The modern rhythm of life and the abundance of stress often cause placental abruption in the early stages of pregnancy. With such a pathology, many women are on conservation. During the first trimester, any negative impact on the physical or moral state of the mother can be fatal. But if you notice a deviation in time, there is every chance of avoiding the loss of a child.
What is the placenta
The placenta is a unique organ, it is formed in the female body and is necessary only during pregnancy. It has a round shape, flattened on the sides, which is why it bears such a name. From the Latin "placenta" is translated as "flat cake". The umbilical cord departs 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, successively passing through several stages.
The placenta should depart after the birth of the baby. If it is separated 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 degrees of maturity:
- Zero - up to 27-30 weeks. The use of tobacco and alcohol can contribute to the fact that the first degree of maturity comes ahead of schedule.
- The first - from 30 to 34 weeks. During this period, it ceases to grow, and begins to thicken.
- The second - from 34 to 37 weeks. This is the most stable stage.
- The third - from 37 weeks. From this moment, the process of natural aging is activated in the placental tissue. If it begins earlier, the child will not receive the necessary substances and oxygen in full. This can cause fetal pathologies and even death.
Excessive diets and lack of weight also cause premature aging of the "child's place". Pregnancy is not the time for diets.
The placenta consists 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 “child’s place”. Maternal blood washes them from the outside, but transfers oxygen and nutrients through the vessels. The embryo also pumps back carbon dioxide and metabolic products back to the mother. Being in the womb, the child does not breathe easy.
The placental barrier serves as a filter for substances coming from the mother's body. It skips useful ones, but blocks those that can harm a child. An interesting feature is that the toxins from the baby are transmitted to the woman, and in the opposite direction - practically none.
One of the main functions of the afterbirth is the production of hormones. Sex hormone begins to appear when the placenta is fully formed, it is necessary to maintain pregnancy. With his appearance, the threat of losing a child decreases significantly, doctors no longer need to administer hormonal drugs to a woman.
At first, the afterbirth grows faster than the baby. By the end of the first trimester (14th week), the embryo weighs about 25 grams, and the "child's place" is several times more. By the end of pregnancy, the placenta can reach a mass of 500-600 grams, and its circumference is up to 18 cm.
Severity
If the affected area is large, detachment of the placenta can lead to fetal death. Due to the separation of tissues, blood circulation between the mother and the child is disturbed. Exfoliation has several degrees of severity:
- Light - a small detachment of the placenta in the early stages. There may be no severe symptoms, it is possible to notice it only upon examination.
- Medium - accompanied by pain in the abdomen, the uterus is stony, bleeding is observed.
- Severe placental abruption in early pregnancy. Symptoms of an emergency are also manifested by bloody discharge of varying intensity. Additionally, nausea, vomiting, loss of consciousness, palpitations, asymmetric position of the uterus can be observed. Placental rejection by 1 / 3-1 / 2 leads to fetal death. There is also a serious risk to the mother.
Types of exfoliation
Tissue rejection can be different: a small detachment of the placenta (in the early stages of pregnancy is quite common) and complete detachment of the "child's place". With total defeat, fetal death occurs.
Partial withdrawal of the placenta from the uterine wall is observed in a separate area of the organ. It can increase in area or remain in the same size throughout pregnancy during thrombosis of the uterus.
The marginal separation of the placental tissue and the central one are also distinguished. In the latter form, there is no external bleeding.
It should be noted that during the first six weeks of pregnancy, the placenta itself does not exist. In very early stages, it is called the chorion and is located around the entire ovum. As a rule, the detachment of the chorion leads to spontaneous miscarriage.
Causes
There are a lot of reasons for placental abruption in the early stages of pregnancy, sometimes they act in the aggregate.
- Pathological changes in the vessels that interfere with blood circulation between the uterus and the placenta. These disorders occur in pregnant women due to obesity, diabetes mellitus, infectious diseases of the kidneys, and hypertension. With pathology, capillaries become brittle and brittle, heart attacks and thromboses of placental tissue occur. As a result of poor 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 critical situation.
- Inflammatory and pathological processes in the uterus, as well as myoma, anomaly in the anatomy of the structure of the reproductive organ.
- The cause of placental abruption in early pregnancy can be an unhealthy lifestyle - smoking, alcohol, unbalanced nutrition.
- The detachment of the "child's place" can be affected by injuries of the abdomen, falls, bruises, excessive physical exertion.
- Multiple births.
- Complicating factors, such as multiple pregnancy, polyhydramnios, short umbilical cord, maternal age, many abortions before this pregnancy.
- Immune system disorders.
- Postponed pregnancy.
- In rare cases, placental abruption is possible in the early stages due to an allergic reaction to the administration of medications or donated blood.
- Rhesus conflict of mother and fetus.
Symptoms of pathology
In the early stages, symptoms of mild placental abruption often do not appear. A woman may feel a pulling pain in the lower abdomen, but not attach importance to this, considering it the norm.
The average degree is characterized by pains in the lower abdomen (as a rule, they have a pulling character), insignificant blood secretions. On palpation, the doctor discovers uterine hypertonicity.
A severe degree of pathology manifests itself in the form of symptoms:
- Severe abdominal pain, they can have a different nature: from dull and aching to acute. Sensations are given to the inguinal or hip area.
- The increased tone of the uterus and its asymmetric location.
- Bleeding can be internal and external, as well as mixed. The color of the discharge is from scarlet to dark red, which depends on the prescription of the pathology.
- The critical condition of a woman is a decrease in blood pressure, increased heart rate and heart rate, pallor of the skin, dizziness, fainting.
- 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 consequence of hypoxia can be the loss of a child.
If at least one symptom is detected, an immediate medical examination is required.
Diagnostics
As already mentioned, it is difficult to visually determine the rejection of placental tissues in a mild form, it can be noticed only during a routine examination or after the birth of a child and a "child's place".
With an average and severe form 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 must identify the size of the rejection site, as well as its location. For this, an ultrasound examination is prescribed.
Dopplerography will determine if there is a violation 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 the 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 on time, pregnancy can be maintained and the negative consequences for the fetus minimized.
If the focus of exfoliation is partial, and the pathology does not progress, in the first trimester a woman is placed in a hospital. The attending physician prescribes:
- Bed rest. Since the causes of placental abruption in the early stages may be physical exertion, it is important for the patient to ensure complete rest. It is also necessary to limit exposure, stress and strong emotional experiences.
- Sex life with such a pathology in the first trimester of pregnancy is not recommended.
- Drugs that stop blood loss ("Vikasol").
- Drugs against anemia (supplementing iron deficiency). Products that increase hemoglobin levels will also help.
- Medications that reduce the tone of the uterus to reduce the tone of the uterus, antispasmodics (Papaverine). In addition, a solution of magnesium sulfate is prescribed in the form of droppers or injections.
- Medicines to relieve pain.
- Be sure to assign a diet. Products that can bring the uterus into tone (chocolate, spicy dishes, spices) are excluded from the pregnant woman’s diet.
- Be sure to control the stool of a pregnant woman. She should not have constipation. The bowel movement should be carried out easily, without strong stress and effort.
The gynecologist will constantly monitor the patient's condition with the help of blood tests, dynamic ultrasound examinations, coagulation and Doppler ultrasound.
These measures can protect a woman and a child from the further development of pathology.
If rejection began in the third trimester of pregnancy, preservation is usually not practiced. Provided that the woman is ready to give birth on her own, and her birth canal has entered the active phase, an amniotic bladder is punctured. After this, regular contractions begin. The process takes place under the close supervision of cardiomonitors.
A woman who is not able to give birth on her own is given a cesarean section. In severe cases (with internal bleeding), stimulation will be performed at any period of the fetus. When the baby’s head is already in the narrow part of the pelvis of the woman in labor, special obstetric forceps are used. When the placenta is rejected, procrastination will lead to the death of the child, so he needs to help to be born faster.
After removing the child and the "child's place", you need to make sure that there are no blood clots left. A change in the uterine myometrium can lead to its removal.
At the end of the procedure, drugs are prescribed that do not allow blood loss, painkillers. If necessary, a woman is prescribed antishock therapy.
The consequences of pathology
A mild form of placental tissue rejection with a timely diagnosis and correct treatment can do without consequences. Placental abruption (in the early stages) of an average degree in half the cases ends in fetal death. With a severe form of pathology, the child does not survive. There is a serious risk for the mother.
The consequences for a pregnant woman can be fatal. The development of profuse bleeding leads to the formation of a hematoma behind the uterus. This phenomenon is called the uterus of Kouveler (named after the French gynecologist who first described him). In severe cases, to save the patient’s life, doctors have to remove this organ. Thus, the development of placental rejection may deprive a woman of reproductive function.
Large blood loss leads to anemia and the development of thrombohemorrhagic syndrome. Together, these factors can be fatal for a woman.
The worst variant of the consequences of placental abruption in the early stages of 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, the baby can be saved by emergency birth. The baby will be born prematurely, which implies a rehabilitation period.
If the detachment was mild to moderate, while it does not progress, then a woman can report a pregnancy subject to full medical control.
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 exfoliation from 1/4 to 1/3 - a severe stage of oxygen starvation. This condition will further affect the health of the newborn and its development. Throughout childhood, the baby will need to be observed by a neurologist.
Reviews
There are many reports of women about placental abruption in early pregnancy. The rejection of the "child's place" before the natural birth is one of the most frequent 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? The reviews allow us to conclude that the easy stage of the pathology is, in principle, a common phenomenon, easily amenable to therapy.
The main thing is to remain calm and comply with all the recommendations of the obstetrician-gynecologist.
A severe form of pathology is critical. Moreover, in a rare case, it is possible to maintain a pregnancy. In this situation, doctors fight mainly for the health and life of a woman.
Ladies who underwent rejection of placental tissue in the first trimester, say that they rarely experienced all of these symptoms. As you can see, sometimes it is better to rely on your own intuition and play it safe.
Basically, everyone felt pain in the lower abdomen and spotting. In some, they were significant, in others they were only "smeared."
Many women advise not to insist on maintaining 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 become pregnant again almost immediately. It is necessary to give time to the body and uterus to recover, so that a repeated 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 with absolutely healthy people.
To reduce the likelihood of an early detachment, women are advised to plan a pregnancy. Up to this point, you need to give up all bad habits in advance and switch to a balanced diet.
Before conception, the girl must undergo a complete medical examination to identify diseases. If there are any health deviations from the norm, it is recommended to be treated first. If the disease is chronic and does not respond to therapy, the woman should be monitored by a specialist throughout pregnancy.
It is impossible to predict rejection if the cause of placental abruption in the early period was an injury or a fall. You can only recommend not to be in places where many people gather, to avoid slippery and difficult terrain, not to go unaccompanied, if there is a possibility of fainting or sudden muscle weakness. You can not make long trips, especially on the road. Also, you can not expose the body to vibrations and sudden movements, for example, to visit attractions, a water park and other similar entertainment centers.
Close friends of a woman in an interesting position should protect her from stress and severe emotional upheaval.
If there is a detachment of the "child'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.