Premature detachment of the normally located placenta

Premature detachment of the normally located placenta. Causes: vascular diseases of the mother (severe forms of late toxicoses of pregnant women, hypertension, nephritis, etc.), inflammatory and dystrophic changes in the uterus, degenerative changes in the placenta (pregnancy delay, hypovitaminosis), overgrowth of the uterus (polyhydramnios, multiple fetuses, large fetuses). The accumulation of blood between the peeling placenta and the wall of the uterus leads to the formation of a retropacental hematoma, which increases in volume and permeates the wall of the uterus with blood. If blood penetrates between the wall of the uterus and the membranes, then there is external bleeding. The arrival of retrocolar blood, rich in thromboplastic substances, into the mother's bloodstream can lead to a state of hypofibrinogenemia.

Symptoms, the course depends on the strength of internal bleeding. A small stable retrocoparental hematoma may not appear clinically. If there is significant bleeding in the pregnant woman (mother in childbirth), severe pain occurs in the abdomen, the uterus becomes dense, the abdomen swollen, and painful in the area of ​​the hematoma. The blood pressure decreases, the pulse becomes faster. With external bleeding, the degree of anemia does not correspond to the degree of hemorrhage. The fetus quickly develops intrauterine asphyxia. Differential diagnosis is carried out with placenta presentation, rupture of the uterus, torsion of the leg of the ovarian cyst, peritonitis due to perforation of the organ.

Treatment. With severe bleeding and lack of conditions for natural delivery, a caesarean section is indicated even with a dead fruit. The pronounced impregnation of the uterine wall with blood is an indication for amputation of the uterus. During labor, a fetal bladder is opened, obstetric forceps or a vacuum extractor are applied. In the third stage of labor, manual separation and excretion of the offspring are made, not expecting its independent birth (the risk of hypotonic bleeding). Carry out prophylaxis of hypotonic bleeding and hypofibrinogenemia. In case of bleeding due to a clotting disorder, fibrinogen (up to 10 g IV), aminocaproic acid (100 ml of 5% IV solution), fresh donor blood, dry plasma is injected.