Second trimester hemorrhage: Premature placental abruption
The premature detachment of the placenta (PPD) or premature detachment of the placenta, belongs to the group of hemorrhages that can occur in the second trimester of pregnancy.
In addition, it is estimated that the frequency of this pathological entity that compromises the life of the fetus has a presentation percentage between 0.52%-1.29%.
What is placental abruption?
It is the total or partial separation of a well inserted placenta, which can occur from the 28th week of gestation onwards, but before delivery.
Also, this pregnancy disease is linked to several risk factors such as, for example.
Mother with high blood pressure levels during pregnancy
Advanced maternal age
Multiparity
Multiple pregnancy
Mother with a history of diabetes mellitus or gestational diabetes
Smoking
Consumption of alcoholic beverages
Why does premature detachment of the placenta occur?
Basically, there are 4 theories that seek to explain the origin of this detachment.
What they do have in common, however, is that as the placenta detaches, blood automatically begins to pool, leading to the formation of a hematoma.
In turn, this hematoma will separate the placenta from the mother's blood vessels. Consequently, the fetus does not receive enough oxygenation.
Theory 1. Uterine hypertonia
What happens is that the pressure of the muscular tissue of the uterus increases. Next, the myometrium will compress the blood vessels. Then the blood can reach the uterus, but it cannot return.
Consequently, this pressure "ruptures" the placenta and vessels, causing a retroplacental hematoma and placental abruption.
Theory 2. Vascular
This theory suggests that a degenerative process occurs in the arteries of the placenta, generating a rupture of these vessels and separation of the placenta.
Theory 3. Folates
In the folate theory, mention is made that the lack or defect of folate metabolism is responsible for the detachment of the placenta.
Theory 4. Trauma
Of all the theories this is the least likely. According to this theory, detachment can be caused by a direct impact on the maternal abdomen.
Also, some obstetric falls or maneuvers performed with an inadequate technique are included.
Symptoms of placental abruption
It is worth mentioning that whether it is a partial or total detachment, the blood can first accumulate before being externalized. Thus, the predominant symptoms are usually.
Vaginal bleeding, which is usually light, moderate and dark red.
Severe abdominal pain that starts suddenly.
Pallor
Hypotension
Tachycardia
Sweating
Loss of consciousness
In addition, the fetus may begin to experience acute fetal distress, which may manifest as fetal bradycardia.
Degrees of placental abruption
It ranges from grade 0 to grade IV. In this sense, grade 0 comprises the following aspects.
Clinically there is no involvement of the mother, the diagnosis is made postpartum.
It represents 20% of the cases.
On the other hand, grade I detachment includes the following items.
Genital bleeding
No fetal distress
48% of cases
Now, grade III detachment is represented by the presence of the following symptoms.
Moderate bleeding
Abdominal pain
There is fetal distress
27% of cases
Finally, in grade IV detachment the following events occur.
Maternal shock
Total detachment of the placenta
Fetal death
How is placental abruption diagnosed?
The diagnosis depends on the risk factors that the mother has. In addition to this, the signs that suggest a placental abruption.
Additionally, ultrasound can reveal findings, but it all depends on the location of the placenta. Also, the vitality of the fetus can be assessed.
Treatment of placental abruption
The resolution of the clinical picture depends on the volume of the hemorrhage and the gestational age.
In addition, there is no pattern to follow, each case must be individualized. The obstetrician must decide whether to perform an emergency cesarean section or vaginal delivery.
Complications of placental abruption
Complications that can occur are mainly due to blood loss. So the complications are.
Acute renal failure (ARF)
Blood clotting disorders
Renal tubule necrosis