Pregnancy

Retro-placental hematoma: causes, symptoms and risk of recurrence

Hématome rétro-placentaire : causes, symptômes et risque de récidive

Retro-placental hematoma is a rare, but serious, complication of pregnancy. What is it and how is it supported? We take stock of the risks, symptoms and causes of premature placental abruption in pregnant women, with the advice of Anh-Chi Ton, midwife.

The placenta plays a fundamental role during pregnancy. It not only allows the exchange of oxygen and nutrients between the fetus and its mother, but it also fulfills a very important protective function. But it happens that this precious placenta has serious complications, the most common being that of an insertion fault. We will then talk about placenta previa or accreta. In some cases, the placenta can also come off prematurely. A serious complication, potentially fatal, which requires rapid management and often the performance of an emergency cesarean depending on the stage of pregnancy at which it occurs.

Retro-placental hematoma (HRP) designates a premature placental abruption. This is an emergency which constitutes a risk situation for the mother and the unborn child. “It occurs when a placenta artery ruptures due to a vasospasm, or if a vein in the placenta thromboses“explains Anh-Chi Ton.

The retro-placental hematoma occurs during the third trimester. When there is red bleeding in early pregnancy, it is usually a separation of the placenta.

The midwife first wants to reassure the mothers: “The retro-placental hematoma is very rarely consecutive to an abdominal trauma, a fall or a blow for example“The specialist specifies that three mechanisms can be at work in the occurrence of such a complication.

Dysimmunity

Half of the fetus comes from genes foreign to the maternal body, and normally there is tolerance by the immune system. But it sometimes happens that the molecule linked to this immune tolerance seems to be expressed less and interacts with other cells, which can explain retro-placental hematoma. The immune system will then somehow reject the pregnancy.

Angiopathy

It is a vascular problem in the placenta, the arteries called “maternal spiral arteries ” have more resistance to pass blood, so the placenta is less well supplied with blood.

Acute or chronic inflammation

That could play a role, there would be alterations of interaction between the cells in the event of inflammation. The chorioamniotitis, Infection of the placenta and amniotic fluid, is also a risk factor.

Other risk factors have been identified : smoking, multiparity, maternal age over 35, hypertension arterial, history of retroplacental hematoma, pre-eclampsia.

The symptoms of a retro-placental hematoma can be very discreet. But in the typical form, the midwife explains that there are three major signs:

  • Pains, often stabbed, and brutal in appearance. The uterus contracts, it is hard as wood, and does not relax.
  • Metrorrhagia (bleeding) which can be scarce and blackish because the blood has accumulated before going out in small quantities. Pregnant women can also expel clots.
  • Of heart rhythm abnormalities fetal.

There is no treatment. It’s about a life-threatening emergency for mother and child and the latter must be removed as quickly as possible“explains Anh-Chi Ton. The presence of a retro-placental hematoma imposes a emergency care after assessing the state of health of the mother and fetus. Evacuation of the uterus is the only solution to avoid aggravation, therefore caesarean section is systematically favored in the face of signs of fetal distress.

Fortunately, cases are rare, but the risk is real and the consequences can be dramatic: neurological sequelae for the fetus due to lack of oxygen or even fetal death; bleeding disorders, hemorrhage and risk of recurrence of HRP for the mother.

The risk of recurrence during a subsequent pregnancy is multiplied by 10 compared to someone without a history of retro-placental hematoma. Therefore, “pregnant women will be closely monitored“specifies the midwife.

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