Premature placental detachment

Description:

Premature amotio of normally located placenta is a complication which is shown by untimely department of a placenta which occurs not after the fruit birth as it has to be normal, and during pregnancy or in the course of the course of childbirth. This complication meets frequency of 0,5 - 1,5% of cases. In 1/3 cases premature placental detachment is followed by plentiful bleeding, with development of the corresponding complications in the form of hemorrhagic shock and the IDCS (the disseminated intravascular blood coagulation).

Symptoms of Premature placental detachment:

If the site of placental detachment small, then after formation of a retroplacental hematoma thrombosing of uterine vessels is possible, and further placental detachment stops. At considerable placental detachment, plentiful bleeding and an extensive retroplacental hematoma, the streaming blood can impregnate a uterus wall that leads to disturbance of its sokratitelny ability. Such fortune was come into by the name "Kuveler's uterus" by the name of A.Couvelaire, for the first time described a similar picture.

If placental detachment forms closer to its edge, then blood, getting between fetal membranes and a wall of a uterus streams in a vagina that is shown by outside bleeding. At emergence of bleeding right after placental detachment the blood expiring from a vagina, usually scarlet color, dark blood with clots is noted if from the amotio moment before emergence of bleeding there passed some time.

Premature placental detachment can proceed benign, a condition of the patient at the same time most often satisfactory, the uterus in a usual tone or is a little strained, heartbeat of a fruit does not suffer, bloody allocations from a vagina in a small amount are observed.

The severe form of placental detachment is, as a rule, characterized by the expressed bleeding and considerable pain. However bleedings can not be if blood accumulates between a placenta and a wall of a uterus. In that area of a uterus where the placenta is located, in connection with formation of a retroplacental hematoma the local swelling is formed, and there are pains which quickly amplify and gradually extend to other departments of a uterus.

At a placenta arrangement on a back wall of pain have diffuse and not clear character. Local morbidity can be poorly expressed or is not expressed in general at the blood expiration outside. The uterus becomes intense, painful, gets an asymmetric form. The stomach is blown up, at the patient weakness, dizziness, vomiting is observed. Skin is cold, wet and pale. Breath is speeded up, pulse frequent, arterial pressure is reduced.

Along with amotio signs of the increasing shortage of oxygen at a fruit appear. At the size of a retroplacental hematoma of 500 ml and more and/or the areas amotio more than 1/3, the probability of death of a fruit is highest.

At the progressing bleeding and increase in an interval of time from the placental detachment moment before delivery, the phenomena of disturbance of coagulant system of blood accrue that finally is shown by the fact that blood in general ceases to turn.

Reasons of Premature placental detachment:

Premature amotio of normally located placenta develops at primapara women more often. At premature births placental detachment is observed by 3 times more often than at timely. The reasons which lead to emergence of premature amotio of normally located placenta can conditionally be divided into two groups.

The first group is the reasons which directly promote development of this complication. Carry to them: a gestosis (a nephropathy, late toxicosis) it is most often long current, not treated or insufficiently treated; various diseases from which diseases with increase or lowering of arterial pressure, heart diseases, diseases of kidneys, a diabetes mellitus, diseases of a thyroid gland, a disease of bark of adrenal glands are distinguished; incompatibility of blood of mother and a fruit on a Rhesus factor or on a blood group; anti-phospholipidic syndrome; system lupus erythematosus; blood diseases; inflammatory diseases of a uterus; the operations undergone on a uterus; uterus malformations; a placenta arrangement in a projection of a myomatous node; postmature pregnancy.

The second group of the reasons are the factors provoking emergence of premature placental detachment against the background of already existing disturbances. Treat them: restretching of walls of a uterus because of a hydramnion, polycarpous pregnancy, existence of a large fruit; sudden, bystry and plentiful izlity amniotic waters at a hydramnion; an injury (falling, blow in a stomach); diskoordination of sokratitelny activity of a uterus; the wrong use of uterotonichesky means in labor.

The listed factors lead to disturbance of bonds between a placenta and a wall of a uterus, to a rupture of vessels with formation of hemorrhage (a retroplacental hematoma).

Treatment of Premature placental detachment:

At the progressing premature placental detachment, its heavy current, and lack of conditions for urgent delivery in natural patrimonial ways (during pregnancy, irrespective of term, or at the time of delivery) it is necessary to execute only the emergency Cesarean section providing immediate delivery. In the absence of patrimonial activity it is not necessary to open a bag of waters as decrease in intrauterine pressure can worsen the begun premature placental detachment.

At the insignificant not progressing placental detachment during pregnancy, satisfactory condition of the patient, absence of anemia and signs of disturbance of a condition of a fruit, use of waiting tactics of maintaining in the conditions of a maternity home is possible. At the same time careful control of a condition of a fruit and placenta is necessary. For this purpose regularly carry out ultrasonography, a dopplerometriya, a kardiotokografiya. Estimate also a condition of coagulant system of blood. Carry out treatment of associated diseases and complications.

If there are repeated, even insignificant blood allocations testimonial of progressing of placental detachment, even at satisfactory condition of the pregnant woman, then it is necessary to refuse waiting tactics and to resolve an issue in favor of the emergency Cesarean section according to vital indications, both from mother, and from a fruit.

At an easy form of premature placental detachment conducting childbirth in natural patrimonial ways only at a favorable obstetric situation when head presentation, a mature neck of uterus, full proportionality of a head of a fruit and mother's basin, normal patrimonial activity takes place is possible. In the course of conducting childbirth in natural patrimonial ways it is necessary to carry out constant monitor control behind a condition of a fruit and a sokratitelny uterine activity and to organize careful medical observation.

At the developed regular patrimonial activity it is reasonable to open a bag of waters. At the same time reduction of volume of a uterus after an izlitiya of amniotic waters reduces a tone of a uterus and promotes reduction of bleeding. Rodovozbuzhdeniye and a rodostimulyation at premature placental detachment are contraindicated. At aggravation of amotio at the time of delivery, increase in intensity of bleeding, development of a hyper tone of a uterus and an aggravation of symptoms of a fruit, Cesarean section is shown.

Right after extraction of a fruit, in case of conducting childbirth in natural patrimonial ways, it is necessary to execute manual department of a placenta and allocation of an afterbirth. It is also necessary to examine by means of mirrors a neck of uterus and walls of a vagina for an exception of possible damages, and their elimination in case of detection.