Placenta previa during pregnancy causes. Central placenta previa. Placenta previa - what is it?

Placenta previa is the most common cause painless bleeding from the vagina later dates gestation (after 20 weeks).

The placenta is a temporary organ that connects the mother and fetus. Oxygen and nutrients are transferred through its vessels. It has the shape of a disk, the diameter of which is 20 cm at the end of the gestational period. The placenta is attached to the wall of the uterus, usually in the lateral or upper part of it, and is connected to the fetus through the umbilical cord. Her presentation is a complication that occurs as a result of attaching a "baby place" near or directly above the cervix.

The placenta is rich in blood vessels. Therefore, when the cervix and lower segment of the uterus are stretched, bleeding may occur.

Basic facts about the disease:

Placenta previa is a condition when it is attached to the uterine cavity in such a way that it partially or completely closes the exit from it.
The main sign of pathology is bleeding after the 20th week of gestational age.
Ultrasound is used to diagnose the disease.
Treatment includes activity restriction, bed rest. Depending on the severity of the condition, you may need medications to relax the uterus, intravenous administration of solutions, transfusion of blood or plasma.
At full form presentation requires a caesarean section.

With this pathology, other complications are possible, but most patients give birth to healthy children.

Development mechanism

The placenta develops near the site of implantation of the embryo into the uterine wall, usually in its lower part. With growth and development, it can block the internal uterine os. It is believed that the main reason for the development of placenta previa is inflammatory or atrophic changes in the normal endometrium.

Why is placenta previa dangerous?

This is the main cause of bleeding from the genital tract at the end of pregnancy. Bloody discharge occurs due to stretching of the lower segment of the uterus in the third trimester. As you prepare for childbirth, this area stretches and the placenta gradually separates from it. At the same time, the myometrium cannot contract in the area of abnormal attachment, and blood is constantly released from the gaping vessels.

In response to blood loss in the body, the production of thrombin increases - this substance contributes to the spasm of blood vessels and muscles for the formation of blood clots. The result is a vicious circle: placenta previa bleeding - uterine contraction - further tissue separation - continued blood loss.

Classification

Previously, such types of placenta previa were distinguished: complete, incomplete and marginal. Now they are combined into two concepts - full and regional.

Full presentation is defined as the overlap of the uterine os, that is, the place where the uterus passes into the cervix. If the edge is less than 2 cm from the internal opening of the cervical canal, but does not completely cover it, this is an incomplete presentation.

There is another, more accurate classification of this pathology (see the figure below):

low - the edge of the placenta is less than 7 cm from the uterine os, but does not touch it;
marginal presentation - only the edge of the "children's place" touches the uterine pharynx;
lateral (incomplete) - the organ closes the internal pharynx by 2/3;
central (complete) - the placenta completely covers the uterine os.

Classification of placenta previa: 1-low; 2 - marginal; 3 - incomplete; 4 - complete

The main threat of this pathology is the complications of childbirth, which can lead to the death of the mother or child. Therefore, according to ICD-10, 2 main types of the disease are distinguished - complicated by bleeding or without it.

Also, according to ultrasound data, the exact position of the “children’s place” is determined - on the anterior or posterior surface of the uterus (respectively, the anterior and posterior presentation).

Causes

The exact cause of development has not been elucidated. It is believed that the condition occurs under the influence of several factors at once. The main ones are:

age over 35 years;
previous fertility treatment;
a short interval between repeated pregnancies;
transferred operations on the uterus, curettage, abortion;
transferred caesarean section;
previously transferred presentation of the "children's place" (the recurrence rate is from 4 to 8%);
submucosal uterine fibroids;
low social and economic status;
smoking and drug use.

A violation of the properties of a fertilized egg can also cause a too low location of the “children's place”. For unknown reasons, the production of substances that dissolve endometrial proteins can be disrupted in its shell. As a result fertilized egg as if slipping into the lower segment, where it is implanted.

Placenta with umbilical cord

Childbirth with placenta previa is often complicated by secondary bleeding. This is due to the intensive expansion of the cervix and the separation of the placental membrane from it. In this case, the inefficiency of contractions of the uterine muscles develops, and the bleeding cannot be stopped.

The following groups of pregnant women are at greater risk:

Asian origin;
with a male fetus;
older than 35-40 years;
who had placenta previa during one of the previous pregnancies.

Pathology frequency and prognosis

The disease occurs in 1 in 200 pregnancies. The risk increases by 1.5-5 times with a previous caesarean section.

At the age of over 40 years, the incidence of pathology reaches 5%, which is 9 times more common than in women under 20 years of age.

If a pathologically low placenta previa is detected by ultrasound in the early stages of pregnancy, you should not worry too much. Up to 90% of such cases are no longer registered by the third trimester, that is, the "children's place" occupies a normal position. If the pathology persists at a gestational age of 20 weeks or more, the risk of complications increases.

Complications

The presentation of a child's place can cause such complications on the part of the mother:

bleeding during childbirth;
placental accreta or its detachment; such a complication accompanies 5-10% of cases of presentation and usually requires after a caesarean section;
the need for a blood transfusion;
early outflow of water and premature birth;
postpartum endometritis;
sepsis;
thrombophlebitis.

Mortality rates of about 0.03% are associated with intense bleeding that cannot be controlled and the development of DIC.

In addition, like other complications of pregnancy, this pathology has bad influence on the emotional comfort of the future mother, causing long-term stress.

For a newborn, placenta previa is also dangerous and can cause the following complications:

congenital malformations;
intrauterine growth retardation;
fetal anemia, Rhesus conflict;
abnormal presentation, most often gluteal;
incorrect position of the child inside the uterus, for example, oblique;
low birth weight;
prolonged jaundice;
the need for treatment in the intensive care unit, prolonged hospitalization;
increased risk of sudden infant death and mental retardation.

Mortality of newborns with this pathology is recorded in 1.2% of cases.

Tips for patients during pregnancy with the presentation of a "children's place", which will help to avoid serious complications:

avoid intense physical activity, vaginal examinations and sexual intercourse;
consume enough iron and folic acid to prevent possible anemia (we talk about the importance of folic acid intake during pregnancy);
notify the attending physician about the previous presentation.

First symptoms and their assessment

Basic clinical symptom Placenta previa is a painless discharge of bright red blood from the vagina that stops and then recurs, especially with exercise. Most often, such a symptom appears in the second trimester, during the third, or with the onset of contractions. This symptom may occur before the 30th week (in 34% of patients) or after this period (in 45% of women). This symptom may be absent.

Additionally, it can be defined malpresentation a child or a high location of the fundus of the uterus.

Placental presentation in 44% of cases leads to earlier than 37 weeks.

Clinical guidelines state that any woman who has vaginal bleeding at 12 weeks or later needs to see a doctor followed by an ultrasound. Because of the risk of life-threatening bleeding, any vaginal examination is absolutely contraindicated until the possibility of this pathology has been excluded.

When examining a woman with placental presentation, the following objective signs are determined:

low blood pressure;
cardiopalmus;
softening of the uterus;
normal fetal heart sounds.

Should be done differential diagnosis to exclude the following conditions:

rupture of the cervix or vagina;
miscarriage;
premature detachment of the placenta (read about this pathology);
cervicitis, vaginitis, vulvovaginitis;
DIC;
normal childbirth;
early outflow of water or premature birth;
rupture of the uterus during pregnancy, for example, with the insolvency of the sutures after a caesarean section.

Diagnostics

In the diagnosis of pathology, ultrasound of the uterus with visualization of the placenta is of decisive importance. Its location should be determined at 16 weeks (up to 20 weeks of gestation). If a pathology is detected, a second ultrasound is indicated at the 32nd week to select the method of delivery.

Laboratory research

If placenta previa is suspected, the following laboratory tests should be performed:

determination of the Rh factor and the likelihood of a Rh conflict;
fibrinogen and fibrin levels;
prothrombin or activated partial thromboplastin time;
determination of the blood group;
advanced blood test;
if necessary, and determining the degree of maturity of the lungs of the fetus.

Ultrasonography

Ultrasound is necessary not only to determine the location of the placenta. It helps to assess the gestational age, fetal weight, suspected malformations, presentation, position of the umbilical cord.

You can read more about ultrasound during pregnancy (when it is performed, how it is deciphered) at.

Transvaginal ultrasound

This is the "gold standard" for diagnosing placental presentation. This method of research is well tolerated and gives accurate information. False positive results are recorded in 1% of cases (that is, in fact, there is no pathology), and false-negative ones - in 2% (there is a pathology, but it cannot be recognized).

Transvaginal ultrasound is also used to determine cervical length. Its shortening up to 34 weeks indicates the likelihood of having a baby by caesarean section.

When planning the tactics of childbirth, the distance between the edge of the placenta and the internal uterine os, determined after 35 weeks, is also important. If it exceeds 2 cm, there may be natural childbirth. With a smaller gap, a caesarean section is most often performed, although in some cases, a normal birth is still possible.

According to ultrasound, the following degrees of pathology are distinguished:

I - the edge of the placenta is located at a distance of more than 3 cm from the internal pharynx;
II - the edge reaches the pharynx, but does not close it;
III - the placenta covers the internal pharynx, while both anterior and posterior presentation are possible, that is, it is located asymmetrically;
IV - the placenta lies symmetrically, located in the central part directly above the uterine os.

Transabdominal ultrasound

This is a simple and safe diagnostic method, but it is less accurate than the transvaginal method. Thus, the frequency of false positive diagnosis is 7%, and false negative - 8%.

Transperineal ultrasound

With this method, the sensor is located in the perineal region. It is an alternative to vaginal examination when it is not possible. However, this method is also not accurate enough.

MRI

Magnetic resonance imaging can be used to determine the tactics of labor management. It is especially useful for diagnosing concomitant.

Management of pregnancy

If a pregnant woman is diagnosed with placenta previa, the doctor must establish:

exact gestational age;
the presence of bleeding;
the intensity of blood loss and the presence of posthemorrhagic anemia.

If the pathology is diagnosed in the II trimester, there is no bleeding, then the patient is observed as usual, under conditions antenatal clinic. In addition, she is prescribed a blood coagulation study (coagulogram) and bed rest is recommended.

About bed rest

Bed rest improves blood flow to the placenta and blood supply to the fetus. With placenta previa, it reduces the load on the lower uterus and thereby helps prevent bleeding and premature birth.

The doctor may prescribe a different degree of activity:

in some cases, you can move around the house, but do not do heavy homework and not to lift weights;
more often it is recommended to stay in a sitting or lying position for a long time, getting up only to use the toilet or take a shower.

sexual contacts;
douching;
using vaginal suppositories or tampons;
repetitive squats;
fast walking.

Bed rest during pregnancy can cause some complications, including:

deep vein thrombosis of the legs;
decrease in bone mass (bone demineralization);
deterioration in the function of the musculoskeletal and cardiovascular systems;
maternal weight loss or gain;
stress due to the need to lie in bed, especially if this causes financial difficulties or no one to look after the children;
depression and anxiety.

When prescribing bed rest, ask your doctor about:

Why is it needed, how long will it take?
Is it possible to squat, climb stairs? Do I need to lie in bed in a certain position? What measures should be taken to prevent venous thrombosis?
Can I get up and go to the toilet, shower? Can you wash your hair while leaning forward?
Is it possible to have lunch while sitting at the table? Is it possible to use washing machine? Can you drive a car?
Is it possible to have sex, what options are acceptable?

Hospitalization

If the pathology persists in the third trimester, but there is no bleeding, the issue of hospitalization is decided individually:

if a woman, if necessary, can get to the maternity hospital in 5-10 minutes, she continues to be observed in a consultation and it is recommended to exclude physical work, sexual life and any travel
If Fast shipping the patient in a medical institution is impossible, she is hospitalized at 32-33 weeks; while prolonging the pregnancy should be up to 37-38 weeks, and then decide on a planned caesarean section.

Any bleeding after the 30th week requires hospitalization. To address the issue of treatment for the development of bleeding, various factors are taken into account, in particular:

volume of blood loss;
whether the bleeding has stopped at the time of hospitalization;
gestational age;
mother's health;
the state of development of the fetus, signs of its oxygen deficiency;
the position of the head and the exact location of the placenta.

If the bleeding is heavy, a caesarean section is performed, regardless of the gestational age (read about how it is carried out, recovery, consequences).

At minor secretions in the hospital, they carry out therapy aimed at stopping bleeding. Fresh frozen plasma is used, anemia is corrected, and ultrasound control of the position of the placenta is carried out.

Questions to ask your doctor:

Can presentation disappear over time in my case?
What to do if there is bleeding from the vagina?
What monitoring and research will I need until the end of my pregnancy?
Is it necessary to limit physical and sexual activity, and for how long?
For which symptoms do I need to visit an unscheduled antenatal clinic?
What symptoms do I need to urgently go to the hospital for?
Will I be able to have a baby naturally?
How much does this condition increase the risk of a subsequent pregnancy?

Birth management

When hospitalized, the patient must provide the doctor with the following information:

when signs of bleeding appeared;
the episode was single or the discharge recurred;
how much was or is bleeding;
whether it is accompanied by abdominal pain or contractions;
whether there were complications during previous pregnancies;
whether there were operations on the uterus, including caesarean section, removal of fibroids or curettage.

The treatment protocol for placenta previa recommends always taking into account the risk of massive bleeding and preterm birth. Therefore, doctors should be prepared to stop bleeding by one of the following methods:

suturing the site of attachment of the placenta;
bilateral ligation of the uterine arteries;
ligation of the internal iliac artery;
circular suturing of the lower segment of the uterus;
tamponade with gauze or a special inflatable catheter;
C-section.

Additionally, with postpartum hemorrhage, blood transfusion is used. Treatment includes the use and medications- oxytocin, methylergonovine, misoprostol. The risk of bleeding increases if there is an anterior location of the placenta.

Independent childbirth

Birth management naturally possible with incomplete presentation and the absence of bleeding. After opening the amniotic sac and pressing the head to the lower segment, the vessels of the placenta are compressed, and then birth process proceeds without complications.

If there is a weakness of the birth forces or the head is not tightly pressed against the entrance to the pelvis, it is possible by introducing oxytocin. If this does not help stop the bleeding, an emergency caesarean section is performed.

Management of vaginal bleeding

With bleeding in the 3rd trimester, hospitalization is indicated, it is necessary first of all to assess the condition of the mother and fetus and, if necessary, start an urgent blood transfusion. After stabilization of the condition, the cause of blood loss is established. Assign transperineal or transabdominal ultrasound, examine the vagina.

Important! A vaginal examination is never done once the diagnosis has been made, as it can lead to separation of the placenta and profuse bleeding.

If the gestational age is less than 36 weeks, vaginal bleeding is stopped, the fetus is normal, expectant management is indicated. At a gestational age of less than 34 weeks, the use of glucocorticoids is indicated. In a stable condition, the pregnant woman is observed for at least 2 days, after which she can be discharged. In the event that the bleeding does not stop or the fetus suffers, an emergency caesarean section is indicated.

Surgical interventions

The optimal timing for delivery in placenta previa has not been precisely defined. In women with placenta accreta, delivery is recommended at 36-37 weeks, and in its absence - at 38-39 weeks. This minimizes the risk of bleeding and reduces the chance of prematurity. An earlier delivery is indicated if the patient has recurrent bleeding or has previously had a preterm delivery.

C-section shown at:

The distance between the placenta caramel and the center of the cervix, not exceeding 2 cm. During this operation, especially if the "baby place" lies along the back wall, a low transverse incision of the uterus is usually used. Anterior presentation may be an indication for a vertical incision.
The presence of concomitant dense attachment or accreta of the placenta. In spontaneous childbirth, this pathology is accompanied by high level mortality (up to 7%), as well as the risk of infection of the uterus or damage to neighboring organs. In this case, the uterus may need to be removed.
Previous caesarean section or abortion, as well as central placenta previa.

In the absence of bleeding, the operation can be performed under epidural anesthesia. In other cases, general anesthesia is required.

C-section

In the 3rd stage of labor, it is imperative to examine the birth canal using mirrors, since placenta previa is often accompanied by them. In addition, drugs are administered that reduce the uterus, and antibiotics are started to be administered, since in postpartum period high risk of developing endometritis.

Possible complications of the early postpartum period:

hypotonic and atonic bleeding, which may be an indication for manual examination of the uterus and separation of the placenta, and if such measures are ineffective, to remove the uterus;
embolism with amniotic fluid;
pulmonary embolism;
ascending infection of the genital tract.

Both in natural childbirth and surgical operation a neonatologist should be present, since often a child is born in a state of asphyxia, which requires immediate treatment.

Features of nursing care

During childbirth with placenta previa, the midwife plays an important role. She is constantly monitoring the pregnant woman. Her responsibilities include:

measurement blood pressure every 5-15 minutes;
evaluation of the fetal heart rate;
contraction control;
determination of the volume of blood lost by weighing the vaginal pads;
instilling confidence in a pregnant woman in a favorable outcome of childbirth;
answers to all the questions of the woman in labor, which will help her cope with stress;
competent provision of obstetric care during childbirth.

It largely depends on the midwife how the patient will feel, how high the level of adrenaline will be in her blood, which can adversely affect the course of childbirth. Therefore, medical personnel should treat the pregnant woman with understanding, kindness, politeness, and provide quick and confident assistance.

Information for pregnant women

For the prevention of long-term psychological stress, the following recommendations are given:

Learn more about this complication. The information will help reduce the woman's fears and concerns. You should talk to the doctor leading the pregnancy, look for information on your own, or talk with women who have already suffered such a complication.
Accurately determine the method of hospitalization, do not be left alone in case an ambulance is called.
Prepare for a caesarean section, including creating conditions at home that make household work easier for the first time. If there are other children in the family, determine who will take care of them at least during the first month after the operation. Make a stock of frozen food, convenience foods, clean clothes, perhaps disposable tableware, prepare a room and a dowry for a child, arrange with a loved one or a cleaning company to clean the apartment. Collect a bag for the maternity hospital in advance (everything should be ready after the 30th week).
Rest as much as possible, preferably lying in bed.
Protect your emotional peace.

Prevention

Taking into account the main causes of the development of pathology, the prevention of placenta previa includes:

reduction in the number of abortions and intrauterine interventions;
refusal of unnecessary operations of conservative myomectomy;
reduction in the number of caesarean sections due to more careful preparation and childbirth.

However, pathology can occur even in completely healthy woman. Therefore, it is impossible to completely get rid of the risk of placental presentation, as well as to cure this condition during pregnancy.

Location of the placenta: norm and pathology, causes of anomalies, symptoms and possible complications, diagnosis and treatment. Childbirth and precautions

The placenta is an organ located in the uterus and functions only during pregnancy. It is thanks to him that the normal development of pregnancy until the very birth becomes possible, therefore it is important that the placenta "works" normally. In this case, not only the correct structure of the placenta is important, but also its correct location. Placenta previa is a serious complication of pregnancy, which, fortunately, is not very common.

The placenta is laid at the very beginning of pregnancy and is fully formed. It provides nutrition to the fetus, excretion of metabolic products, and also performs the function of the lungs for it, because. it is through the placenta that the fetus receives the oxygen necessary for its life. In addition, the placenta is a real "hormonal factory": hormones are formed here that ensure the preservation, normal development of pregnancy, growth and development of the fetus.

The placenta is made up of villi - structures within which blood vessels pass. As pregnancy progresses, the number of villi, and, accordingly, the number of blood vessels is constantly growing.

Location of the placenta: norm and pathology

From the side of the uterus at the site of attachment of the placenta there is a thickening of the inner membrane. Deepenings are formed in it, which form the intervillous space. Some placental villi fuse with maternal tissues (they are called anchor), while the rest are immersed in maternal blood, which fills the intervillous space. Anchor villi of the placenta are attached to the partitions of the intervillous spaces, vessels pass through the thickness of the partitions, which carry maternal arterial blood saturated with oxygen and nutrients.

The villi of the placenta secrete special substances - enzymes that "melt" the small arterial vessels that carry maternal blood, as a result of which blood flows out of them into the intervillous space. It is here that the exchange between the blood of the fetus and the mother takes place: with the help of complex mechanisms, oxygen and nutrients enter the blood of the fetus, and metabolic products of the fetus enter the mother's blood. The fetus is connected to the placenta by the umbilical cord. One end is attached to the umbilical region of the fetus, the other to the placenta. Inside the umbilical cord are two arteries and a vein that carry blood, respectively, from the fetus to the placenta and vice versa. Blood rich in oxygen and nutrients flows through the vein of the umbilical cord to the fetus, and venous blood from the fetus, containing carbon dioxide and metabolic products, flows through the arteries.

Normally, the placenta is located closer to the bottom of the uterus along the anterior or, less often, its posterior wall. This is due to more favorable conditions for the development of the fetal egg in this area. The mechanism for choosing the place of attachment of the fetal egg is not completely clear: there is an opinion that the force of gravity plays a role in choosing a place - for example, if a woman sleeps on her right side, then the egg is attached to the right wall of the uterus. But this is just one of the theories. We can only say unequivocally that the fetal egg does not attach to places that are unfavorable for this, for example, to the locations of myomatous nodes or to places of damage to the inner lining of the uterus as a result of previous curettage. Therefore, there are other options for the location of the placenta, in which the placenta is formed closer to the lower part of the uterus. Allocate a low location of the placenta and placenta previa.

The placenta is said to be low when bottom edge it is located at a distance of no more than 6 cm from the internal pharynx of the cervix. This diagnosis is established, as a rule, during ultrasound. Moreover, in the second trimester of pregnancy, the frequency of this pathology is about 10 times higher than in the third trimester. It's pretty easy to explain. Conventionally, this phenomenon is called the "migration" of the placenta. In fact, the following happens: the tissues of the lower part of the uterus, very elastic, with an increase in the duration of pregnancy, undergo significant stretching and stretch upwards. As a result of this, the lower edge of the placenta seems to move upward, and as a result, the location of the placenta becomes normal.

Placenta previa is a more serious diagnosis. In Latin, this condition is called placenta praevia. "Pre via" literally means before life. In other words, the term "placenta previa" means that the placenta is on the way to the emergence of a new life.

Placenta previa is complete or central, when the entire placenta is located in the lower part of the uterus and completely covers the internal cervical os. In addition, there is a partial placenta previa. It includes marginal and lateral presentation. They say about lateral presentation of the placenta when up to 2/3 of the outlet of the uterus is covered with placental tissue. With marginal placenta previa, no more than 1/3 of the opening is closed.

Causes of anomalies

The main cause of anomalies of placental attachment are changes in the inner wall of the uterus, as a result of which the process of attaching a fertilized egg is disrupted.

These changes are most often due to inflammatory process uterus, arising against the background of curettage of the uterine cavity, abortion, or associated with sexually transmitted infections. In addition, deformation of the uterine cavity predisposes to the development of such a pathology of the placenta, due either to congenital anomalies in the development of this organ, or to acquired causes - uterine fibroids (benign tumor of the uterus).

Placenta previa can also occur in women who have serious heart, liver, and kidney disease as a result of congestion in the pelvic organs, including the uterus. That is, as a result of these diseases, areas with worse blood supply conditions than other areas appear in the wall of the uterus.

Placenta previa in multiparous women occurs almost three times more often than in women carrying their first child. This can be explained by the "baggage of diseases", including gynecological ones, which a woman acquires by the age of the second birth.

There is an opinion that this pathology of the location of the placenta may be associated with a violation of some functions of the fetal egg itself, as a result of which it cannot attach itself to the most favorable part of the uterus for development and begins to develop in its lower segment.

Beware of bleeding!
Bleeding with placenta previa has its own characteristics. It is always external, i.e. blood flows out through the cervical canal, and does not accumulate between the wall of the uterus and the placenta in the form of a hematoma.
Such bleeding always begins suddenly, as a rule, without any apparent external cause, and is not accompanied by any painful sensations. This distinguishes them from bleeding associated with premature termination of pregnancy, when, along with spotting, there are always cramping pains.
Often bleeding begins at rest, at night (woke up "in a pool of blood"). Once having arisen, bleeding always repeats, with greater or lesser frequency. Moreover, it is never possible to foresee in advance what the next bleeding will be in terms of strength and duration.
After such bleeding can be provoked by physical activity, sexual intercourse, any increase in intra-abdominal pressure (even coughing, straining, and sometimes a gynecologist's examination). In this regard, examination on the chair of a woman with placenta previa should be carried out with all precautions in a hospital, where emergency assistance can be provided in case of bleeding. The bleeding itself is dangerous for the life of mother and baby.

Quite often, placenta previa can be combined with its dense attachment, as a result of which the independent separation of the placenta after childbirth is difficult.

It should be noted that the diagnosis of placenta previa, with the exception of its central variant, will be quite correct only closer to childbirth, because. the position of the placenta may change. This is all due to the same phenomenon of "migration" of the placenta, due to which, when the lower segment of the uterus is stretched at the end of pregnancy and during childbirth, the placenta can move away from the area of \u200b\u200bthe internal os and not interfere with normal childbirth.

Symptoms and possible complications

The main complications and the only manifestations of placenta previa are spotting. Depending on the type of presentation, bleeding may occur for the first time in different periods pregnancy or childbirth. So, with central (complete) placenta previa, bleeding often begins early - in the second trimester of pregnancy; with lateral and marginal options - in the third trimester or directly in childbirth. The amount of bleeding also depends on the type of presentation. With a complete presentation, bleeding is usually more abundant than with an incomplete version.

Most often, bleeding occurs during pregnancy, when the preparatory activity of the lower segment of the uterus is most pronounced. But every fifth pregnant woman with a diagnosis of placenta previa notes the appearance of bleeding in the early stages (16-28 weeks of pregnancy).

What causes bleeding in placenta previa? During pregnancy, the size of the uterus constantly increases. Before pregnancy, they are comparable in size matchbox, and by the end of pregnancy, the weight of the uterus reaches 1000 g, and its dimensions correspond to the size of the fetus along with the placenta, amniotic fluid and membranes. Such an increase is achieved, mainly due to an increase in the volume of each fiber that forms the wall of the uterus. But the maximum change in size occurs in the lower segment of the uterus, which stretches the more, the closer the term of delivery. Therefore, if the placenta is located in this area, then the process of "migration" is very fast, the low-elastic tissue of the placenta does not have time to adapt to the rapidly changing size of the underlying uterine wall, and placental abruption occurs over a greater or lesser extent. In the place of detachment, damage to the vessels occurs and, accordingly, bleeding.

With placenta previa, the threat of termination of pregnancy is often noted: increased tone uterus, pain in the lower abdomen and in the lumbar region. Often, with this location of the placenta, pregnant women suffer from hypotension - stably reduced pressure. A decrease in pressure, in turn, reduces performance, causes weakness, feelings of weakness, increases the likelihood of fainting, the appearance of a headache.

In the presence of bleeding, anemia is often detected - a decrease in the level of hemoglobin in the blood. Anemia can exacerbate the symptoms of hypotension, in addition, oxygen deficiency caused by a decrease in hemoglobin levels adversely affects the development of the fetus. There may be growth retardation, fetal growth retardation syndrome (FGR). In addition, it has been proven that children born to mothers who suffered from anemia during pregnancy always have a reduced hemoglobin level in the first year of life. And this, in turn, reduces the defenses of the baby's body and leads to frequent infectious diseases.

Due to the fact that the placenta is located in the lower segment of the uterus, the fetus often takes the wrong position - transverse or oblique. Often there is also a breech presentation of the fetus, when its buttocks or legs are turned towards the exit from the uterus, and not the head, as usual. All this makes it difficult or even impossible to have a child naturally, without surgery.

Diagnosis of placenta previa

Diagnosis of this pathology is most often not difficult. It is usually established in the second trimester of pregnancy based on complaints of intermittent bleeding without pain.

The doctor on examination or during an ultrasound scan may reveal an incorrect position of the fetus in the uterus. In addition, due to low location placenta, the underlying part of the baby cannot descend into the lower part of the uterus, so hallmark also is the high standing of the presenting part of the child above the entrance to the small pelvis. Of course, modern doctors are in a much more advantageous position compared to their counterparts 20-30 years ago. At that time, obstetrician-gynecologists had to navigate only by these signs. After the introduction of ultrasound diagnostics into wide practice, the task has become much simpler. This method is objective and safe; Ultrasound allows you to get an idea of the location and movement of the placenta with a high degree of accuracy. For these purposes, it is advisable to triple ultrasound control at 16, 24-26 and at. If according to the data ultrasound no pathology of the location of the placenta is detected, the doctor, upon examination, can identify other causes of bloody discharge. They can be various pathological processes in the vagina and cervix.

Observation and treatment of placenta previa

An expectant mother who has been diagnosed with placenta previa needs careful medical supervision. Of particular importance is the timely conduct of clinical trials. If even a slightly reduced level of hemoglobin or disorders in the blood coagulation system are detected, the woman is prescribed iron supplements, because. in this case, there is always a risk of rapid development of anemia and bleeding. If any, even minor, deviations in the state of health are detected, consultations of the relevant specialists are necessary.

Placenta previa is a formidable pathology, one of the main causes of serious obstetric bleeding. Therefore, in the event of bleeding, all a woman’s health problems, even small ones, can aggravate her condition and lead to adverse consequences.

regime plus diet
If there is no bleeding, especially with a partial variant of placenta previa, a woman can be observed on an outpatient basis.
In this case, it is recommended to observe a sparing regime: physical and emotional stress should be avoided, sexual contacts should be excluded. It is necessary to sleep at least 8 hours a day, more to be in the fresh air.
In the diet, there must be foods rich in iron: buckwheat, beef, apples, etc. Be sure to have a sufficient protein content, because. without it, even with a large intake of iron, hemoglobin will remain low: in the absence of protein, iron is poorly absorbed. It is useful to regularly eat vegetables and fruits rich in fiber, because. stool retention can provoke the appearance of spotting. Laxatives for placenta previa are contraindicated. Like all pregnant women, patients with placenta previa are prescribed special multivitamin preparations. If all these conditions are met, the manifestations of all the symptoms described above, which in most cases accompany placenta previa, are reduced, which means that conditions are provided for normal growth and development of the child. In addition, in the event of bleeding, the adaptive capabilities of the woman's body increase, and blood loss is more easily tolerated.

In the presence of bloody discharge, observation and treatment of pregnant women with placenta previa at gestational ages over is carried out only in obstetric hospitals that have the conditions for providing emergency assistance in the intensive care unit. Even if the bleeding has stopped, the pregnant woman remains under the supervision of the hospital doctors until the due date.

In this case, treatment is carried out depending on the strength and duration of bleeding, gestational age, general condition woman and fetus. If the bleeding is insignificant, the pregnancy is premature and the woman feels well, conservative treatment. Strict bed rest, drugs to reduce the tone of the uterus, improve blood circulation are prescribed. In the presence of anemia, a woman takes drugs that increase the level of hemoglobin, general strengthening drugs. Calming agents are used to reduce emotional stress.

childbirth

With complete placenta previa, even in the absence of bleeding, a caesarean section is performed at 38 weeks of gestation, because. spontaneous childbirth in this case is impossible. The placenta is located on the path of the baby's exit from the uterus, and when you try independent childbirth its complete detachment will occur with the development of very heavy bleeding, which threatens the death of both the fetus and the mother.

The operation is also resorted to at any stage of pregnancy in the presence of the following conditions:

placenta previa, accompanied by significant bleeding, life-threatening;
recurrent bleeding with anemia and severe hypotension, which are not eliminated by the appointment of special drugs and are combined with a violation of the fetus.

In a planned manner, a cesarean section is performed when a partial placenta previa is combined with another pathology, even in the absence of bleeding.

If a pregnant woman with partial placenta previa carried the pregnancy to term, in the absence of significant bleeding, it is possible that childbirth will occur naturally. With the opening of the cervix by 5-6 cm, the doctor will finally determine the variant of placenta previa. With a small partial presentation and slight bleeding, an opening of the fetal bladder is performed. After this manipulation, the fetal head descends and compresses the bleeding vessels. The bleeding stops. In this case, the completion of childbirth in a natural way is possible. With the ineffectiveness of the measures taken, childbirth is completed promptly.

Unfortunately, after the birth of a child, the risk of bleeding remains. This is due to a decrease in the contractility of the tissues of the lower segment of the uterus, where the placenta was located, as well as the presence of hypotension and anemia, which have already been mentioned above. In addition, it has already been said about the frequent combination of presentation and dense attachment of the placenta. In this case, the placenta after childbirth cannot completely separate from the walls of the uterus on its own, and it is necessary to conduct a manual examination of the uterus and separation of the placenta (the manipulation is performed under general anesthesia). Therefore, after childbirth, women who had placenta previa remain under the close supervision of hospital doctors and must carefully follow all their recommendations.

Infrequently, but still there are cases when, despite all the efforts of doctors and a caesarean section, the bleeding does not stop. In this case, it is necessary to resort to the removal of the uterus. Sometimes this is the only way to save a woman's life.

Precautionary measures

It should also be noted that with placenta previa, one should always keep in mind the possibility of developing severe bleeding. Therefore, it is necessary to discuss with the doctor in advance what to do in this case, which hospital to go to. Staying at home, even if the bleeding is light, is dangerous. If there is no prior agreement, you need to go to the nearest maternity hospital. In addition, with placenta previa, you often have to resort to blood transfusions, so if you have been diagnosed with such a diagnosis, find out in advance which of your relatives has the same blood type as you and get their consent to donate blood for you if necessary (the relative must pre-test for HIV, syphilis, hepatitis).

You can arrange in a hospital where you will be observed so that your relatives donate blood for you in advance. In this case, it is necessary to enlist a guarantee that the blood is used specifically for you - and only if you do not need it, it will be transferred to a general blood bank. It would be ideal for you to donate blood for yourself, but this is only possible if your condition does not cause concern, all indicators are normal and there is no spotting. You can donate blood for storage multiple times during your pregnancy, but you also need to ensure that your blood is not used without your knowledge.

Although placenta previa is a serious diagnosis, modern medicine allows you to endure and give birth healthy child, but only on condition timely diagnosis this complication and with strict observance of all doctor's prescriptions.

When everything is over and you and your baby are at home, try to organize your life properly. Try to rest more, eat right, be sure to walk with the baby. Do not forget about multivitamins and drugs for the treatment of anemia. If possible, do not refuse breastfeeding. This will not only lay the foundation for the health of the baby, but also speed up the recovery of your body, because. stimulation of the nipple by sucking causes the uterus to contract, reducing the risk of postpartum hemorrhage and uterine inflammation. It is desirable that at first someone helps you in caring for the child and household chores, because your body has suffered difficult pregnancy and he needs to recover.

Evgeniya Nazimova
obstetrician-gynecologist, Moscow

12/17/2007 00:07:52, Olga

Doctors do not like this diagnosis and try to convince her to terminate the pregnancy at the beginning, when the presentation was established on the first ultrasound. and do not say that everything can change. I liked the article, detailed, necessary, at one time I bit by bit collected any information about this complication. In conclusion, the article is very optimistic. very necessary words about the possibility of giving birth to a healthy child no matter what. I want another child and I hope this complication does not tend to recur.

The article is interesting, but leaves no hope for women with previa that the placenta will return to its normal position by 30 weeks. I had bleeding at 22 weeks, the diagnosis was full presentation. So in a month the placenta rose by 6 cm from the internal pharynx (the lower limit of the norm). So I would like to say that presentation is not a final diagnosis at the beginning of the 2nd trimester and it is not necessary to go to the hospital before delivery.

07/10/2006 13:21:58, Katyusha

Placenta previa during pregnancy is one of the most serious pathological complications that occurs during the period of bearing a baby. In this case, the placenta completely or completely blocks the uterine os.

This complication cannot be cured. medical method and difficult to prevent, forecasts are unpredictable. There is a chance that the fetus itself will move into place and the problem will disappear.

In obstetrics, placenta previa is pathological process in the body of a future mother, in which the fetus exfoliates from the walls and attaches very low to the uterus. Pathology is quite rare.

If the problem was discovered in the 1st trimester of pregnancy, then it is not dangerous. By the end of gestation, she will again fall into place and free the passage for the child. In the event that the condition was detected in late pregnancy, internal bleeding appears. If the disease is not detected in time, there may be serious problems during the gestation period and during childbirth.

During labor, the baby exits through the cervix into the birth canal. If a deviation is detected, then during contractions, the vessels attached to the walls of the uterus can burst and cause severe bleeding in the womb. It is fatal for the child and the mother herself. Therefore, with some types of presentation, the birth of a baby is impossible.

Provoking factors

The pathological condition occurs in women for the following reasons:

Sexual infectious diseases. Pregnancy is difficult and possible consequences due to the presence in the body of infectious bacteria that affect the endometrium (inner part of the uterus). Due to infection during fertilization, the placenta cannot stably attach to the walls and falls to the uterine os. In this case, there is a risk of not only the appearance of an incorrect location of the embryo, but also a miscarriage at 10-13 weeks of gestation.
genetic factor. When the fetus has deviations in genetic norms, its enzymes cannot reach the endometrium. As a result, the embryo is not fixed in the womb.
Deformation of the structure of the uterus. If the girl had unsuccessful operations or she has congenital deformities, fibroids and polyps with depletion of the walls of the vagina can be observed. Such a problem does not allow the embryo to gain a foothold and fully begin to develop.
Insufficiency of the endometrium. During abortions and curettage, the upper layer of the endometrium is injured and removed. If the procedure was done poorly, then there is a low development of the endometrium. The placenta fails to attach anywhere, and it sinks to the bottom of the vagina.

And also to the significant factors provoking breech presentation of the fetus include:

in past births there was a caesarean;
the woman's age is over 30;
endometriosis;
drug and alcohol abuse;
multiple pregnancy;
adenomyosis;
trauma to the vagina;
chronic diseases of the lower genital organs;
pathologies that disrupt the full development of the baby.

Types of placenta previa

Depending on the nature of the disease and the location of the fetus in the region of the short neck, several types of the disease are distinguished. There are two main classifications. The first is formed on the basis of the location of the child's place, the second on the basis of the results of ultrasound. It is worth noting that the size and location of the baby change as the fetus develops and the uterus grows.

There are the following types pathological condition:

Complete

At full placental presentation the internal os of the fetus is completely closed. When the uterus opens, the baby will not be able to go out. natural appearance a baby in such a situation is impossible. If the pregnancy reaches 30–34 weeks without progression of the disease, then only a cesarean will be performed. This type of disease is most dangerous for mother and baby. With complications, a lethal outcome is observed.

Incomplete (partial)

With a partial pathological condition, the clinical picture is as follows: the cervix does not completely overlap, due to incomplete closure of the tube, the fluid cannot circulate normally inside. Complications arise due to the exfoliation of the embryo from the walls of the vagina. The placenta falls and blocks the tube. If this happened before the 20th week of gestation, there is a chance that she will rise back. With a weak course of the pathological condition, problems are not observed.

In this case, childbirth does not take place naturally, since the baby's head is not able to go out into the narrow opening. Therefore, a caesarean is performed. Partial presentation occurs in 40% of pregnant women in the presence of pathology. It is a safer type of pathological condition, despite the surgical intervention, the procedure performed does not harm the development of the baby and the health of the woman.

Low (lower)

In this view, the embryo is 48 mm from fallopian tube. That is, the internal pharynx remains completely open. Against the background of low presentation, the baby may appear naturally. According to experts, this is the most favorable and safe view pathology during gestation and childbirth.

Central

The cervical inlet is blocked by the placenta. When examining and feeling the vagina, it is impossible to determine the fetal membrane. In such a situation, the appearance of the baby in a natural way is impossible, since the passage is completely closed. central presentation according to the results of ultrasound, it can be grades 3 and 4, which is dangerous for the child.

Lateral

Part of the fetus covers the fallopian tube, the rest is located on one of the sides. The type of disease refers to partial presentation. According to the results of ultrasound, 2-3 degrees of progression of the disease are detected. In this form, there are both natural childbirth and with the help of surgical intervention.

Regional

Or extreme. On examination, only the rough shell of the embryo is revealed, which indicates that there is a small gap in the uterine passage and the child is placed from its edge. Natural childbirth is possible with this type, but sometimes medical intervention is required.

Posterior (placenta previa on the posterior wall)

The most popular type of deviation. Most of the fetus is located on the back of the wall. You can give birth naturally, but there is a chance of a bad baby passing.

Anterior (placenta previa along the anterior wall)

In this type, the placenta is adjacent to the front. It is not considered a dangerous and pathological case, therefore natural childbirth is acceptable. It is considered as a variant of the norm and does not interfere with the full development of the fetus.

The disease is divided into stages of development.

There are 4 degrees of cervical overlap:

I degree - the embryo develops in the tube area, there is a small hole with a diameter of 2 cm.
II degree - part of the fetus lies on the edge of the entrance to the cervical canal while not affecting it completely.
III degree - the embryo completely closes the channel, leaving no space. In this case, the fetus will be located on one of the walls of the uterus, and its Bottom part aisle locations.
IV degree - the placenta is located in the lower part of the womb and blocks the entire cervical passage. In this case, the embryo is located on the anterior and posterior walls of the vagina.

The degree of the disease is determined only by the results of ultrasound. Only after diagnosis, you can find out the severity of the disease and find out possible complications.

What is the danger of such an ailment - possible complications

What is the risk? If the marginal position of the child's place is diagnosed in the early stages of gestation, there is a risk that when the child begins to grow, the placenta, along with the uterine walls, will move sideways. In addition, the fetus may peel off and move down. In this case, the channel will be completely closed. In this case, damage to the fetus may occur.

If the child's place is fixed on the front or back wall, then the risk of developing complications is minimal. With this diagnosis, the pregnancy proceeds normally, and a caesarean section is not required.

But, if by the 22nd week of gestation the child has not changed its position, treatment and supervision of a doctor will be required. There is a risk to the life of the mother and baby.

Due to the development of the disease, the following complications are possible:

The body of the baby in the womb of the mother will put pressure on the placenta, this will worsen the supply of oxygen and blood. There are foci of ischemia, the baby will die due to the rapid aging of the child's place.
The lower part of the uterus has less elastic and strong tissues. With the development of the disease, the risk of detachment and opening of internal bleeding increases. This will harm the girl's body and destroy the child.
Even if the pregnancy proceeded well, and there are no complications, the incorrect position of the baby can provoke the appearance of hypoxia and the newborn will die during childbirth.
When exiting, the baby can touch the placenta and pull it out sharply. This will cause damage to the walls, severe internal bleeding.

If a girl gives birth naturally, and complications arise, then doctors are forced to do a caesarean section, otherwise there is a risk of the baby's death when going outside. In this case, emergency measures are taken and the baby is removed surgically.

Treatment Methods

The course of treatment is prescribed after a complete medical examination and examination of the woman in labor. The duration and characteristics of treatment depend on the duration, location of the child and the type of internal bleeding. Therapy should take place under the supervision of specialists.

The course includes the following treatments:

Hospitalization of the expectant mother to preserve and identify the nature of the disease.
Taking drugs that increase blood clotting and relieve spasms.
Bed rest and rest.
Restriction on active physical exercises and loads.
Daily examination of the patient to determine the course of the disease.
Premature birth and caesarean section are possible.

If a woman in labor has severe bleeding and detachment of the child's place from the walls is revealed, then a certain clinical protocol comes into play. The patient is urgently hospitalized and undergo emergency medical care. This condition is very dangerous for a woman and a baby. If internal bleeding is not stopped in time, the child will die in the womb and the woman will begin to have serious complications that will lead to disastrous consequences. A loss a large number blood can lead to a critical condition of a woman. The loss of 350-400 ml of blood at a time is considered especially dangerous.

If the disease is characterized by a small amount of blood excretion, and the woman’s condition is not life-threatening, then they are not admitted to the clinic, treatment is allowed to be carried out at home, but under the supervision of a gynecologist. When symptoms of anemia appear, low pressure and severe bleeding, the woman is scheduled for an emergency delivery by caesarean section.

Childbirth with such a diagnosis

In the presence of such a diagnosis, natural childbirth and caesarean section are observed. What exactly will be prescribed depends on the condition of the woman in labor and the nature of the pathology. The main danger of childbirth in a natural way is that during contractions detachment of the child's place can occur. This condition will provoke a severe form of hypoxia of the baby, internal bleeding will open. This will be a threat to the life of the newborn and mother. Therefore, immediate surgical intervention is needed.

The natural exit of the child, for example, with a low location of the baby in the womb. With a partial or incomplete form of the disease, each case is considered separately. The central location requires surgery and a caesarean section. Which procedure will be prescribed, only the obstetrician decides. Sometimes two methods can be used at once.

Caesarean section is done regardless of the trimester. If necessary, he may be appointed to early stages gestation, if premature pregnancy is diagnosed.

And also the procedure is carried out in the following emergency cases:

if a woman has lost more than 300 ml during bleeding;
arose acute form hypotension and anemia;
strong simultaneous blood loss in a volume of 350 ml;
bleeding opened at full presentation.

The operation is done regardless of the development and condition of the unborn child. The main indicator is the condition of the mother. What kind of childbirth will be determined before 37-38 weeks of pregnancy. If the pregnancy gave complications, then premature birth is possible. In the early stages of gestation, the child may not survive.

Preventive measures

How to behave in order to prevent pathology? This question is of interest to all girls who are concerned about their health and the health of the unborn baby. As a prevention, you first need to know about the prevention of abortion. They can be the main cause of problems during the period of bearing a baby.

In addition, the girl must undergo scheduled examinations by a gynecologist every six months. When genital diseases and hormonal disruptions are detected, complex treatment is necessary.

Recommendations: if symptoms of presentation appear in the early stages, you need to undergo a complete laboratory examination in order to establish an accurate diagnosis and the nature of the disease. During pregnancy, the girl is forbidden to overstrain, carry heavy weights, overcool and overheat the body, as the likelihood of opening internal bleeding increases.

Conclusion

Placenta previa is a serious complication that is detected at different stages of pregnancy. There are different types of diseases that differ in their nature. If a pathology is detected, it is necessary to undergo a complete medical examination and start the prescribed course of therapy.

An abnormal condition can lead to serious consequences, so it is impossible to delay therapy. Sometimes the diagnosis is not dangerous for the mother and child, while in other cases it is a risk and threat to life for both the woman and the baby.

How to give birth with placenta previa

How to avoid placenta previa

Normally, the placenta is attached to the upper part of the uterus and, when the baby is born, remains inside for some time, supplying the baby with oxygen and allowing you to calmly take the first breath. However, sometimes the placenta is not in place - it partially or completely blocks the “exit” from the uterus and, accordingly, the child cannot leave “his home” first. A complication is rare, but, alas, not exotic.

How do pregnancy and childbirth proceed with placenta previa?

Placenta - a new organ of a pregnant woman

Many expectant mothers anxiously await the birth of a baby, tracking his growth by weeks and even by days. But few people think that together with the baby inside a woman, a unique beauty appears and develops. new organ - . And the organ, by the way, is rather big - it weighs as much as half a kilo! If we talk about its functions, it becomes clear that not “whole”, but “only” a pound.

Firstly, it allows you to take water, electrolytes, nutrients and minerals, vitamins, and, most importantly, oxygen from the mother's blood. But at the same time, the blood of mother and baby does not mix - is it not a miracle?

Secondly, to remove everything superfluous from the baby's body, first of all - carbon dioxide, because the baby breathes, although it does not breathe in and out.

Thirdly, the placenta produces (or contributes to the production of) various hormones: including chorionic gonadotropin, and progesterone, prolactin, and estrogens, and this is not a complete list.

Finally, the placenta is a kind of "watchman" that takes useful substances from the mother's blood (for example, some antibodies that provide the child with immune protection from birth) and does not let in harmful ones.

” A healthy placenta, which grows and develops with the child, is the key to his health and well-being. But she can suffer if she is "in the wrong place, at the wrong time."

Location of the placenta: top, side, bottom

The best location for the placenta is at the top (where the bottom of the uterus is located) on the back wall (the side of the uterus that is “facing” the spine). Why?

During growth, the uterus stretches in front and downwards - there its wall becomes thinner, blood supply, respectively, is worse. The anterior wall of the uterus is more vulnerable - an accidental fall or blow can hit the placenta directly, while at the back it is reliably protected by the body of the uterus and amniotic fluid. But most importantly, the wall of the uterus is stretched, but the placenta is not so elastic. If it is located in front and below, then the placenta simply “does not keep up” behind the wall of the uterus, and is constantly “unfastened”.

The lower the placenta is located (especially if we are talking about the front wall), the more vulnerable it is. If 5-6 centimeters remain from its edge to the cervix, then they talk about - a condition requiring special attention doctors and pregnant women.

” However, it happens that the placenta is located so low that it partially or completely closes the cervical canal - the “passage” in the cervix, which should open slightly during childbirth.

If childbirth takes place naturally, then the placenta will be “born” first. At this moment, the blood supply to the child will stop, the unborn baby will literally “cut off oxygen”. The chances of survival with natural childbirth are minimal.

” Fortunately, this is a fairly rare complication - it occurs no more than 1% of the total number of births. And only in 20 cases of all presentations, complete presentation is observed, when the placenta completely covers the area of \u200b\u200bthe internal pharynx.

Why does placenta previa occur?

When a fertilized egg enters the body of the uterus from the fallopian tube, it naturally ends up at its very top, where the exits from the tubes are located. Usually, the attachment of the fetal egg to the wall of the uterus occurs immediately, which is why the placenta in most cases is fixed from above, at the bottom of the uterus.

” If attachment for some reason did not happen, the fetal egg, under the influence of gravity, falls lower and lower, until, finally, it “finds” a place where it can gain a foothold. Sometimes a favorable site is found only at the internal os of the uterus - it is there that the placenta begins to grow.

But why doesn't attachment occur where nature intended? The reason is damage to the inner layer of the endometrium. This may be due to:

inflammation;

operations (abortion, caesarean section, removal of neoplasms or ingrown placenta during previous births);

neoplasms (eg, uterine fibroids)

endometriosis;

malformations of the uterus;

multiple pregnancy.

” Placenta previa is rare in first pregnancies, but the more pregnancies a woman has, the higher the chance of a complication.

How is placenta previa diagnosed?

Located in such an unfortunate way, the placenta is constantly “breaking away” from the stretching walls of the uterus. Therefore, such pregnant women often uterine bleeding. Sometimes they begin already in the first trimester, and in the second half of the term - almost always. Any contractions of the uterus (including training contractions) provoke their strengthening.

” After partial detachment placenta, the uterine wall saturated with blood vessels bleeds. The embryo, as we have already mentioned, has an independent circulatory system, and it does not lose blood. However, its development suffers due to the deteriorating supply of oxygen and nutrients.

Also, factors provoking bleeding can be:

coughing or sneezing, provoking tension in the abdominal wall;

straining during bowel movements, especially with constipation;

intimacy;

gynecological examination;

bath, sauna and hot tub.

In this case, pain usually does not occur, often bleeding begins and ends suddenly for the pregnant woman herself. It can be both meager (spotting spotting) and frighteningly abundant.

The development of pregnancy with placenta previa

The position of the placenta may change during pregnancy. After all, it is a living active organ, in which some areas can die off, while others, on the contrary, grow. In addition, the wall of the uterus can stretch below the placenta, and thus it will rise. It is important that the doctor monitors her position - this is usually done with an ultrasound at the 12-16th, 20-22nd and 36th weeks of pregnancy, but if necessary, the doctor can conduct a study more often.

” From the point of view of placental migration, it is just its location on the anterior wall of the uterus that is favorable: it stretches more and, accordingly, it is more likely that the placenta will rise.

If placenta previa persists, then expectant mother this threatens with anemia - the body during pregnancy already has to increase the volume of circulating blood (about a liter), and if it is necessary to compensate for regular blood loss, then the hemoglobin level can drop to critical. The baby, accordingly, has hypoxia, which slows down its development and negatively affects the development of the baby's brain.

But the most dangerous is, of course, placental abruption. How more area separated from the wall of the uterus, the worse the supply of oxygen and nutrients to the baby. IN last resort this can lead to fetal death.

” If no more than a quarter of the area of the placenta has exfoliated, then the prognosis for the child is relatively favorable. Detachment of more than 1/3 of the area of the placenta most often leads to fetal death.

Approximately one in three pregnancies with placenta previa has low blood pressure.

Placenta previa. What to do?

Lie! This, of course, is some exaggeration, but still the main rule for a pregnant woman with placenta previa is maximum rest. No physical and emotional stress (stress can also cause uterine spasm) and no intimate life. However, if there is no regular heavy bleeding, in the first half of pregnancy, a woman can stay at home and do simple household chores.

Starting from the 24th week, pregnant women with placenta previa, especially complete, are hospitalized. What awaits a pregnant woman in a hospital?

Bed rest. Even in the absence of bleeding, compliance with it is vital for the health of the baby.

Treatment to prevent any uterine contractions. Periodic spasms are completely normal phenomenon, and at the end of pregnancy they are completely necessary: this is how the body prepares for childbirth. However, for the placenta previa, they are detrimental.

Treatment of anemia and manifestations . It is necessary to compensate the mother and child for the lack of oxygen and nutrients due to persistent placental abruption.

” In the hospital, they try to extend the pregnancy, if possible, to 37-38 weeks.

How to give birth with placenta previa

Alas, with complete placenta previa, the possibility of natural childbirth is completely excluded. After all, in order to free the way for the child, the placenta must completely separate and exit the uterus. And as soon as it separates, the child will lose oxygen and reflexively try to inhale - it will simply drown in the intrauterine fluid. That is why pregnant women are not discharged from the hospital, even if they do not have bleeding. Sudden onset of bleeding, a drop in blood pressure, critical hemoglobin values - all these are direct indications for an emergency caesarean section.

Also, a caesarean section is performed in the presence of scars on the uterus, multiple pregnancies and an abnormal position of the fetus, which is especially common with placenta previa.

” With incomplete (marginal) placenta previa, the obstetrician-gynecologist acts "according to the situation." The main reference point is the presence of bleeding.

If the child is located correctly, there is no bleeding or it is small, the cervix is \u200b\u200bready to open, then the fetal bladder is opened. The baby descends and presses the placenta against the wall of the uterus with its head, preventing it from exfoliating. At the same time, the baby presses on the cervix, causing it to open faster. If the bleeding not only does not stop, but even intensifies, an emergency operation is performed.

” Natural childbirth with incomplete placenta previa is possible, but in reality they take place in no more than 25-20% of cases. Too many favorable circumstances must converge: the correct position of the child, and the cessation of bleeding under the pressure of the fetus, and the high degree of maturity of the cervix, and active labor.

Another problem of childbirth with placenta previa is ... separation of the placenta after the birth of the baby! It would seem that what is the problem - the placenta and so strove to exfoliate for 9 months. However, the uterus after childbirth is reduced unevenly. The strongest is the upper section, where the bottom of the uterus is located. And the stretched lower one contracts much longer and weaker. Therefore, firstly, the areas of the placenta that did not separate during attempts are then separated with great difficulty. And secondly, after its separation, profuse uterine bleeding occurs, since weak spasms “do not pinch” small blood vessels.

How to avoid placenta previa

Probably, if you are just thinking about the upcoming pregnancy, you want to avoid such an unpleasant complication as placenta previa. For this you need:

avoid abortion, especially medical abortion (up to 12 weeks), giving preference to another method of contraception;

treat any inflammatory diseases on time and to the end reproductive organs;

in the presence of hormonal disorders follow all the recommendations of the gynecologist-endocrinologist.

Fortunately, even complete placenta previa is not a sentence. Obstetricians will help you bear and give birth to a healthy child, the main thing is calmness and strict adherence to all medical recommendations!

Prepared by Anna Pervushina

Reading time: 7 minutes

During pregnancy, the baby is in the placenta. With the help of this shell, the child receives oxygen, nutrients from the mother's body. If the organ is in order and fixed on the back wall of the uterus, then nothing threatens the life of the fetus. A serious pathology during pregnancy is placenta previa syndrome (low or marginal). What danger to the fetus it carries, the symptoms of the disease are described below.

What is placenta previa

The incorrect location or presentation of the child's place is a pathology that is detected in the early stages of pregnancy. With this problem, the organ overlaps the internal pharynx partially or completely. It is located in the cervical area and can block the birth canal. In the first trimester of pregnancy, pathology is common, but at later stages, “placental migration” may occur - during the development of the child, the uterus stretches, the placenta moves further from the cervix.

Symptoms

The main clinical symptom of placenta previa is bleeding. Its cause is the detachment of the organ: the presence of bloody discharge indicates that the part moves away from the side walls of the uterus and damages the vessels. Allocate:

vaginal bleeding;
internal bleeding (with low presentation).

With heavy and frequent bleeding, a woman may suffer from hypotension (low stable pressure) and anemia (hemoglobin levels decrease). The pregnant woman is sent to the hospital for preservation for constant monitoring and examination. In difficult cases, with pathology, fetal death is possible. The bleeding is sudden and always during sleep.

Causes

Placental presentation occurs for many reasons. This can happen after active physical activity examining the cervix by a gynecologist. Pathology can develop in the first weeks. Until the 24th week, doctors do nothing: there is a chance of normal movement of the organ and attachment to the walls of the uterus. The causes of the appearance of pathology include other factors:

features characteristic of a fertile egg;
pathology of the endometrium;
C-section;
perforation of the uterus;
scraping;
multiple births with complications;
myomectomy;
anomalies in the location of the uterus;
contraction of the uterus;
diseases of the reproductive system.

Kinds

There are several types of presentation in the cervical area and two main classifications. The first is determined using transvaginal ultrasound diagnostics. The second is determined during childbirth, when the cervix opened by 5 cm. The degree and type of pathology changes as the opening of the pharynx, cervix and growth of the uterus increase. In total, there are three presentation options:

complete;
low;
incomplete;
central;
lateral.