, slow down if hypoxia persists. The placenta can grow up until the middle of the second trimester, after which it loses this capacity and is unable to make up for the lost tissue. Therefore, if the detachment happened earlier than 20–21 weeks, the prognosis is better. The forecasts are not as colorful after this point.
Pathology poses the biggest risk in the later stages. It is physically impossible to make up for some of the lost functions, so "Children’s Place" can no longer expand. Fetal hypoxia will only worsen, potentially leading to the child’s death. A woman undergoes a cesarean section to save the child if the detachment grows and increases in the area.
Since children can be born extremely prematurely, saving them is not always possible. Acute respiratory failure can result from the immaturity of the lung tissue or from the incapacity to maintain body temperature.
A strict bed regimen and round-the-clock monitoring in a gynecological hospital are the only ways to preserve pregnancy if the third trimester detachment does not worsen. A lady can’t remain at home.
Although there are many causes of placental abruption during labor, it usually happens to twin pregnant mothers or laboring women with polyhydramnios. Excessive blood flow can cause the uterine walls to lose their ability to contract. In this case, doctors try to induce contractions at any point during the labor process. If this doesn’t work, they perform an emergency cesarean section.
Treatment
Placental abruption should not be treated if there is not much time left before the due date. Depending on the time and circumstances, doctors advise either performing a cesarean section or inducing natural labor. Waiting and postponing is pointless since it may result in catastrophe.
However, if the detachment does not progress and the child is not yet deemed viable, medical professionals will make every effort to extend the pregnancy. There is no one-size-fits-all solution; rather, the patient and the physician must carefully consider the risks involved in each particular scenario. These include the possibility of having a premature baby who may not survive or taking a chance that could result in the baby’s condition becoming critically low due to detachment and hypoxia.
Hospital treatment is the norm for the detachment. Treatment is only administered when the detachment is partial, the pregnancy is less than 36 weeks, vaginal bleeding is absent or moderate, there are no signs of severe fetal hypoxia, and the detachment of the "baby’s place" is progressing. The medication regimen will include hemostatics that stop bleeding as well as other drugs of the doctor’s choosing.
Antispasmodics are prescribed to eliminate the threat; these medications are intended to keep the uterine muscles relaxed and prevent even temporary tonic contractions. Drugs that will improve blood circulation between the uterus and the placenta and replenish the child’s nutritional deficit will be given to the mother. Additionally, iron supplements and sedatives may be suggested to her in order to help treat her anemia’s symptoms.
In a medical setting, the mother will almost certainly have a Doppler ultrasound almost every day in addition to a CTG to monitor the baby’s health. The pregnant woman’s lab results will be closely watched by the doctors, who will pay particular attention to blood clotting factors. The goal of every action will be to prevent bleeding again.
In the event that placental abruption progresses even slightly, expectant management and preservative therapy are discontinued in favor of emergency delivery.
When the placenta abruptly separates from the uterus during pregnancy, it can be a dangerous condition that puts the mother and the fetus at risk for complications. It’s critical to recognize symptoms like abrupt abdominal pain, bleeding, and decreased fetal movement because prompt intervention can help reduce risks. The fetal consequences can vary, ranging from growth issues to preterm birth or, in extreme situations, stillbirth. The causes can include anything from high blood pressure to trauma. Knowing the symptoms and causes can help expectant mothers get the care they need in a timely manner, which will benefit their unborn child.
Prevention
Every expectant mother ought to take every precaution to avoid developing such a disease. The doctor will report any even slight risk of abruption and provide several crucial recommendations to safeguard both your health and the health of the unborn child.
Because it doesn’t occur in nature, no one can provide preventive treatment to women who have already experienced this unpleasant complication. However, it is advised that the expectant mother register with the antenatal clinic as soon as possible to avoid a recurrence of the issue.
It is not advised for women with low placentation or placenta previa to engage in sexual activity, excessive physical activity, or stress when they are pregnant because of the possibility of pregnancy termination owing to abnormalities of the "baby’s place." You cannot avoid going to the doctor and doing required tests during pregnancy.
If a woman has high blood pressure, she needs to keep an eye on it and, if needed, take the prescribed drugs as directed by her physician. These drugs will effectively lower blood pressure without endangering the health of the child. Anti-Rh immunoglobulin must be given to pregnant women who have a negative Rh factor and are carrying a Rh-positive child during the second trimester of their pregnancy.
During the time of giving birth, a woman should stop smoking and limit her alcohol intake, even if she does not fall into the detachment risk category. When driving, women should always buckle up, and the belt should sit either above or below the level of the abdomen. You should move very carefully in the winter, when the abdomen gets quite large, as you run the risk of falling and getting blunt abdominal trauma. Your own legs also become invisible.
A woman should stay away from allergens and only take prescription drugs under a doctor’s supervision because many medications have the potential to cause placental abruption and bleeding. When a woman has a chronic illness, her pregnancy should be closely monitored by two medical professionals: an obstetrician-gynecologist and a specialist in the field that treats the expectant mother’s illness. Complications can only be avoided with a combined medical tandem.
The expectant mother must follow all medical advice if symptoms of gestosis (such as protein in the urine, elevated blood pressure, edema, and pathological weight gain) develop. If required, she may need to visit the hospital to receive the required care and supervision from medical professionals.
Forecasts
Prognoses improve if a woman consults a physician as soon as possible. You shouldn’t turn to friends, acquaintances, or the Internet for information if there is discomfort in your abdomen, bloody discharge appears, or your general health deteriorates. Making an ambulance call as soon as possible is crucial. Bloody discharge is not normal during pregnancy and is usually a clear indication that there are issues with the integrity of the "baby’s place."
It is crucial to predict the outcome and ramifications of placental abruption every day and every hour. The prognosis will be more negative the longer the pregnancy. Forecasts are also impacted by the detachment’s size and the existence of its progression.
Signs of Placental Abruption | Causes and Consequences for the Fetus |
Vaginal bleeding, abdominal pain, uterine tenderness, rapid contractions, and decreased fetal movement | Causes: High blood pressure, trauma, smoking, substance abuse, and multiple pregnancies. Consequences: Premature birth, low birth weight, and in severe cases, stillbirth |
Early detection of placental abruption symptoms is essential for the mother’s and the child’s health and safety. While not all cases can be prevented, knowing the causes can aid in taking preventive action.
The fetus may suffer grave consequences from placental abruption, such as preterm birth and occasionally even life-threatening complications. Nonetheless, risks can be reduced and mother and child can get the care they require with quick medical attention.
It is imperative that expectant mothers remain educated, schedule routine examinations, and promptly seek medical attention in the event that they notice any worrisome symptoms. Results can be significantly altered by taking the initiative.