Contents
Retro-placental hematoma, HRP or “placenta abruptio”: definition
We call retro-placental hematoma (HRP) a mass of blood between the placenta and the uterus, due to a premature and more or less important detachment of the placenta during pregnancy. Obstetrician-gynecologists also often speak of “placenta abruptio”Or premature detachment of the normally inserted placenta (DPPNI).
It is a very serious complication of pregnancy, which occurs in 0,25 to 0,5% of pregnancies, usually in the last few months, or at the start of labor.
Concretely, the detachment of the placenta can cause a lack of oxygen (anoxia) of the fetus, and a risk of maternal death due to hemorrhage. It is therefore necessary to take care of the retro-placental hematoma urgently.
Retro-placental abruption or hematoma: causes and risk factors
It is not always easy to know the precise cause of the occurrence of a retro-placental hematoma. However, some direct or indirect trauma can be the cause of placental detachment, such as a fall, an accident, physical violence, a version by external maneuver because the baby is in breech, or even a version by maneuver. internal.
On the other hand, risk factors for retro-placental hematoma are well documented. They include smoking, cocaine, being over 35, being multiparous (multiple pregnancies), and having a history of HRP. High blood pressure and pre-eclampsie are also risk factors, found in at least half of the cases of PRH.
Symptoms of a placental hematoma
While it may be asymptomatic, a retro-placental hematoma most often manifests itself by blood loss brown or even black (coagulated blood), pelvic pain due to close uterine contractions, of high intensity, of long duration, a hard belly (called “wood”), less or more fetal movements, a state of shock for the mother, signs of preeclampsia (hypertension, protein in urine).
Note that we distinguish the lateral placental abruption, which generally induces blackish bleeding, central placental abruption, which can be more difficult to diagnose due to the absence of bleeding.
The diagnosis of retro-placental hematoma is made both by observing the signs and symptoms mentioned above, ultrasound or even vaginal examination, the latter only to be carried out in the absence of cake review (when the placenta covers the cervix).
Treatment and management of retro-placental hematoma
Retro-placental hematoma is a life-threatening emergency for both the mother and the unborn baby.
If the fetus has died, delivery should be started immediately because the mother’s vital prognosis is involved.
If the fetus is alive, the management depends on the situation, according to the heart rate of the fetus that is observed, the vascular context, the evolution of symptoms, etc. What to do will also depend on the stage of pregnancy. If the term is relatively close, the medical team will probably prefer to induce labor (by rupturing the membranes if possible). The childbirth will then be done either by vaginal route or by a emergency cesarean, especially if the retro-placental hematoma is associated with placenta previa blocking the cervix, or if there are signs of fetal distress. A blood transfusion may also be necessary for the mother, especially if the bleeding is severe.
Sources and additional information:
- http://www.cngof.net/E-book/GO-2016/32-ch25-275-308-9782294715518-grossesse-com.html
- http://www.aly-abbara.com/livre_gyn_obs/termes/hematome_retroplacentaire.html