Bleeding in premature detachment of the placenta

One of the causes of bleeding during pregnancy can be a premature detachment of the placenta during its normal attachment to the uterine wall. This clinical situation is accompanied by pain, which is an important diagnostic criterion in the process of diagnosis. Bleeding with placental abruption can be external and internal, which is defined for this detachment.

Bleeding from the genital tract is typical of the regional variant detachment. The severity of the pregnant woman will correspond to the volume of lost blood. If blood will accumulate between the wall of the uterus and placenta, the vaginal discharge are not available, to the forefront of the clinical picture comes pain. Intense pain is a sign of the presence of placental abruption area Placental abruption - why is it so dangerous to a woman's life? . Confirmation of the presence of internal bleeding is a change in hemodynamic parameters. Pay attention to the complaints of pregnant general weakness, dizziness. The form of detachment from the internal bleeding is the most unfavorable in terms of impact on the fetus and the pregnant. When progressive detachment comes fetal death, while a pregnant develop severe hemodynamic disorder.

Authentically can confirm the diagnosis using ultrasound scanning. This method detects not only the presence of placental abruption area, as well as signs of fetal suffering (confirmation of the fetus acute hypoxia). When bleeding, which is caused by premature detachment, it is necessary to conduct regular monitoring of fetal condition. Significant changes are detected in the fetus kardiotokogramme. Despite the fact that there are difficulties in the process of clinical interpretation kardiotogrammy compared with the assessment results in the delivery method CTG (or CTG) must be given to all pregnant women, in whom there was a placental abruption.

If a pregnant woman has addressed in consultation with complaints of bleeding from the genital tract, and the doctor suspects she placental abruption, the laboratory and instrumental examination should be performed only in a hospital. In a polyclinic stage it is very important to timely patient hospitalized in maternity hospital and do it as quickly as possible, as time savings helps to save the life of the woman and the fetus.

The effectiveness of conservative treatment for bleeding

In the presence of a pregnant woman bleeding and the absence of indications for surgical treatment can be held conservative measures in the pathology department of the maternity hospital. Pregnant women with placenta previa should be assigned to bed rest with the exception of physical activities and emotional experiences. This condition is the determining factor to increase the effectiveness of the remedial measures.

Drug therapy should include drugs for tocolysis. Tocolytic therapy reduces the tone of the uterus The tone of the uterus - the most important indicator for pregnant women Which can cause premature termination of pregnancy. An effective remedy is hexoprenaline (or drug, sold under the name ginipral). During the first three days of intravenous administration of the drug is carried out with a subsequent transition to tableted reception. Depending on the clinical situation to be individually adjusted rate of drug administration. Before the end of the first infusion is assigned a pill ginipral, after the drug is taken every 4-6 hours. At night you can not take more than 8 tablets, ie, 4 mg. One tablet contains 500 mg of the active ingredient, so the doctor has to determine the optimal dose, taking into account the multiplicity of receiving.

If the bleeding has evolved in the time when the fetus is not yet formed the respiratory system (not completed the process of maturation of surfactant), then the prophylactic treatment of respiratory distress syndrome glucocorticoid hormones. Three consecutive days intramuscularly injected hormone dexamethasone in a daily dose of 8 mg. Dose is divided into two steps. It allows reception of dexamethasone in tablet form, but in this embodiment, the treatment assignment scheme should change. On the first day of treatment and the daily dose is 8 mg, but subsequently it is reduced by 2 mg each day. On the second day of the drug dose to be 6 mg, on the third day - 4 mg. The three-day hormonal means sufficient for a course of preventive treatment.

Tocolysis carried out only in the absence of heavy bleeding from the genital tract. If the blood loss exceeds the amount of 250 ml, it must be held urgent surgical delivery. In this situation, the operation is carried out at any stage of pregnancy. Unacceptable tactic is conducting a long conservative measures, especially in the existing hemodynamic changes that indicate the severity of the patient. Indications for emergency surgery should be evaluated from the perspective of the mother and the fetus.

As additional treatment methods are assigned antispasmodic drugs, tranquilizers or sedatives. As part of the treatment they have a complex effect on the mechanisms of development of pathological process. Use the drug papaverine, no-spa (or drotaverine) baralgin and others. Antispasmodic drugs are available in the form of candles, so the shape is a good addition to the ongoing ginipralom tocolytic therapy. Sedative therapy has an effect on the level of central regulatory mechanisms, helps to normalize the emotional state of a woman that has a positive effect on the whole process of treatment.

Against the background of hemodynamic changes in the female body naturally affected fetus. The frequency of perinatal mortality (ie, death of the fetus) when placenta previa is almost 26%, in the case of premature detachment of the placenta, this percentage increases even more (35%). Analysis of the statistics clearly shows the need for urgent medical measures in case of bleeding in pregnant women.

Of great importance is the regular prenatal care in the antenatal clinic. A doctor can determine the presence of predisposing factors to the development of a pathological condition, and undertake appropriate preventive measures. If necessary, preventive treatment is given in a maternity hospital pathology department, especially for pregnant women at high risk for bleeding. The doctor's task is to carry out explanatory talk and persuade the woman not to abandon recommended hospital treatment, which is a means of prevention.

Marina Solovyov

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