Obstetrics and gynecology. Diagnosis, delivery of premature placental abruption (most important)

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Obstetrics and gynecology. Diagnosis, delivery of premature placental abruption (most important)

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26. Diagnosis, delivery in case of premature detachment of the placenta

Diagnosis of premature detachment of a normally located placenta is based on clinical manifestations. These include the presence of bloody discharge from the vagina against the background of increased uterine tone, a change in the shape of the uterus, increasing signs of fetal hypoxia. When making a diagnosis, the complaints of the pregnant woman, the data of the anamnesis, the clinical course of the complication, as well as the results of an objective, instrumental and laboratory study, in particular ultrasound, which makes it possible to determine the volume and boundaries of the retroplacental hematoma, are taken into account.

Delivery with premature placental abruption. Emergency caesarean section is indicated in cases of progression of placental abruption and impossibility of vaginal delivery. Opening the amniotic sac is contraindicated in the absence of labor, since premature placental abruption may worsen as a result of decreased intrauterine pressure.

Expectant management of labor is possible in the conditions of an extended operating room of the maternity hospital in the case of minor placental abruption, the absence of anemia and signs of fetal hypoxia, with a satisfactory condition of the woman. At the same time, careful simultaneous monitoring of the fetus and placenta is carried out. With the progression of placental abruption, accompanied by repeated bleeding, according to vital indications, both from the side of the mother and from the side of the fetus, an emergency caesarean section is performed.

Delivery through the natural birth canal is possible with a mild form of placental abruption, in the case of head presentation of the fetus, with a mature cervix, the correspondence of the fetal head to the mother's pelvis, and under the condition of normal labor activity.

The opening of the fetal bladder is carried out with the development of regular labor activity. The opening of the fetal bladder leads to a decrease in the tone of the uterus, thereby reducing bleeding. An increase in bleeding volume, progression of placental abruption, uterine hypertonicity, and an increase in fetal hypoxia are indications for caesarean section.

After the birth of the fetus, it is necessary to immediately proceed to the manual separation of the placenta and the allocation of the placenta, after which they are examined with the help of mirrors of the cervix and vaginal walls for damage and their elimination.

Preventive measures. All pregnant women must be examined to identify possible risk factors leading to premature separation of a normally located placenta. Pregnant women are treated if risk factors are identified. Particular attention should be paid to pregnant women with gestosis. If there is no effect from the therapy, the pregnant woman must be hospitalized in a maternity hospital. Pregnant women are subject to mandatory hospitalization at 38 weeks. The issue of timing and method of delivery is decided on an individual basis.

Author: Ivanov A.I.

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