Premature placental abruption

Premature placental abruption - placental abruption during pregnancy or in childbirth before the birth of the fetus. Distinguish premature detachment of normally situated and placenta previa.

Violation of the placenta due to uterine wall leads to the formation of a hematoma retroplatsentarnoy and further separation of the placenta from the uterine wall. When placental abruption in the central part of the hematoma may be significant in the absence of external bleeding. Hematoma is putting pressure on the uterine wall, stretching it; in the maternal part of the placenta occurs impression. When detachment close to the edge of the placenta blood from the hematoma retroplatsentarnoy detaches fetal membranes and flows out of the genital tract, t. E. There is external bleeding.

Clinically distinguish mild, moderate and severe forms of premature detachment of the placenta. In mild form, there are no distinct symptoms, and placental abruption can be detected only by ultrasound or after birth when it detects on maternal surface of the placenta small depressions filled with dark blood clots.

In the form of moderately severe pathology appear abdominal pain and minor bleeding with clots from the genital tract. External bleeding may be omitted, depending on the location and size of placental detachment retroplatsentarnoy hematoma. On palpation reveals a few tense uterus, sometimes marked mild local tenderness. Auscultation of fetal cardiac abnormalities are determined by activity, indicating its hypoxia; the severity of these disorders depends on the size of placental abruption.

In severe suddenly there are strong arching abdominal pain, dizziness , severe weakness, sometimes fainting occurs. There have pale skin, tachycardia , pulse weak filling, lowering blood pressure. There are dark bloody discharge from the genital tract in moderate amounts. Uterus dramatically tense, asymmetric: on one hand it is determined by tenderness protrusion. Palpation of fetal parts is difficult. The heartbeat of the fetus does not listen.

Pregnant women with premature detachment of the placenta, and suspected it (abdominal pain, bleeding from the genital tract) are subject to immediate hospitalization in a maternity hospital.

Treatment depends on the severity of clinical symptoms and the time of occurrence of placental abruption. With ill-defined clinical symptoms during pregnancy and the absence of signs of fetal hypoxia is held stationary observation and treatment of the underlying pathology. In this case shows the dynamic ultrasound examination of the uterus and control the state of the blood coagulation system. When premature detachment of the placenta during childbirth shown autopsy of membranes, and the appearance of signs of fetal hypoxia and the presence of conditions produce an emergency delivery was vaginal (forceps, extraction of the fetus for pelvic end).

Forms of mild and severe are the indication for immediate cesarean delivery.

The prognosis of premature detachment of the placenta is always serious for both the woman and the fetus. The main danger for women is the possibility of severe hemorrhagic shock with disseminated intravascular coagulation syndrome.

Prevention is primarily to early diagnosis and rational treatment of late toxicosis of pregnancy and extragenital pathology in pregnant women.