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Detachment of the placenta: what is it?
Detachment of the placenta, or retroplacental hematoma, is a rare but severe complication of pregnancy that can endanger the life of the fetus, or even that of its mother. Its potential severity justifies monitoring hypertension, its main risk factor, and consulting at the slightest bleeding, its main symptom.
What is placental abruption?
Also called retroplacental hematoma (HRP), placental detachment corresponds to a loss of adhesion of the placenta to the wall of the uterus. It is an obstetric emergency, the hematoma formed interrupting maternal-fetal circulation. About 0,25% of pregnancies are affected in France. Its consequences vary depending on the stage of pregnancy and the extent of the detachment.
Causes of placental abruption
The occurrence of a placental abruption is most often sudden and unpredictable, but there are, however, risk factors. The most famous are :
- L‘hypertension gravidarum and its direct consequence, pre-eclampsia. Hence the importance of being attentive to their symptoms: strong headaches, ringing in the ears, flies in front of the eyes, vomiting, significant edema. And to be followed throughout your pregnancy to benefit from regular blood pressure measurements.
- Smoking and cocaine addiction. Doctors and midwives are subject to medical confidentiality. Do not hesitate to discuss addiction issues with them. Specific treatments are possible during pregnancy.
- Abdominal trauma. Normally the fetus is protected from the consequences of shocks and falls by the amniotic fluid which acts as an airbag. However, any impact on the stomach requires medical advice.
- History of placental abruption.
- Pregnancy after 35 years.
Symptoms and diagnosis
Detachment of the placenta most often results in blackish blood loss associated with violent abdominal pain, nausea, a feeling of weakness or even loss of consciousness. But the severity of the situation is not proportional to the intensity of the bleeding or abdominal pain. These symptoms should therefore always be considered as warning signs.
Ultrasound can confirm the presence of the hematoma and assess its importance but also detect the persistence of a heartbeat in the fetus.
Complications and risks for mother and baby
Because it compromises the proper oxygenation of the fetus, placental abruption can cause death. in utero or irreversible disorders, in particular neurological. The risk becomes significant when more than half of the placental surface is affected by the detachment. Maternal mortality is rarer but it can occur, especially following massive bleeding.
Management of placental abruption
If the detachment is small and occurs early in the pregnancy, absolute rest may allow the hematoma to resolve and the pregnancy to continue under close supervision.
In its most frequent form, i.e. occurring in the 3rd trimester, placental abruption most often requires an emergency cesarean section in order to minimize fetal suffering and the risk of bleeding for the mother.