Premature abruption of the placenta
In premature placental ab ruption, the placenta has detached from the uterine attachment surface before the birth of the child. Maternal perfusion of the placenta is no longer guaranteed. This detachment can be partial or complete.
The formation of a hematoma behind the placenta can cause it to dissolve. This hematoma can be triggered by various factors, such as trauma, high blood pressure, premature rupture of the membranes, uterine anomalies, short umbilical cord, but also malnutrition or nicotine and drug abuse of the mother. Furthermore, the risk of placental abruption increases with each child.
In addition to dark red vaginal spotting (→ peripartum haemorrhage) of varying intensity, there is severe continuous pain with permanent hardening of the uterus. Furthermore, restlessness, weakness, feelings of anxiety and thirst, and nausea occur. Signs of acute oxygen deficiency can be found in the fetal heart sound (CTG). In the case of severe maternal blood loss, the mother also shows signs of shock with the occurrence of coagulation disorders.
In addition to ultrasound with Doppler sonography, coagulation diagnostics are of particular importance, since the activation of the coagulation cascade leads to an increased consumption of platelets and coagulation factors.
The mortality of the mother is about 1 %; that of the child, depending on its weight, between 10 % and 67 %.
If the child is alive, an immediate caesarean section is indicated. If the child is dead and the mother is free of symptoms, vaginal delivery is attempted. If the mother is impaired, caesarean section is performed even if the child is dead. If shock due to hemorrhage occurs, blood should be given. Here, too, attention should be paid to coagulopathy.
- Schneider, Husslein. Obstetrics. Springer Verlag, ISBN 3-540-44032-1