Tight attachment or placenta accreta

Delay child seats in the uterus.  Photo courtesy of www.  veer.com

Within 30 minutes after the birth of a child should be born last. If not, doctors may suspect a dense attachment or placenta accreta.

More dangerous is the increment of the placenta, which is extremely rare: 1 in 24,000 births, and occurs almost exclusively in multiparous.

Causes

  • structural changes in the uterus due to surgeries, abortion and inflammatory diseases;
  • pathology location of the placenta (placenta previa or low position of the placenta);
  • violation of the enzymatic balance in system hyaluronic acid-hyaluronidase between the chorionic villi and decidua (mucosa) endometrium.

What's going on?

In the process of placental chorionic villi "embedded" in the lining of the uterus (endometrium). This is the same shell that is torn away during the menstrual bleeding. However, there are times when naps grow into the muscle layer, and sometimes the full thickness of the wall of the uterus. There is a tight attachment or placenta accreta, which differ in the depth of germination of chorionic villi in the uterine wall.

Recognize the increment and tight attachment of the placenta (and to distinguish them from each other), unfortunately, can only be in labor during the operation manual removal of the placenta. Dense attachment of the placenta and the increment in the afterbirth period (III stage of labor)placenta does not spontaneously separated.

Tight attachment or increment placenta may be complete when the entire area of the placenta is attached to its box and partial if placenta attached onlysome site. In the first case of spontaneous bleeding does not happen. The second — which began with placental abruption occurs bleeding. which can be quite abundant.

Diagnostics

Dense attachment of the placenta appears or bleeding in the III stage of labor (partial tight attachment or increment) or absence of signs of self placenta within 30 minutes after birth (full dense attachment or increment).

Manual department Placenta

Indications for surgery:

  • no signs of placental separation without bleeding 30 minutes after the birth of the child;
  • no signs of placental separation at the onset of bleeding, as blood loss reaches 250 ml

The operation is performed under intravenous anesthesia. Simultaneously with the start of operations commence drip of glucose crystalloid solutions that reduce the uterus means. Dense attachment of the placenta separates easily from the uterine wall.

After manual inspection of the walls of the uterus and its complete emptying of self, intravenous oxytocin, put an ice pack on the abdomen and periodically by palpation through the abdominal wall monitor the condition of the uterus. In order to prevent postpartum infection in all cases, surgical intervention in the afterbirth period prescribed antibiotics. When abnormal blood loss (500 ml or more) offset the loss of blood.

This increment — placenta (or part thereof) can not be separated from the uterus. In this situation, doctors are obliged to stop all attempts of the placenta and make an emergency hysterectomy.

Bleeding in the III stage of labor associated with placental abnormalities, should be differentiated from bleeding caused by delay or infringement of the placenta.

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