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Premature detachment of a normally located placenta


Causes: vascular diseases of the mother (severe forms of late toxicosis, hypertension, nephritis, etc.), inflammatory and dystrophic changes in the uterus, its overstretching (polyhydramnios, multiple pregnancy, large fetus), degenerative changes in the placenta (prolongation of pregnancy, hypovitaminosis). The accumulation of blood between the exfoliating placenta and the uterine wall leads to the formation of a retroplacental hematoma. If blood penetrates between the wall of the uterus and the membranes, then external bleeding occurs.
Symptoms and course:
A small stable hematoma may not be clinically apparent. With minor bleeding, a pregnant woman (woman in childbirth) experiences severe abdominal pain, the uterus becomes dense, the abdomen is swollen and painful in the area of ​​the hematoma. Blood pressure decreases, pulse increases. With external bleeding, the degree of anemia does not correspond to the degree of blood loss. The fetus quickly has intrauterine asphyxiation.
Treatment:
During childbirth, the fetal bladder is opened, obstetric forceps or a vacuum extractor are applied. In the 3rd period of labor, manual separation and isolation of the placenta is performed, not expecting it to be born independently due to the danger of hypotonic bleeding. With severe bleeding and the absence of conditions for natural delivery, a cesarean section is indicated even with a dead fetus.