The uterus has localized mild tenderness

Introduction The uterus has limited tenderness and tenderness, and it is hypertonic. The elevation of the fundus is a symptom of placental abruption. After 20 weeks of gestation or during childbirth, the placenta in the normal position is partially or completely detached from the uterine wall before the delivery of the fetus, called placental abruption. Placental abruption is a serious complication in the third trimester of pregnancy. The short-term training course is urgent and rapid. If it is not handled in time, it can endanger the mother and child. The incidence is related to whether the placenta is carefully examined after delivery. Some patients with mild placental abruption can have no obvious symptoms before labor. Only when the placenta is examined after delivery, it is found that there is clot blockage in the early exfoliation. Such patients are easily overlooked.

Cause

(1) Causes of the disease:

After decades of research by scientists, early placental dissection and hypertension (including pregnancy-induced hypertension syndrome, essential hypertension, renal hypertension), trauma, premature rupture of membranes, age of pregnant women, smoking, use of cocaine, etc. Factors are related, and its onset may be related to the following major risk factors.

1. Hypertension: Hypertension includes pregnancy-induced hypertension syndrome (referred to as pregnancy-induced hypertension, especially severe pregnancy-induced hypertension), essential hypertension, chronic nephritis with hypertension, which are the primary causes of early exfoliation of the placenta. Some scholars have reported that the early placental ablation of hypertensive patients with gestational hypertension is five times higher than that of normal blood pressure during pregnancy. The pathogenesis is mainly caused by the occurrence of sacral hemorrhage in the sacral sacral artery of the placenta, acute atherosclerosis, causing ischemia, necrosis, rupture and hemorrhage of the distal capillary, forming a hematoma, gradually expanding, and separating the placenta from the uterine wall. It causes early exfoliation of the placenta. If a pregnant woman has a vascular lesion such as essential hypertension and complicated with pregnancy-induced hypertension, and the vascular disease is aggravated, there is more chance of early exfoliation of the placenta.

2. Mechanical factors: The abdomen is directly impacted, often the cause of early exfoliation of the placenta, such as the impact of a car, the sudden braking of a bus, the first landing on the abdominal wall, and the beating of the abdominal wall can cause early exfoliation of the placenta. External reversal to correct the fetal position is blocked and the force is too large, and early exfoliation of the placenta may occur. Amniocentesis may also cause early exfoliation of the placenta when the placenta is located in the anterior wall of the uterus. Other indirect factors such as excessive amniotic fluid, sudden discharge of amniotic fluid when the membrane is ruptured, or the first fetus delivered too fast during twin pregnancy, can cause sudden pressure drop in the uterine cavity and early exfoliation of the placenta. American research data reported that the early exfoliation of placenta caused by pregnant women's trauma accounted for 1% to 2%.

3. Smoking: Nearly 10 years of research have confirmed the association between smoking and early exfoliation of the placenta. It has been reported that smoking increases the risk of early exfoliation of the placenta by 90%, and the risk of early exfoliation of the placenta increases with the increase in the number of cigarettes per day. . Smoking causes degeneration of blood vessels and increases the fragility of capillaries. The effect of nicotine on vasoconstriction and elevated concentrations of carbon monoxide-binding protein in serum can lead to vasospasm ischemia, which induces early exfoliation of the placenta.

4. Premature rupture of membranes: Many studies at home and abroad have reported the correlation between premature rupture of membranes and early exfoliation of placenta. The risk of early exfoliation of the placenta in pregnant women with premature rupture of membranes is three times higher than that of premature rupture of membranes. The mechanism of its occurrence is unclear and may be related to chorioamnionitis after premature rupture of membranes.

5. Abuse of cocaine: It has been reported that 50 pregnant women were abused during pregnancy, and 8 of them were due to early exfoliation of the placenta. It was also reported that 112 pregnant women abused cocaine during pregnancy, resulting in 13% of early placental ablation.

6. Age and birth of pregnant women: The age of pregnant women is related to the early exfoliation of the placenta, but some scholars have reported that the birth rate is more likely to be related to the early exfoliation of the placenta than the age. As the number of births increases, the risk of early exfoliation of the placenta increases geometrically.

7. Others: The pregnant woman is in a supine or semi-recumbent position for a long time, so that the enlarged uterus compresses the inferior vena cava, hinders the venous return, and causes partial or complete placental dissection of the decidual venous congestion or rupture. The umbilical cord is too short or the umbilical cord around the neck, around the body, during the delivery process, the fetal first dew drops, the umbilical cord length is insufficient and is strongly pulled, which can also lead to early stripping of the placenta.

an examination

Related inspection

Gynecological ultrasound examination of laparoscopic

1. Diagnosis basis:

(1) may have a history of trauma, history of vascular disease.

(2) There is vaginal bleeding accompanied by abdominal pain.

(3) The uterus has limited tenderness and tenderness, and it is in a hypertonic state, and the fundus is elevated.

(4) The fetal heart is weakened or even disappeared.

(5) Ultrasound examination showed a dark area between the uterine wall and the placenta. The echo in the amniotic fluid increased and the villus board protruded into the amniotic cavity.

(6) Blood protein is reduced, and coagulation dysfunction may occur.

(7) postpartum examination of the placenta can be seen on the maternal surface of the placenta with clots and pressure marks.

2. Classification diagnosis:

(1) Light placental abruption: the placental stripping surface usually does not exceed 1/3 of the placenta area, manifested as vaginal bleeding, anemia signs are not significant, mild abdominal pain or no abdominal pain, intermittent contractions, clear fetal position, fetal heart rate More normal, sometimes symptoms and signs are not obvious, only found in the placenta maternal surface clots and pressure marks.

(2) severe placental abruption: the placental stripping surface exceeds 1/3 of the placenta area, showing abdominal pain is severe and continuous, no vaginal bleeding or a small amount of vaginal bleeding, the degree of anemia is not consistent with external bleeding, the uterus is as hard as a plate, tenderness, There is no contraction, the fetal position is unclear, the sheep is bloody, and the fetal heart can disappear when the condition is serious.

Differential diagnosis

In late pregnancy, in addition to placental abruption, there are still placenta previa, uterine rupture and bleeding of cervical lesions, etc., should be identified, especially in the identification of placenta previa and uterine rupture.

1, placenta previa: light placental abruption, can also be painless vaginal bleeding, signs are not obvious, B-mode ultrasound to determine the lower edge of the placenta, you can confirm the diagnosis. Placental abruption on the posterior wall of the uterus, abdominal signs are not obvious, it is not easy to distinguish from the placenta previa, B-ultrasound can also be identified. The clinical manifestations of severe placental abruption are very typical and it is not difficult to distinguish from placenta previa.

2, aura uterus rupture: often occurs in the process of childbirth, there is strong contractions, lower abdominal pain refused to press, irritability, a small amount of vaginal bleeding, fetal distress signs. The above clinical manifestations are more difficult to distinguish from severe placental abruption. However, there are many uterine ruptures in the aura, uterine tube obstruction or cesarean section history, examination can be found in the uterus pathological retraction ring, catheterization has gross hematuria, etc., and placental abruption is often a patient with severe pregnancy-induced hypertension, check the uterus The plate is hard.

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