What's going on
The placenta attaches to the wall of the uterus and provides the baby with oxygen and nutrition. During abruption, the vessels at the attachment site rupture, blood accumulates between the placenta and the uterus, forming a hematoma, which peels off the tissue further. The larger the area of detachment, the less working placenta remains and the more the child suffers. The blood can pour out, and then discharge appears, or remain inside - with such a hidden detachment, there is no visible bleeding, but the pain and tension of the uterus are very pronounced.
- Rupture of blood vessels at the placenta insertion site
- Hematoma formation and further detachment
- External bleeding - there is discharge
- Hidden bleeding - there may be no discharge
- Decreased oxygen supply to the baby
- Risk of maternal bleeding disorders
Risk factors
The main factor is high blood pressure and preeclampsia, which affects the blood vessels of the placenta. Abdominal trauma plays a significant role, including from a fall or a road accident, so after any blow to the abdomen, a pregnant woman needs to be examined by a doctor, even if she is feeling well. Smoking, drug use, multiple pregnancies, polyhydramnios with rapid rupture of water, a short umbilical cord, age over 35 years, and placental abruption in a previous pregnancy increase the risk.
- Arterial hypertension and preeclampsia
- Abdominal injury
- Smoking and drug use
- Multiple pregnancy
- Polyhydramnios and rapid rupture of water
- Past placental abruption
- Blood clotting disorders
Symptoms
The classic combination is abdominal pain and spotting in the second half of pregnancy. The pain is usually constant rather than cramping, and the uterus becomes firm, tense, and tender to the touch. The amount of blood does not reflect the severity: with a hidden detachment, there may be almost no discharge, and the condition is serious. A woman often notices a change in movements: at first they become violent, then weaken or disappear. Weakness, dizziness, pallor and rapid heartbeat occur.
- Constant abdominal pain
- Bloody discharge, sometimes absent
- Hard, tense, painful uterus
- Change or cessation of movements
- Lower back pain
- Weakness, dizziness, pallor
What to do and how to examine
There is only one correct action - immediately call 103 and lie on your side, without taking painkillers and without trying to get there on your own. In the hospital, the condition of the woman and child is assessed: they perform CTG, ultrasound with Doppler, take a general blood test, coagulogram and determine the blood type. It is important to know that ultrasound does not always detect a detachment, especially a fresh one, so the diagnosis is made primarily based on the clinical picture. Observation is carried out in conditions where immediate surgery is possible.
- Call an ambulance immediately
- Side lying position
- Fetal heart rate assessment and CTG
- Ultrasound with Doppler
- General blood test and coagulogram
- Determination of blood group and Rh factor
Treatment and prevention
Tactics depend on the area of the detachment, the duration of pregnancy and the condition of the mother and child. In case of severe abruption, fetal suffering or continued bleeding, an emergency cesarean section is performed and blood loss is replaced. If the detachment is small, the condition is stable, and the term is premature, observation in a hospital is possible to prepare the baby’s lungs for possible premature birth. Prevention comes down to monitoring blood pressure, quitting smoking, wearing a seat belt in a car, and timely visits to an obstetrician-gynecologist.
- Emergency delivery for severe abruption
- Replenishment of blood loss and correction of coagulation
- Observation in hospital for mild cases
- Blood pressure control
- Quitting smoking
- Correct use of seat belt
- Examination by a doctor after any abdominal injury
