Placental abruption is the premature detachment of the placenta from the wall of the uterus at 20 weeks or more of pregnancy.
Women may have abdominal pain and tenderness and vaginal bleeding and may go into shock.
When the placenta detaches too soon, the fetus may not grow as much as expected or may even die.
Doctors diagnose placental abruption based on symptoms and sometimes do ultrasonography to confirm the diagnosis.
If the fetus or the woman is in danger or if the pregnancy is at term, the baby is delivered as soon as possible.
The placenta may detach incompletely (sometimes just 10 to 20%) or completely. The cause of placental abruption is usually unknown.
Detachment of the placenta occurs in 0.4 to 1.5% of all pregnancies.
Matatizo ya Kondo la nyuma
Kwa kawaida, kondo linapatikana sehemu ya juu ya uterasi, na hujipachika kwenye ukuta wa uterasi baada ya mtoto kuzaliwa. Kondo hubeba oksijeni na virutubisho kutoka kwa mama hadi kwa kijusi. Wakati wa kondo kujitenganisha na mfuko wa uzazi (abruptio placentae), kondo linajitenganisha na ukuta wa uterasi kabla ya wakati unaofaa, hali inasyosababisha uterasi kuvuja damu na kupunguza kiasi cha oksijeni na virutubisho vinavyomfikia mtoto hupungua. Wanawake walio na tatizo hili hulazwa hospitalini, na huenda mtoto akazaliwa mapema. Kondo linapojipachika upande wa chini, huwa juu ya shingo ya kizazi, upande wa chini wa uterasi. Kondo kujipachika upande wa chini kunaweza kusababisha mama kuvuja damu ghafla bila maumivu yoyote, baada ya wiki 20 za ujauzito. Huenda mama akavuja damu nyingi. Kawaida mtoto huzaliwa kwa njia ya upasuaji. |
Viashiria vya hatari
Risk factors (conditions that increase the risk of a disorder) for placental abruption include the following:
Older age
High blood pressure (including preeclampsia, a type of high blood pressure that develops during pregnancy)
Lack of oxygen to the placenta
Infection in the tissues around the fetus (intraamniotic infection)
Vasculitis or other blood vessel disorders
Previous placental abruption
Abdominal injury
Blood clotting disorders such as antiphospholipid syndrome
Prelabor rupture of membranes, especially when there is too much amniotic fluid around the fetus (polyhydramnios)
Dalili za Kutenguka kwa Kondo la Nyuma
Symptoms of placental abruption depend on the degree of detachment and the amount of blood lost (which may be massive).
Symptoms may include sudden continuous or crampy abdominal pain, tenderness when the abdomen is gently pressed, and dangerously low blood pressure (shock). Some women have slight or no symptoms.
The uterus bleeds from the site where the placenta has detached. The blood may pass through the cervix and out the vagina as an external hemorrhage, or the blood may be trapped behind the placenta as a concealed hemorrhage. Thus, abdominal pain may seem worse than expected for the amount of blood lost. If bleeding occurs, the blood may be bright or dark red, and bleeding may be continuous or spotty.
Premature detachment of the placenta sometimes leads to severe blood loss with widespread clotting inside the blood vessels (disseminated intravascular coagulation), kidney failure, and bleeding into the walls of the uterus, especially in pregnant women who also have preeclampsia.
When the placenta detaches, the supply of oxygen and nutrients to the fetus may be reduced. If detachment occurs suddenly and greatly reduces the oxygen supply, the fetus may die. If it occurs gradually and less extensively, the fetus may not grow as much as expected (intrauterine growth restriction) or there may be too little amniotic fluid (oligohydramnios). Gradual detachment may cause less abdominal pain and have a lower risk of shock in the mother than sudden detachment, but the risk of subsequent prelabor rupture of membranes is increased.
Utambuzi wa Kutenguka kwa Kondo la Nyuma
Monitoring the fetus's heart rate
Sometimes blood tests
Sometimes ultrasonography
Doctors suspect and usually diagnose premature detachment of the placenta based on symptoms, such as vaginal bleeding and abdominal pain and tenderness.
Ultrasonography may help doctors confirm the diagnosis of premature detachment and distinguish it from placenta previa, which can cause similar symptoms. Ultrasonography may be done by placing a handheld device on the abdomen (called abdominal ultrasonography) or inside the vagina (called transvaginal ultrasonography). However, ultrasonography findings may be normal when the placenta detaches prematurely.
Doctors may measure blood pressure and do blood and urine tests to check for preeclampsia because it can increase the risk of problems.
To check for problems that premature detachment can cause, doctors may do blood tests and may monitor the fetus's heart rate.
Matibabu ya Kutenguka kwa Kondo la Nyuma
Sometimes hospitalization and monitoring
Sometimes prompt delivery
A woman with premature detachment of the placenta may be hospitalized depending on how severe the symptoms are and how long the pregnancy has lasted. Doctors also advise against sexual intercourse.
Hospitalization and monitoring are appropriate if all of the following are present:
The bleeding does not threaten the life of the mother or fetus but continues.
The fetus's heart rate is normal.
The pregnancy is preterm (less than 37 weeks).
This approach enables doctors to closely monitor the woman and fetus and, if needed, rapidly treat them. Usually, when the risk of early delivery is high, corticosteroids are also recommended (to help the fetus's lungs mature). If symptoms lessen and the fetus is not in danger, the woman may be discharged from the hospital.
Delivery is usually done as soon as possible if any of the following is present:
Bleeding continues or worsens.
The fetus's heart rate is abnormal (suggesting that the fetus is not getting enough oxygen).
The pregnancy is at term (37 weeks or more).
If vaginal delivery is not possible, a cesarean delivery is done.
If the woman goes into shock or disseminated intravascular coagulation develops, she is given blood transfusions and monitored in an intensive care unit.
