Placental detachment: the causes, risk factors and how to intervene promptly. The risks for the mother and the fetus
When you are in an interesting state everything is magnificent and every future mother always hopes that the pregnancy goes for the better. But sometimes it can happen, for reasons that we will soon see, what is commonly called “ detachment of the placenta” but what is it really? and what are the risks for the future mother and the fetus? What happens if during the pregnancy a detachment of the placenta occurs? Can we do something to prevent it? Surely yes, if this is taken in time. How to recognize, therefore, a detachment of the placenta and its symptoms? We try to shed light on all these questions that expectant mothers want to know. Always remembering that the first step to prevent certain consequences is being informed
Detachment of the placenta: what is it?
Let’s start by specifying what the placenta is. It is an organ that develops in the maternal uterus during pregnancy; separates the child’s blood from that of the mother, but provides a sort of connection in order to perform functions that the unborn child is not able to perform alone. Oxygen and nutrients pass from the maternal blood to that of the child, while the waste products follow the reverse path to be disposed of by the mother; the placenta also produces hormones that help the baby grow and develop, as well as providing some protection from infections during the nine months of gestation. The placenta is connected to the baby from the umbilical cord.
The placenta detachment in pregnancy consists in the separation premature placenta from the uterine mucosa, ie after the 20th week and before the secondmentation (with secondment we mean the natural expulsion of the placenta and fetal appendages, which usually occurs between 10 and 20 minutes after the expulsion of the fetus). What could happen if the placenta detaches? Separating part of the placental tissue, a sort of “ wound ” is created on the uterus which then begins to bleed. The blood, however, can:
- Manifesto: in which there is a loss of blood from the vagina, which therefore becomes visible on the outside and gives rise to an external bleeding.
- Occult or hidden: when there is no vaginal bleeding with formation of an internal retro-placental hematoma. That is, without you noticing,
- “break” the membranes and enter the amniotic fluid;
- the collection becomes wider and a real hematoma, clot, behind the placenta or infiltrate the uterine wall, giving the uterus the typical purplish, purple, blackish color.
Sometimes in pregnancy it can happen that by performing an obstetric ultrasound, the specialist notices a “ detachment of the placenta” the that could put you future mom in alarm and apprehension. Detachment may occur before labor begins ( premature detachment ) or in the course of labor ( early detachment ). A detachment that can occur at any time during pregnancy, either in the first trimester or even in the following months; in all cases an important attention is required
The detachment occurs therefore following a bleeding on the border between uterus and placenta with the formation of a hematoma that progressively “breaks” the insertion between the two organs.
The causes and risk factors of the detachment of the placenta
Already at the beginning of pregnancy, the trusted gynecologist or midwife, should specify to the future mother, the risk factors associated with a probable detachment of the placenta and the risks that this detachment entails for the mother and for the fetus. Among these factors, some are purely maternal such as:
- advanced age,
- having had so many pregnancies,
- cigarette smoking,
- poor social conditions,
- severe state of malnutrition
- twin pregnancy
- drug abuse, such as cocaine
- untreated high blood pressure,
- diseases that can lead to an alteration of normal placental mother-fetus exchanges (such as preeclampsia, diabetes, renal and vascular diseases, congenital and / or acquired thrombophilias).
Other maternal risk factors include: pregnancy with PROM (premature rupture of the membranes) or a preterm birth . Both cases could result in a placental detachment.
Among the mechanical risk factors we find:
- traumas ,
- road accident,
- sudden intrauterine decompression.
Therefore, it is absolutely essential that a future mother knows everything that could possibly contribute to the posting, in order to be able to act accordingly and, if necessary, limit the damage .
The precise cause of the placenta detachment is not known; however, it was found that certain circumstances favored its onset. Taken individually, these risk factors may not be enough to detach the placenta from the uterus; vice versa, their concomitance is decisive. Placental detachment occurs with an estimated frequency of 1 case per 100 parts.
Symptoms of placental detachment
Among the symptoms that characterize a detachment of the placenta, we find:
1. In the mother:
- Vaginal bleeding (hemorrhage ante partum )
- Abdominal pain
- Lumbar pain
- Rapid uterine contractions (tetanic-type contractions)
- Fragility of the uterus
For the mother the clinical consequences are heavy; in massive detachments symptoms may occur such as:
- hemorrhagic shock from massive blood loss,
- renal failure,
- heart failure,
- CID, or disseminated intravascular coagulation,
- multi-organ failure and death.
2. In the fetus:
- Oxygen deficiency,
- Abnormal heart beat (lower heart rate)
- Fetal distress: term that identifies a number of different disorders, including cardiac anomalies, reduced intrauterine growth and oligohydramnios (scarce presence of amniotic fluid in the amniotic sac)
risk to the fetus depends particularly on two factors:
- Extent of placental detachment (the risk is very high for the fetus when the detachment exceeds 50% of the placental insertion).
- Gestational epoch (a detachment in the first trimester is more serious than one occurred in the last quarter).
For most of these symptoms there is a direct correlation between their severity and the severity of placental detachment. The only symptom, which does not always follow this trend, is hemorrhage .
The consequences of a placental detachment for the pregnant woman and the fetus
The bleeding is perhaps the most important symptom of placental detachment. Unlike what one might think, the amount of blood lost outside by the mother is not always related to the severity of the detachment. Indeed, many times the opposite occurs.
In fact, it is easier for the bleeding to remain almost completely confined within the uterus, if the detachment is moderate-severe ( hidden hemorrhage ); and it is, instead, more probable to observe a conspicuous bleeding towards the outside, if the detachment is mild ( external hemorrhage ). The explanation of this behavior is not known. Quantitatively speaking, the blood lost (both from external hemorrhage and from hidden hemorrhage) is less than 1000 ml in cases less severe ; while, it is higher than 1000-1500 ml in the more serious cases
Finally, the frequency with which external bleeding occurs is 80% of the cases of placental detachment , while the remaining 20% is characterized by hidden or hidden hemorrhage. The loss of blood for the pregnant woman determines a particular condition, called hemorrhagic shock or hypovolemic which can also lead to death.
The pregnant woman could have a lowering of blood pressure, tachycardia, skin pallor, sweating, dizziness, anxiety, restlessness, state of general malaise
As later complications can be found in the mother: coagulopathies that is defects or disorders of coagulation, renal failure and damage to load of the uterus with loss of contractility (in this case it may be necessary to remove the uterus to save your life). As regards the fetus instead, besides hypoxia and fetal distress a premature birth or intrauterine death can occur .
Classification of placental detachment: 3 degrees of risk
Detachment of mild placenta : in 40% of the cases, with
- poor blood loss,
- no signs of shock
- vital parameters of the fetus in the norm.
Detachment of the moderate placenta : occurs in 40% of cases with
- major bleeding,
- persistent abdominal pain,
- tachycardia (rapid heart beat),
- arterial hypotension. (low blood pressure)
Detachment of the severe placenta : present in 20% of cases, with
- massive hemorrhage,
- rapid and strong uterine contractions,
- state of shock, signs of fetal distress with risk of both maternal and fetal death
In any case the placental detachment, when widespread, triggers a intense labor and very rapid. When should the expectant mother go to the doctor? If you experience any of these symptoms:
- abdominal and lumbar pain
- rapid uterine contractions
- Is subject to vaginal bleeding
Diagnosis of placental detachment
clinical evaluation is useful and essential. In other words, the midwife or the specialist doctor who took care of you goes to evaluate the blood loss, their color and also the entity. He then performs a ‘vaginal exploration to understand also where the blood comes from, whether from inside the cervix or from the outside.
If the pregnant woman also complains abdominal pain the doctor also performs a palpation to understand if there is it is actually dolenzia and in that specific area. A trace is then carried out to assess the well-being of the fetus (finding the unborn child’s heartbeat) and then ascertaining or excluding a suffering, as well as recording any uterine contractions, if any, and the type. Alongside the clinical picture, the following are also important for the purposes of diagnosis:
- Blood tests: which will show a more or less significant reduction in red blood cells and hemoglobin as a result of hemorrhage.
- Ultrasonography (in case of pregnancy CT is obviously contraindicated being an examination based on the use of ionizing radiation), which however may be the cause of false negatives in 50% of cases, since the placental detachment does not always present suggestive images that allow recognition.
Treatments and medical care
If the detachment of the placenta one is verified in the very first weeks of gestation, after having ascertained with an ultrasound scan, the presence, besides the embryo, of the cardiac activity you will be recommended ass rest, no work, sexual abstention, taking a drug such as progesterone via the vaginal, oral or intramuscular route. If it has been established that there is placental abruption but there is no fetal viability (the heart is missing or does not beat), there is a spontaneous abortion.
If, instead, the detachment occurs in the second or third trimester of pregnancy and, once diagnosed the detachment in the hospital, and you are in good state, the fetus is well, the labor of birth has not begun and the bleeding has stopped , a conservative treatment is justifiable. In this case, the expectant mother will be constantly monitored and prescribed drugs will be used to block uterine contractions. But, if the detachment takes place with a strong blood loss, such as to compromise the health of the mother and child, action will be taken for a emergency cesarean section . Finally, when the placenta detachment is so severe that intrauterine death is determined, vaginal delivery is used to extract the fetus.
The fact remains that the detachment of the placenta remains an absolutely unpredictable event, even in the absence of risk factors. Detachment may occur even if the expectant woman is healthy. For this reason it is recommended, as soon as one notices blood loss especially if abundant, to call immediately the trusted gynecologist or go immediately to the obstetric emergency room.
Can the detachment of the placenta be prevented?
The decrease in the risk of developing a placenta detachment is possible through a scrupulous attention to the lifestyle of the pregnant woman, who plans to avoid:
- substances of abuse ,
- physical activities at risk
It is also of great importance the correct management of maternal pathologies, such as
- gestational diabetes,
- gravidic hypertension.
In the case of a placental detachment in a previous pregnancy, the specialist will assess the risks for your current pregnancy with you, as the danger that the disorder may recur is high. If it is a twin pregnancy, this should be followed very carefully, with frequent and targeted checks. If, on the other hand, you plan to have another child after a placental detachment experience, the advice is to talk to your gynecologist who will evaluate your clinical and personal history.