Who is prone to placental abruption?

Placental abruption mainly occurs in older mothers and women who experience abdominal pain during delivery. In addition, behaviors such as smoking and drinking can lead to placental abruption, so pregnant women need to take relevant preparatory measures during pregnancy. Placental abruption usually occurs after 20 weeks of pregnancy, and it will cause uterine contractions, abdominal pain and irregular pain, so we need to do relevant preventive work.

1Who is prone to placental abruption

Pregnant women with the following conditions are more likely to experience placental abruption:

Elderly (>35 years old) pregnant women, multiparous women, smokers, drinkers, cocaine and other drug users, pregnant women with metabolic abnormalities such as diabetes, those with thrombotic tendencies, uterine fibroids, or systemic vascular diseases such as gestational hypertension.

Therefore, women with a family history of vascular or metabolic diseases need to undergo detailed examinations before pregnancy to avoid placental abruption during pregnancy.

2 What symptoms may be caused by placental abruption in pregnant women?

If you experience unexplained abdominal pain, back pain, vaginal bleeding, or bloody amniotic fluid before 20 weeks of pregnancy or during delivery, you should be alert to the possibility of placental abruption.

In addition, uterine contraction and abdominal pain during premature labor or labor often range from irregular to paroxysmal and regular pain, occurring every few minutes. Pregnant women should also pay attention and seek medical attention immediately.

3How to diagnose placental abruption

1. Ask about the relevant condition

The diagnosis can be made based on whether the pregnant woman has high-risk factors or related causes, combined with abdominal pain, vaginal bleeding, abdominal signs and laboratory test results. But further examination is needed to confirm the diagnosis.

2. Ultrasound examination

Pregnant women suspected of having placental abruption can be diagnosed through B-ultrasound examination. Ultrasound examination can reveal the location of the placenta, the type of placental abruption, the size of the fetus and whether it is alive, but there is also the possibility of missed diagnosis.

3. Laboratory examination

Pregnant women with placental abruption should also have blood drawn to check complete blood cell count and coagulation function, II

Patients with placental abruption of degrees or above should also undergo renal function tests, blood gas analysis, and disseminated intravascular coagulation (DIC) tests because of the possible life-threatening situation.

4How to treat placental abruption

The principles of treatment for placental abruption are to actively deal with shock, terminate pregnancy promptly, control DIC, and reduce complications.

1. Correct shock

If a pregnant woman with placental abruption has symptoms of shock, she should be placed in the shock supine position, and an intravenous access should be established immediately to quickly replenish blood volume and improve blood circulation. Depending on the amount of hemoglobin, red blood cells, plasma, platelets, cold precipitate, etc. are transfused. Fresh blood is best, which can replenish blood volume and coagulation factors. The hematocrit should be increased to above 0.30 and the urine volume should be >30ml/h.

2. Timely termination of pregnancy

Placental abruption may continue to worsen before the fetus is delivered. Once grade II or III placental abruption is confirmed, the pregnancy should be terminated promptly. The method of terminating pregnancy is determined based on the severity of the pregnant woman's condition, the intrauterine condition of the fetus, the progress of labor, the type of delivery, etc.

(1) Vaginal delivery: If the pregnant woman has previous childbirth experience and is in good condition and can complete the delivery in a short time, vaginal delivery is the first choice when the cervix is ​​dilated and there is obvious bleeding. During this delivery process, you should pay close attention to the pregnant woman's blood pressure, uterine contractions, bleeding, pulse, etc., check the fetal heart rate changes at any time, and if any abnormality is found, deal with it in a timely manner and perform a cesarean section if necessary.

(2) Cesarean section: Cesarean section is required if the pregnant woman is giving birth for the first time and cannot complete the delivery in a short time, or if any of the following situations occurs: although it is a mild placental abruption, the fetus has symptoms of distress and requires emergency treatment; it is diagnosed as severe placental abruption; the mother's condition is serious and the fetus is stillborn; there is no progress in labor after rupture of membranes, etc.

After adopting this delivery method, uterotonic drugs should be injected immediately and uterine massage should be performed at the same time to control uterine bleeding. If the amount of bleeding is large but there is no coagulation, it may be a coagulation disorder, which requires timely treatment by a doctor. If bleeding is uncontrollable or DIC develops, a hysterectomy may be performed.

3. Treatment of complications

(1) Postpartum hemorrhage: Uterine contraction drugs, such as oxytocin and prostaglandin preparations, are given immediately after the fetus is delivered; artificial placenta removal and continuous uterine massage are performed after the fetus is delivered. If there is still uncontrollable uterine bleeding, or the blood does not coagulate or the clot is soft, it should be treated as a coagulation dysfunction.

(2) Coagulation dysfunction: terminate the pregnancy promptly to block the entry of procoagulants into the maternal blood circulation and correct the coagulation mechanism disorder: ① replenish blood volume and coagulation factors; ② apply heparin; ③ antifibrinolytic therapy.

(3) Renal failure: If the patient's urine output is <30 ml/h, it indicates insufficient blood volume and blood volume should be replenished in time. If the blood volume has been replenished but the urine output is <17 ml/h, furosemide 20-40 mg can be given by intravenous push and the medication can be repeated if necessary. If the urine volume does not increase in a short period of time and the serum urea nitrogen, creatinine, and blood potassium increase progressively, and the carbon dioxide binding capacity decreases, it indicates renal failure. When uremia occurs, hemodialysis treatment should be performed promptly.