Преждевременное отслоение плаценты: причины, риски и лечение

The cause of placental abruption is not entirely clear. It is classified as a complication of pregnancy. If everything is stable, vaginal delivery may be tried, otherwise cesarean section is recommended. Along with placenta previa and uterine rupture it is one of the most common causes of vaginal bleeding in the later part of pregnancy. Placental abruption is the reason for about 15% of infant deaths around the time of birth.

Although the risk of placental abruption cannot be eliminated, it can be reduced. Avoiding tobacco, alcohol and cocaine during pregnancy decreases the risk. Staying away from activities which have a high risk of physical trauma is also important. Women who have high blood pressure or who have had a previous placental abruption and want to conceive must be closely supervised by a doctor. The risk of placental abruption can be reduced by maintaining a good diet including taking folate, regular sleep patterns and correction of pregnancy induced hypertension. Use of aspirin before 16 weeks of pregnancy to prevent pre eclampsia also appears effective at preventing placental abruption.

Treatment depends on the amount of blood loss and the status of the fetus. If the fetus is less than 36 weeks, and neither mother or fetus are in any distress, then they may simply be monitored in hospital until a change in condition or fetal maturity whichever comes first. Immediate delivery of the fetus may be indicated if the fetus is mature or if the fetus or mother is in distress. Blood volume replacement to maintain blood pressure and blood plasma replacement to maintain fibrinogen levels may be needed. Vaginal birth is usually preferred over Caesarean section unless there is fetal distress. Caesarean section carries an increased risk in cases of disseminated intravascular coagulation. The mother should be monitored for 7 days for postpartum hemorrhage. Excessive bleeding from uterus may necessitate hysterectomy. The mother may be given Rhogam if she is Rh negative.

The prognosis of this complication depends on whether treatment is received by the patient, on the quality of treatment, and on the severity of the abruption. Outcomes for the baby also depend on the gestational age. Without any form of medical intervention, as often happens in many parts of the world, placental abruption has a high maternal mortality rate.

A large loss of blood may require a blood transfusion. Maternal death.

The baby may be born at a low birthweight. Preterm delivery (prior to 37 weeks gestation). The baby may be deprived of oxygen and thus develop asphyxia. Placental abruption may also result in death of the baby, or stillbirth. The newborn infant may have learning issues at later development stages, often requiring professional pedagogical aid.

Placental abruption occurs in approximately 0.2–1% of all pregnancies. Though different causes change when abruption is most likely to occur, the majority of placental abruptions occur before 37 weeks gestation, and 12–14% occur before 32 weeks gestation.