Obstetrics and gynecology. Premature abruption of a normally located placenta (most important)

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Obstetrics and gynecology. Premature abruption of a normally located placenta (most important)

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25. Premature detachment of a normally located placenta

Premature detachment of a normally located placenta is a pathological condition in which the placenta is not separated in time. Detachment of the patient occurs during pregnancy or during the course of childbirth. It is accompanied by profuse bleeding with the development of corresponding complications in the form of hemorrhagic shock and DIC.

The causes leading to the occurrence of premature detachment of a normally located placenta are divided into two groups.

The first group of - these are the factors that directly lead to the development of this complication: prolonged preeclampsia; diseases accompanied by changes in blood pressure, heart defects, diseases of the urinary system, thyroid gland, adrenal cortex, diabetes mellitus; incompatibility of mother and fetus according to the Rh factor or blood type; diseases of the blood and connective tissue; changes in the uterus of an inflammatory or cicatricial nature.

The second group of reasons - these are factors leading to premature detachment of the placenta against the background of existing disorders: overstretching of the walls of the uterus due to a large amount of amniotic fluid, multiple pregnancy, too large a fetus; untimely, rapid discharge of amniotic fluid with polyhydramnios; traumatic injury to the placenta (fall, blow to the stomach); violation of synchrony in the contractile activity of the uterus; inadequate use of uterotonic drugs in childbirth.

With detachment of a small area of the placenta, a retroplacental hematoma may form.

Premature placental abruption can be mild or severe. With a mild form of premature placental abruption, there is a small bloody discharge from the vagina, the tone of the uterus is unchanged, but some tension is noted, the woman's condition is satisfactory, the fetal heartbeat is normal.

In a severe form of premature detachment of the placenta, pain with severe bleeding is noted. In case of accumulation of blood between the wall of the placenta and the uterus, there may be no bleeding, a retroplacental hematoma forms in this place, a local painful swelling occurs with an increase in pain and spread to all parts of the uterus.

Local pain may be unexpressed in cases where the placenta is located on the posterior wall of the uterus, as well as when blood flows out. In this case, the following signs are noted: frequent pulse and respiration, arterial hypotension, moisture and pallor of the skin, weakness, dizziness, bloating. Note the tension and soreness of the uterus. The uterus becomes asymmetrical.

With the onset of placental abruption, signs of fetal hypoxia increase. Fetal death can occur as a result of an increase in retroplacental hematoma up to 500 ml, as well as an increase in the area of placental abruption by one third.

There are symptoms of a violation of blood clotting up to the complete absence of blood clotting.

Author: Ivanov A.I.

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