Placental abruption in early pregnancy: causes, symptoms, treatment, consequences

2024 Author: Priscilla Miln | [email protected]. Last modified: 2023-12-16 00:21

The modern rhythm of life and an abundance of stress often cause placental abruption in early pregnancy. With such a pathology, many women lie in conservation. During the first trimester, any negative impact on the physical or moral state of the mother can be fatal. But if you notice the deviation in time, there is every chance to avoid losing the child.

What is the placenta

The placenta is a unique organ, it is formed in the female body and is needed only during pregnancy. It has a round shape, flattened on the sides, which is why it has such a name. From the Latin "placenta" is translated as "flat cake". The umbilical cord extends from the middle of the organ.

The second name of the placenta is "baby place". It begins to form from the third week of pregnancy, and ends by 12-13 weeks, but the placenta continues to develop until the end of pregnancy, sequentiallygoing through several stages.

The placenta should fall off after the baby is born. If it separates from the walls of the uterus in the first trimester, the diagnosis is "placental abruption in the early stages." Treatment in this situation should begin immediately.

The placenta has four stages of maturity:

• Zero - until 27-30 weeks. Tobacco and alcohol use can contribute to early maturity.
• The first - from 30 to 34 weeks. During this period, it stops growing, and begins to thicken.
• Second - from 34 to 37 weeks. This is the most stable stage.
• Third - from 37 weeks. From this moment on, the process of natural aging starts in the placental tissue. If it starts earlier, the child will not receive the necessary substances and oxygen to the fullest. This can cause fetal pathologies and even death.

Excessive diets and lack of weight also cause premature aging of the “children's place”. Pregnancy is not the time to diet.

The placenta is made up of two circulatory systems that do not mix, they are separated by a membrane called the placental barrier. The child's blood circulates through special villi that permeate the entire "children's place". Maternal blood washes them from the outside, but transfers oxygen and nutrients through the vessels. The embryo pumps carbon dioxide and metabolic products back to the mother. While in the womb, the baby does not breathe with lungs.

The placental barrier serves as a filter for substances coming from the mother's body. It lets in useful ones, but blocks those that can harm the child. An interesting feature is that toxins from the baby are transmitted to the woman, and in the opposite direction - almost none.

One of the main functions of the afterbirth is to produce hormones. The sex hormone begins to appear when the placenta is fully formed, it is necessary to maintain pregnancy. With its appearance, the threat of losing a child drops significantly, doctors no longer need to administer hormonal drugs to a woman.

At first, the placenta grows faster than the baby. By the end of the first trimester (14th week), the embryo weighs about 25 grams, and the “baby place” is several times larger. By the end of pregnancy, the placenta can reach a mass of 500-600 grams, and its circumference is up to 18 cm.

Degrees of severity

If the affected area is large, placental abruption can lead to fetal death. Due to tissue separation, blood circulation between mother and child is disturbed. Detachment has several degrees of severity:

• Mild - a slight abruption of the placenta in the early stages. There may be no pronounced symptoms, it is possible to notice it only upon examination.
• Medium - accompanied by pain in the abdomen, the uterus becomes stone, bleeding is observed.
• Severe placental abruption in early pregnancy. The symptoms of an emergency are also manifested by bloody secretions.varying intensity. Additionally, nausea, vomiting, loss of consciousness, palpitations, asymmetric position of the uterus can be observed. Rejection of the placenta by 1/3-1/2 leads to fetal death. There is also a serious risk to the mother.

Types of delamination

Tissue rejection can be different: a small detachment of the placenta (quite common in early pregnancy) and complete detachment of the "baby place". With a total defeat, the death of the fetus occurs.

Partial withdrawal of the placenta from the uterine wall is observed in a separate part of the organ. It can increase in area or remain the same size throughout pregnancy with thrombosis of the uterine vessels.

The marginal separation of the placental tissue and the central one are also distinguished. In the latter view, there is no external bleeding.

It should be noted that during the first six weeks of pregnancy, the placenta as such is not yet. In the very early stages, it is called the chorion and is located around the entire fetal egg. As a rule, detachment of the chorion leads to spontaneous miscarriage.

Reasons

There are a lot of reasons for placental abruption in early pregnancy, sometimes they act in combination.

1. Pathological changes in the vessels that disrupt the blood exchange between the uterus and the placenta. These disorders occur in pregnant women due to obesity, diabetes mellitus, infectious diseases of the kidneys, hypertension. With pathology, the capillaries become brittle and fragile, heart attacks and thrombosis of the placental tissue occur. As a resultpoor contact between the two circulatory systems, blood accumulates between the wall of the uterus and the placenta with the formation of a hematoma. The accumulation of blood exacerbates the current emergency.
2. Inflammatory and pathological processes in the uterus, as well as fibroids, an anomaly of the anatomy of the structure of the reproductive organ.
3. The cause of placental abruption in early pregnancy can be an unhe althy lifestyle - smoking, alcohol, unbalanced diet.
4. Detachment of the "children's place" can be affected by injuries of the abdomen, falls, bruises, excessive physical activity.
5. Multiple births.
6. Complicating factors such as multiple pregnancies, polyhydramnios, short umbilical cord, old age of the mother, many abortions prior to this pregnancy.
7. Disorders of the immune system.
8. Postterm pregnancy.
9. In rare cases, early placental abruption is possible due to an allergic reaction to the administration of medications or donated blood.
10. Rhesus conflict between mother and fetus.

Symptoms of pathology

In the early stages, the symptoms of mild placental abruption often do not manifest themselves. A woman may feel a pulling pain in the lower abdomen, but do not attach any importance to this, considering this to be the norm.

The average degree is characterized by pain in the lower abdomen (as a rule, they have a pulling character), slight bleeding. On palpation, the doctor detects uterine hypertonicity.

Severe degree of pathology manifests itself in the form of symptoms:

1. Severe abdominal pain, theymay have a different character: from dull and aching to acute. Feelings radiate to the groin or hip area.
2. Increased tone of the uterus and its asymmetric location.
3. Bleeding can be internal and external, as well as mixed. The color of the discharge is scarlet to dark red, depending on the age of the pathology.
4. Critical condition of a woman - lowering blood pressure, increased pulse and heart rate, pallor of the skin, dizziness, fainting.
5. Oxygen deficiency in the fetus, as evidenced by a violation of its cardiac activity. With a severe degree of placental abruption in the early stages, the loss of a child can become a consequence of hypoxia.

At least one symptom requires an immediate medical examination.

Diagnosis

As already mentioned, it is difficult to visually determine the rejection of placental tissues in a mild form, it can only be noticed during a routine examination or after the birth of a child and a “baby place”.

With moderate and severe forms of pathology, it is easier to make a diagnosis. The doctor takes into account the general symptoms and condition of the pregnant woman. For reliability, a gynecological examination with palpation is performed.

Regardless of the cause of placental abruption in early pregnancy, the observing gynecologist should determine the size of the rejection site, as well as its localization. For this, an ultrasound examination is prescribed.

Dopplerographywill determine whether there are violations of the movement of blood through the vessels between the fetus and the mother. To diagnose the degree of fetal hypoxia, cardiotocography is performed.

Treatment of placental abruption in early pregnancy

Despite the frightening diagnosis, rejection of placental tissue is not so dangerous if the lesion is not very large. The main thing is to diagnose it in time and start treatment. It is necessary to ensure that the pathology does not progress. With the right medical intervention carried out in time, the pregnancy can be saved and the negative consequences for the fetus are minimally reduced.

If the focus of detachment is partial, and the pathology does not progress, in the first trimester the woman is placed in a hospital. The attending physician prescribes:

• Bed rest. Since physical exertion can become the causes of placental abruption in the early stages, it is important for the patient to ensure complete rest. It is also necessary to limit exposure, stress and strong emotional impressions.
• Sex life with this pathology in the first trimester of pregnancy is not recommended.
• Drugs that stop blood loss ("Vikasol").
• Drugs against anemia (replenishing iron deficiency). Foods that increase hemoglobin levels will also help.

• Drugs that reduce the tone of the uterus to reduce the tone of the uterus, antispasmodics ("Papaverine"). In addition, magnesium sulfate solution is prescribed in the form of droppers or injections.
• Medicines to relieve painsensations.
• A diet is mandatory. Foods that can tone the uterus (chocolate, spicy dishes, spices) are excluded from the diet of a pregnant woman.
• The stool of a pregnant woman must be controlled. She shouldn't be constipated. The act of defecation should be carried out easily, without strong tensions and attempts.

The gynecologist will constantly monitor the patient's condition with the help of blood tests, dynamic ultrasound, coagulogram and dopplerography.

These activities can protect the woman and the child from further development of pathology.

If rejection started in the third trimester of pregnancy, retention is usually not practiced. Provided that the woman is already ready to give birth on her own, and her birth canal has entered the active phase, the amniotic bladder is punctured. After that, regular contractions begin. The process is being carefully monitored by heart monitors.

A woman who is unable to give birth on her own is scheduled for a caesarean section. In severe cases (with internal bleeding), stimulation will be performed at any term of the fetus. When the baby's head is already in the narrow part of the mother's pelvis, special obstetric forceps are used. In case of placental rejection, delay will lead to the death of the child, so he needs help to be born faster.

After removing the baby and the “baby seat”, you need to make sure that there are no blood clots left. Changes in the myometrium of the uterus can lead to its removal.

At the end of the procedure, drugs are prescribed that do not allowblood loss, painkillers. If necessary, the woman is prescribed anti-shock therapy.

Consequences of pathology

A mild form of rejection of placental tissue, with timely diagnosis and proper treatment, can do without consequences. Placental abruption (in the early stages) of moderate degree in half of the cases ends in fetal death. With a severe form of pathology, the child does not survive. There is also a serious risk for the mother.

The consequences for a pregnant woman can be fatal. The development of heavy bleeding leads to the formation of a hematoma behind the uterus. This phenomenon is called the uterus of Couvelaire (after the French gynecologist who first described it). In severe cases, in order to save the patient's life, doctors have to remove this organ. Thus, the development of placental rejection can deprive a woman of reproductive function.

Large blood loss leads to anemia and the development of thrombohemorrhagic syndrome. Together, these factors can lead to a fatal outcome for a woman.

The worst case for the consequences of placental abruption in early pregnancy for the embryo is its death. It occurs when rejection exceeds the threshold of 1/3 of the part. If such detachment occurs in the last weeks of pregnancy, an emergency birth can save the baby. The baby will be born prematurely, which implies a rehabilitation period.

If the detachment was mild to moderate, and it does not progress, then the woman can carry the pregnancy under full medical supervision.

Rejection of any degree is accompanied by fetal hypoxia, since the child begins to receive less oxygen and nutrients from the mother through the vessels. With rejection of 1/4 of the fetus, the initial stage of hypoxia is diagnosed. With detachment from 1/4 to 1/3 - a severe stage of oxygen starvation. This condition will affect the he alth of the newborn and its development in the future. The baby will need to be observed by a neurologist throughout childhood.

Reviews

There are many reports from women about placental abruption in early pregnancy. Rejection of the "children's place" before natural childbirth is one of the most common threats to pregnancy and the causes of fetal loss. Therefore, if any symptoms of this pathology occur, the gynecologist immediately sends the woman to the hospital.

What do doctors say about placental abruption in early pregnancy? Reviews allow us to conclude that the mild stage of the pathology is, in principle, a common phenomenon, easily amenable to therapy.

The main thing is to stay calm and follow all the recommendations of the obstetrician-gynecologist.

Severe pathology is critical. In this case, in rare cases, it is possible to save the pregnancy. In this situation, doctors are fighting mainly for the he alth and life of a woman.

Ladies who experienced placental tissue rejection in the first trimester say they rarely experienced all of these symptoms. As you can see, sometimes it's better to rely on your own intuition.and play it safe.

Basically, everyone felt pain in the lower abdomen and spotting. For some, they were significant, for others they were only "smeared".

Many women are advised not to insist on keeping the pregnancy if there is heavy bleeding, as they believe that there is no guarantee that the baby will be born without deviations.

Also, women and doctors advise after a miscarriage (if it happened) not to get pregnant again almost immediately. It is imperative to give time to the body and the uterus to recover so that a second miscarriage does not occur.

Is it possible to prevent the development of pathology

Pregnant women, who have heard about the risk of placental abruption, try to avoid this trouble. Unfortunately, sometimes this happens even to perfectly he althy people.

To reduce the chance of early detachment, women are encouraged to plan pregnancy. Until then, you need to give up all bad habits in advance and switch to a balanced diet.

Before conception, a girl must undergo a complete medical examination to detect diseases. If there are any he alth deviations from the norm, it is recommended to be treated first. If the disease is chronic and not amenable to therapy, the woman should be under the control of a specialist during the entire pregnancy.

It is impossible to predict rejection if the cause of early placental abruption is trauma or a fall. We can only recommend not to be in places where accumulatesmany people, avoid slippery and difficult terrain, do not go out unaccompanied if there is a possibility of fainting or sudden muscle weakness. Do not make long trips, especially off-road. Also, you can not expose the body to vibrations and sudden movements, for example, visit attractions, a water park and other similar entertainment centers.

Close people of a woman in an interesting position should protect her from stress and strong emotional upheavals.

In the event of a detachment of the "children's place" ahead of schedule, it is important not to panic, but immediately seek qualified help. The modern level of medicine allows you to save the fetus.