We know that pregnancy is a special period during which unfortunately not everything always goes as planned. Some pregnant women may therefore suffer from a detachment of the placenta of varying degrees of severity with more or less serious consequences. Risk factors, symptoms, treatment … Let's take stock of placental abruption to better identify it and treat it as quickly as possible.
Her name alone is enough to tell any pregnant woman that what is happening does not bode well: placental abruption occurs during pregnancy, when the placenta no longer adheres to the uterine wall on which it is located. usually throughout the pregnancy. The placenta must indeed accompany the fetus in the uterus until birth as its role is vital. Because it allows you to feed your future baby as long as it is in your womb, not only in carbohydrates, lipids and proteins, but also in oxygen, water, mineral salts and it is also an important source of hormones . The placenta also acts as a filter to protect the fetus, but unfortunately it cannot stop everything. Thus, many viruses and parasites, such as toxoplasma that every pregnant woman regularly hears about, but also alcohol, tobacco and drugs cross the placenta.
When and how can a placental abruption occur?
You will understand and you certainly already knew it, the placenta is an essential partner for your unborn baby, so we do not want complications to arise during pregnancy, which could weaken it and cause fetal suffering.
Unfortunately, in about 0.4 to 1.5% of pregnancies, premature placental abruption, partial in some cases, will occur before birth, without an exact explanation of the cause (s). When it occurs during the first two months of pregnancy, when the placenta has not yet formed, it is then called trophoblastic detachment, because it is the trophoblast – this area where the egg is implanted – which will allow the development of the placenta and then give way to it.
What are the symptoms of a placental abruption?
Several symptoms should alert the mother-to-be that a placental abruption may be occurring. First, be aware that a placental abruption, also called a retroplacental hematoma, usually occurs after the 21st week of pregnancy. If such an event occurs, you could then potentially suffer from more or less significant bleeding, or intense pain in the stomach or even contractions. The blood loss may be bright red or dark red, continuous or irregular, but some women do not have bleeding.
Only one of these signs, whether it is a slight bleeding or a more severe bleeding, or an abnormal pain, should therefore alert you and make you consult a doctor as soon as possible. You will then most likely be given an ultrasound to verify the diagnosis of a placental abruption, if that is another problem, or if this is all just a false alarm.
What are the consequences of a placental abruption?
Because the placenta provides the fetus with oxygen and nutrients, detachment can be extremely dangerous. If it occurs suddenly and the oxygen supply is suddenly reduced, the fetus may die. If the detachment is progressive, the consequences may be less serious, but the fetus may then be stunted in intrauterine growth or the amniotic fluid may problematically decrease.
To control these possible problems, doctors will certainly have recourse to a blood test and monitoring of the fetal heart rate, always through ultrasound or monitoring.
If the detachment takes place during the first trimester of pregnancy and a heartbeat is still detected, then it is very likely that the hematoma will gradually resolve on its own after a few weeks, and the pregnancy may go away. continue until its term, ie 37 weeks minimum. If no heartbeat is found, then the hematoma may unfortunately only have been a sign of a miscarriage occurring.
For a detachment in the second or third trimester of pregnancy, it may then be a marginal decidual hematoma, for which the detachment will then be only partial, or, more serious, a retro-placental hematoma, which will cut then more or less the circulation of blood between mother and child.
What are the treatments for a placental abruption?
Unfortunately, there is no treatment for placental abruption, other than extreme rest with sick leave, when the hematoma is not too large, with, of course, particularly serious medical supervision, and in some cases even hospitalization. To promote rest, the expectant mother is then generally bedridden, in a sitting and / or lying position, and sexual intercourse is not recommended.
When the detachment is more severe and occurs in the third trimester, premature delivery, usually by cesarean section for fetal extraction, may be considered to save the child's life, especially when the mother continues to bleed, when the fetal heartbeat is abnormal and when the pregnancy is term, after the 38th week. The mother will then be prescribed corticosteroids to speed up the development of the baby's lungs.
The mother's life is more rarely in danger: coagulation problems can, for example, cause a significant hemorrhage, especially in a pregnant woman suffering from pre-eclampsia.
What are the risk factors for placental abruption?
While we do not know the exact causes of placental abruption, we do know that certain factors increase the risk of it happening. Among these, we find arterial hypertension, and in particular pre-eclampsia, this hypertension which appears during pregnancy, the consumption of tobacco and drugs, in particular cocaine, an abdominal shock, problems of the vessels. blood, a history of retroplacental hematoma, or a rather advanced age for pregnancy (after 35 years).
In all cases, the different pregnancies are the times when the woman must pay particular attention to her health, whatever her age, not to take risks and to be monitored regularly by her doctor and midwife, in order to preserve in turn the health of his child.
What is the difference with a placenta previa?
Placental abruption should not be confused with placenta previa which indicates that the placenta is located above or next to the cervix, in the lower part of the uterus, whereas it should normally be positioned in the part superior. Placenta previa can cause painless but fairly severe bleeding. This type of massive bleeding will then certainly require a cesarean delivery.
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