Not long ago, I was on duty in the emergency department, and at about 10 o'clock at night, I received a pregnant mother who was 33 weeks pregnant, had abdominal pain, vaginal bleeding, and high blood pressure. 3 hours before the consultation, the mother-to-be had already felt mild abdominal pain and a little redness, but she did not care, thinking that she had eaten too much at night. It was not until she felt a significant decrease in fetal movement during the fetal movement that she rushed to the obstetric emergency department.
Our examination revealed that the fetal heart rate had slowed, considering the presence of intrauterine hypoxia in the fetus, accompanied by placental abruption, requiring an immediate emergency caesarean section. Our medical team immediately started the emergency process, although the rescue was timely, but the baby's small face was already bruised and in a state of hypoxia when he delivered, and he was immediately transferred to the neonatal intensive care unit. Fortunately, after follow-up positive treatment, the mother and baby are safe.
Among the many obstetric emergencies, placental abruption is a very serious obstetric complication, and once it occurs, regardless of the size of the pregnancy, the mother and baby may face serious consequences.
What is placental abruption?
Normally, the placenta attaches to the inner wall of the uterine cavity and peels off and delivers out of the uterine wall within 30 minutes of delivery of the fetus.
Placental abruption, as the name suggests, is when the placenta is partially or completely stripped from the uterine wall before the fetus is delivered.
The main function of the placenta is to provide nutrients and oxygen for the fetus, so small area of placental abruption can easily lead to fetal growth and development restrictions, and large areas of placental peeling are easy to cause fetal intrauterine hypoxia, fetal distress, premature birth, and even stillbirth, stillbirth and other serious consequences. This is also a major reason why babies of older pregnancy age are "stillborn intrauterine".
On the other hand, placental detachment is manifested as postplacental hematoma or bleeding, and when the amount of bleeding is excessive, it can cause hemorrhagic shock, disseminated intravascular coagulation (DIC), amniotic fluid embolism, multi-organ failure, etc. in pregnant women, endangering the life of pregnant women.
Abdominal pain, vaginal bleeding, be vigilant
Placental abruption can be divided into overt, implicit and mixed peels, and the symptoms of placental abruption are related to their typing and severity...
Note: Placental abruption type
These complex knowledge points are not to see you dizzy, it does not matter, you just need to remember two major symptoms:
Abdominal pain, vaginal bleeding
And note that it is often accompanied by decreased or absent fetal movements.
It is worth mentioning that the size of the placental stripping area does not necessarily match the amount of vaginal bleeding.
If the edge of the placenta and the uterine wall are not peeled off, or the fetal head enters the pelvic entrance to compress the lower edge of the placenta, so that blood accumulates between the placenta and the uterine wall and cannot flow out, it will not manifest as vaginal bleeding, at this time may only feel mild or severe abdominal pain, almost no bleeding, but this does not mean that the disease is not serious!
If there is a certain amount of blood accumulated after the placenta, the blood rushes through the edges of the placenta and the membrane, or it will show vaginal bleeding. At this time, the condition is often very serious, and even endangers the lives of expectant mothers and babies.
Placental abruption is prone to these conditions
Although placental abruption is severe, expectant mothers don't have to be too anxious and nervous. The incidence of placental abruption is not high, about 1-2%. However, the following conditions can increase the risk of placental abruption, so be vigilant!
1. There is vascular lesion
Such as hypertensive diseases during pregnancy, diabetes mellitus during pregnancy, chronic kidney disease, systemic vascular lesions, etc. Such diseases can cause ischemia necrosis of the distal capillaries of the deciduous molting membrane (that is, the maternal part of the placenta), rupture and bleeding of the vascular wall, and the formation of postplain hematoma, and the gradual increase in the area can lead to placental abruption.
2. Mechanical factors
Severe impact or squeezing of the abdomen of pregnant women can induce placental abruption; when the umbilical cord is too short, the fetus descends after delivery and pulls the umbilical cord, which can also cause placental abruption.
3. The pressure in the uterine cavity is suddenly reduced
Amniotic fluid flowing out too quickly during premature rupture of membranes and delivery of the first fetus during twin birth are prone to a sudden reduction in intrauterine pressure, which may cause placental abrupt disuse.
4. Uterine venous pressure rises suddenly
It is more common in the third trimester of pregnancy or during childbirth, and pregnant mothers cause supine hypotension syndrome in the supine position for a long time, and the inferior vena cava and pelvic vein return are obstructed, resulting in placental abruption.
5. Others
The risk of placental abruption will also increase in advanced age, maternal passage, multiple abortions, assisted reproductive technology conception, the use of anticoagulants during pregnancy, and bad habits such as smoking, alcoholism, and drug abuse.
How to prevent placental abruption?
1. Regular obstetric examination
On the one hand, abnormalities can be detected in time; on the other hand, hospitals can give priority monitoring and early intervention to pregnant women with high risk factors, and if a critical situation occurs, they can also identify and treat them with emergency treatment as soon as possible.
2. Active treatment can easily lead to the primary disease of placental abruption
For example, pregnant women with hypertensive diseases in pregnancy and diabetes during pregnancy should control blood pressure and blood sugar during pregnancy, avoid frequent blood pressure is too high or fluctuate too much, and keep blood sugar stable.
3. Pay attention to safety
Avoid falling or causing the abdomen to be impacted and squeezed.
4. Avoid staying in the supine position for a long time in the third trimester
Not only is it prone to placental abruption, but it is also easy to form deep vein thrombosis.
5. Abdominal pain, vaginal bleeding or abnormal fetal movements, timely consultation!
This is very, very, very important!!!
As long as expectant mothers do these 5 points, I believe that everyone will be able to safely pass the pregnancy.
Author Introduction
Yi Sun, Attending Physician, MD, Visiting Scholar in Obstetrics and Gynaecology, University of Auckland, New Zealand. He is good at the diagnosis and treatment of pregnancy-related diseases (such as gestational hypertension, gestational diabetes, etc.), mental health assessment during pregnancy, and especially good at the diagnosis and treatment of various complications during childbirth (such as obstructed labor, caesarean section, forceps midwifery, etc.).
Auditing Specialist
Xia Xian, M.D., Deputy Chief Physician, Intermediate Psychotherapist, Secondary Psychological Counselor. Deputy Director of General Physiological Obstetrics, Director of Huangpu Maternity Ward, Head of Maternal Mental Health Clinic. He is a member of the Infant and Young Child Mental Health Committee of the Maternal and Child Health Research Association, and a member of the Psychosomatic Medicine Branch of the Shanghai Medical Association.
Specialties: maternal health, assessment of mode of delivery, psychological assessment and counselling. He has rich experience in the diagnosis and treatment of high-risk pregnancies (such as gestational diabetes, thyroid dysfunction, hypertension during pregnancy, etc.).
Clinic Hours:
Wednesday and Friday mornings (Huangpu Campus)
Author: Yang Zuwei, Sun Yi
Editor: Li Miaoran