Low presentation of the fetus recommendations. Diagnostic measures for placenta previa. Diagnosis and symptoms

The placenta is one of the most important organs appearing during pregnancy. It is thanks to her that nutrition and breathing of the child, the withdrawal of metabolic products is possible. In addition, placental tissue produces hormones necessary for the normal course and development of pregnancy.

Placenta previa is a pathology caused by the fact that the placenta is attached and develops in the wrong place.

Normally, it is located at the bottom of the uterus, in the part that is least subject to change. If the placenta is from the pharynx, then they talk about previa. It can be partial, when the uterine os is blocked by the placenta by 1/3 or 2/3, or complete, when the center of the placenta is compatible with the uterine os. According to statistics, complete is found almost 5 times less often than incomplete.

In the case of an incomplete presentation (lateral or marginal), there is a hope that the placenta will independently shift into prescribed area closer to the day of birth. In the case of full presentation, unfortunately, this option is completely excluded.

As a rule, placenta previa is due to the fact that fertilized egg cannot be implanted right place due to damage to the endometrium of the uterus. The causes of anomalies of the mucous layer can be:

abortions and other operations performed by scraping, that is, removing special tool the upper layer of the uterus;
deformation of the endometrium due to various inflammatory processes and diseases. Such deformations include scars, impaired secretory function, smoothing of the folding of the mucous layer, fibroids;
atrophy of the endometrium of varying degrees;
poor blood supply to the uterus due to diseases of the liver, kidneys and cardiovascular system.

These factors may well explain why placenta previa is more commonly diagnosed. in multiparous women than those who are expecting their first baby.

In addition, the cause of central presentation of the placenta can be delay in the development of the ovum. If it is formed behind the norm, then the situation is likely when the egg, without reaching the bottom of the uterus, is attached in the area of the pharynx, where the placenta begins to develop.

Symptoms and complications

vaginal bleeding is a complication of placenta previa and its main symptom. In the case of full presentation, heavy bleeding begins as early as the second trimester and can periodically occur until the very birth.

Why does bleeding occur with placenta previa? In order to answer this question, you need to understand how the placental tissue is attached to the body of the uterus.

Placental tissue consists of villi - formations filled with conductive vessels. Some villi fuse with the uterus, others sink into the mother's blood, which fills the so-called intervillous space (thickening of the endometrium in the place where the placenta is attached). Blood enters this space from small arterial vessels, the walls of which are partially destroyed by enzymes secreted by placental villi.

This whole complex mechanism works to ensure the exchange between the organisms of the mother and child: nutrients and oxygen come from the mother's blood, and the placenta removes the waste products of the fetus.

The child, on the other hand, receives nutrition from the placenta through the umbilical cord, namely, two arteries and a vein that go through it.

So we see that the placenta is literally fuses with the uterus. Time is running, the fetus develops, and the uterus increases in volume: this is especially noticeable in its lower part, where the pharynx is located, that is, exactly where the placenta is attached in the case of central presentation. Since the placental tissue is not very elastic, it "does not have time" to stretch after the rapidly growing uterus.

going on partial detachment placenta. The connection is broken, and the vessels begin to bleed into the uterine cavity, pouring out of the genital tract with profuse bleeding, followed by spotting.

Usually, this happens for the first time when the woman is at rest or sleeping at night. As a rule, there is no pain during bleeding - this distinguishes it from bleeding during self-termination of pregnancy, when cramping pains in the lower abdomen are possible.

Close to 30 weeks bleeding can be caused by sex, other physical activities or even examination on a gynecological chair.

In addition to bleeding in women diagnosed with " complete placenta previa» Pain in the lower abdomen and lower back, uterine tone, hypotension can be observed. Low pressure in turn, it is expressed in a depressed state, weakness, drowsiness and dizziness.

If a pregnant woman has periodic, heavy bleeding in most cases, develops anemia. This condition is characterized by low hemoglobin levels and can lead to more serious complications during pregnancy.

The lack of oxygen in the mother's blood (namely, hemoglobin carries oxygen from the respiratory system to all organs and tissues of the body) adversely affects the baby's condition. It usually happens fetal growth retardation, growth retardation. Plus, this will affect the health of the already born child: with a high probability, he will also suffer from anemia in the first year of life.

Most likely, with heavy bleeding and a drop in hemoglobin levels in future mother, the doctor will prescribe the appropriate treatment, but she herself can additionally take care of her health by eating foods rich in iron and positively affecting the level of hemoglobin in the blood:

meat products, liver - with caution: it is rich not only in iron, but also in other vitamins, an excess of which can adversely affect the course of pregnancy;
fruits: apples, pomegranates (be careful, as they can cause constipation), peaches, apricots, dried fruits, etc.;
berries; blueberries, blueberries, as well as black currants and cranberries are the richest in iron;
vegetables and greens: tomatoes, beets, pumpkin, dill, parsley, spinach, etc.;
cereals and legumes: buckwheat, lentils, beans, peas;
walnuts, dark chocolate.

In order for iron to be well absorbed, it is necessary to take it along with vitamin C (citrus fruits, broccoli, cranberries, pineapple), a sufficient amount of protein and not to consume black tea, coffee and milk along with iron-containing foods, as they prevent its absorption. It is necessary to ensure that constipation does not occur, which can provoke spotting.

Related complications

Samo central presentation and the bleeding it causes, other pregnancy complications can also be triggered, such as:

premature rupture amniotic sac;
delayed fetal development;
the probability of incorrect position of the fetus (transverse, oblique, breech presentation);
placenta accreta; they say about the increment when the villi of the placental tissue have grown into the deep layers of the uterus, and the placenta cannot independently separate from it during childbirth. In this case, doctors perform manual separation, it is clear that this is fraught with critical heavy bleeding sometimes in such a situation there is only one way to save the life of a woman in labor - to remove the uterus;
fetal hypoxia, the child actually lies on the placenta and with its movements can put pressure on it, pinching the vessels and making it difficult for oxygen to access.

Diagnostics

Complete placenta previa is diagnosed, usually by ultrasound, but can also be detected during a routine gynecological examination.

Observation and treatment

As such drug treatment complete placenta previa does not exist. All that doctors can do is carefully monitor the condition of the expectant mother and keep her other diseases under control, since a lot of factors can provoke a complication of the pathology. If a woman is not concerned about bleeding, then observation can be carried out on an outpatient basis.

Otherwise, from 24 weeks until the very moment of delivery, she will have to be in the hospital. Usually in such a situation, a pregnant woman is prescribed a strict bed rest, restorative drugs, iron preparations (for anemia), as well as drugs to relieve uterine tone and improve blood supply in order to prevent fetal hypoxia

They always try to prolong pregnancy as long as possible, at least until the moment when the child can already be saved and exited.

Behavior rules

Some simple rules help you alleviate your condition and avoid irreparable complications.

Minimum physical activity. It is impossible to understand gravity and make sudden movements that displace the uterus, as this is fraught with placental abruption. Visit more often fresh air, but if peace is prescribed, then it is advisable to exclude walks, but you can sit with a book in the park;
Try not to worry and completely eliminate intimacy, since all this leads to the appearance of uterine tone and can provoke bleeding;
Eat right, we have already talked about this above;
Visit crowded places as little as possible so as not to be at risk of contracting something. In addition, in the crowd you may be accidentally pushed;
Don't take long trips. It will be better if, with the bleeding that has opened, you will have the opportunity to freely get to your doctor. If you are going somewhere, be sure to take exchange card, where there is information about the pathology.

Childbirth with complete placenta previa

The main problem of delivery with any type of placenta previa is a high probability of bleeding.

Central (complete) placenta previa does not even suggest the possibility natural childbirth, since the placental tissue completely blocks the exit to the birth canal for the fetus, and any attempt can cost the life of both the mother and the child.

Cesarean section with central placenta previa carried out for a period of 38 weeks, if the woman feels satisfactory. If before this period she begins massive bleeding, then the operation is performed urgently.

Surgical delivery for full presentation always carried out using general anesthesia, since bleeding, or even its likelihood, is a contraindication for regional anesthesia.

Postoperative period

Even if the operation went without complications, there is a high risk of bleeding already in the field of delivery. This is due to the low contractility of the body of the uterus in the place where the placenta was located. Given the hypotension and anemia that almost all women with a diagnosis of "central placenta previa" suffer from due to bleeding, the new mother should be in the hospital for some time under close attention doctors.

After discharge

Of course it's very hard. long time is in the hospital, especially when her husband and a mountain of household chores are waiting at home, which are vitally necessary to redo. However, after discharge from the hospital, you need peace both emotional and physical.

Ask relatives to help with household chores, and get plenty of rest yourself, sleep a lot and walk with your baby. It is very important to eat properly and fully in order to bring the level of hemoglobin back to normal. And this applies to both mother and baby.

It may be problematic, but still try to fix breast-feeding . This is very necessary for both mother and her child. baby breast milk will provide strong immunity, which is very important for anemia, and iron, which the mother consumes with food, will be transferred to him. For mommy, HB is the key to intensive contraction of the uterus, and, consequently, reducing the risk of re-bleeding. Read about how to breastfeed after a caesarean section.

As a conclusion, I would like to reassure expectant mothers who had to deal with complete placenta previa. Today, medicine has reached such a level that with this diagnosis live and healthy children are born. Most importantly, follow the recommendations of experts and take care of yourself.

Answer

- an anomaly of the period of pregnancy, characterized by the attachment of the placenta to the lower segment of the uterus with partial or complete overlap of the internal uterine os. Clinically, placenta previa is manifested by recurrent bleeding from the genital tract, anemia of the pregnant woman, the threat of miscarriage, and fetal placental insufficiency. Placenta previa is diagnosed during a vaginal examination, ultrasound. Detection of placenta previa requires prevention spontaneous interruption pregnancy, correction of anemia and fetal hypoxia, choice of optimal delivery tactics (more often - caesarean section).

Placenta previa creates conditions for prematurity and fetal hypoxia, incorrect position and presentation of the fetus, premature birth. The proportion of perinatal mortality in placenta previa reaches 7-25%, and maternal mortality due to bleeding and hemorrhagic shock is 3%.

Causes of placenta previa

Placenta previa is most commonly caused by pathological changes endometrium, disrupting the course of the decidual reaction of the stroma. Such changes can be caused by inflammation (cervicitis, endometritis), surgical interventions(diagnostic curettage, surgical termination of pregnancy, conservative myomectomy, caesarean section, uterine perforation), multiple complicated births.

To the number etiological factors placenta previa include endometriosis, uterine fibroids, uterine anomalies (hypoplasia, bicornuity), multiple pregnancy, cervical polyps. In connection with these factors, the timeliness of implantation of the fetal egg in the upper sections of the uterine cavity is disrupted, and its attachment occurs in the lower segments. Placenta previa is more likely to develop in re-pregnant women (75%) than in nulliparous women.

Symptoms of placenta previa

In the clinic of placenta previa, the leading manifestations are repeated uterine bleeding of varying severity. During pregnancy, bleeding due to placenta previa is recorded in 34% of women, during childbirth - in 66%. Bleeding can develop at different stages of pregnancy - from the first trimester to the very birth, but more often - after the 30th week of gestation. On the eve of childbirth, bleeding usually increases due to periodic uterine contractions.

The cause of bleeding is the repetitive detachment of the presenting part of the placenta, which occurs due to the inability of the placenta to stretch after the uterine wall during the development of pregnancy or labor. With detachment, a partial opening of the intervillous space occurs, which is accompanied by bleeding from the vessels of the uterus. The fetus at the same time begins to experience hypoxia, since the exfoliated area of the placenta ceases to participate in gas exchange. With placenta previa, bleeding can be provoked by physical activity, coughing, sexual intercourse, straining during bowel movements, vaginal examination, thermal procedures (hot bath, sauna).

The intensity and nature of bleeding is usually due to the degree of placenta previa. Complete placenta previa is characterized by the sudden development of bleeding, the absence of pain, profuse blood loss. When incomplete presentation Placental bleeding, as a rule, develops closer to the term of labor, especially often at the beginning of labor, during the period of smoothing and opening of the pharynx. The greater the degree of placenta previa, the earlier and more intense the bleeding. Thus, bleeding in placenta previa is characterized by an external character, suddenness of onset without visible external causes(often at night), discharge of scarlet blood, painlessness, obligatory repetition.

Recurrent blood loss quickly leads to anemia of the pregnant woman. A decrease in BCC and the number of red blood cells can cause DIC and the development of hypovolemic shock, even in the case of minor blood loss. Pregnancy complicated by placenta previa often occurs with the threat of spontaneous abortion, arterial hypotension, preeclampsia. Preterm birth occurs more often with complete placenta previa.

The pathology of the location of the placenta most adversely affects the development of the fetus: it causes fetal placental insufficiency, hypoxia and delayed fetal maturation. With placenta previa, the pelvic, oblique or transverse position of the fetus is often observed. In the II-III trimesters of pregnancy, the localization of the placenta may change due to the transformation of the lower uterine segment and changes in the growth of the placenta in the direction of better blood-supplying areas of the myometrium. This process in obstetrics is called "migration of the placenta" and is completed by the 34-35th week of pregnancy.

Diagnosis of placenta previa

When recognizing placenta previa, the presence of risk factors in the anamnesis of the pregnant woman, episodes of recurrent external uterine bleeding, data objective research. With external obstetric research the high standing of the bottom of the uterus is revealed, due to the location of the presenting part of the fetus, often - the transverse or oblique position of the fetus. During auscultation, placental vascular noise is heard in the lower segment of the uterus, at the location of the placenta.

Prevention of placenta previa

Measures for the prevention of placenta previa are the prevention of abortion, early detection and treatment of genital pathology and hormonal dysfunction. With the development of placenta previa during pregnancy, early reliable diagnosis anomalies, rational management of pregnancy taking into account all risks, timely correction of concomitant disorders, optimal delivery.

Pregnant women with a similar diagnosis are shown constant supervision by doctors. In addition, the expectant mother herself should be more responsible and attentive to the issue of her own health. Any unusual symptoms should be reported to the doctor immediately..

To reduce the risk of premature birth experts recommend expectant mothers wear a special prenatal bandage. With its help, it will be possible to reduce the pressure of the fetus on the cervix, which in turn will protect the woman in labor from its early opening.

When such a diagnosis is made, visit the doctor regularly. During the appointment, he will be able to track the possible opening of the cervix and promptly send the woman in labor to the hospital. Here, the expectant mother will be able to undergo additional examinations, on the basis of which the doctor will prescribe an effective treatment.

Unfortunately, in some cases, in order to prevent preterm birth, one has to resort to the services of uterine ring. With its help, it is possible to close the pharynx and prevent possible infection of the fetus.

Remember, if you have been diagnosed with " low presentation fruit, then you should not panic. Most often, this condition does not pose a particular danger to either the mother or the unborn baby. To avoid complications and bring the child to term, you should simply follow the recommendations of the attending physician.

What is the danger and how is childbirth

During pregnancy, an organ that connects two organisms (the expectant mother and her developing baby) into a single whole becomes the placenta. In its formation, special cells of the outer germinal membrane of the fetus take part, which, at very early stages of pregnancy, produce enzymes that help the embryo penetrate the uterine wall.

In the vast majority of cases, the placenta is attached in the upper part of the uterus, in the region of its bottom - with this position and the absence of other complications of pregnancy, optimal conditions for fetal development.

Important differences

It should be clearly separated low position placenta during pregnancy (low placentation) and placenta previa.

In the case when an ultrasound examination reveals the location of the placenta in lower body of the uterus, but at a distance of at least 5 cm from her internal pharynx, the doctor diagnoses low placentation during pregnancy. If the placenta is partially or completely covers the area of the internal pharynx, then such a condition is called, respectively, complete or partial placenta previa.

Placenta previa occurs in less than 1% of all pregnancies. Of these, about 1/3 is complete placenta previa and 2/3 is partial.

With a low location of the placenta, unlike presentation, the placental tissue never comes into contact with the cervix and, even under the most unfavorable set of circumstances, does not prevent normal course the act of natural childbirth.

Causes

Gynecologists note that the probability of establishing a diagnosis of low placentation is greater than less term gestation. It has been proven that the placenta has unique ability migrations.

The essence of the phenomenon of placental migration is that with the further progression of pregnancy, the placenta can independently move to areas of the uterus with a well-developed network blood vessels.

That is why even in the case when, during the first ultrasound examination of a pregnant woman, usually carried out at a gestational age of 11-12 weeks, the doctor finds that the placenta is forming in the lower part of the uterus, one should not despair - placental attachment shifts weekly and by the time of delivery, this situation may disappear on its own.

The causes of placenta previa are:

various inflammatory processes affecting the mucous membrane of the body of the uterus - much more often this condition is observed with repeated pregnancies(and those that ended with an interrupt on early term, and complicated by purulent inflammation of the uterus in postpartum period);
surgical procedures affecting the uterine mucosa - diagnostic curettage (even if indicated), abortion, therapeutic hysteroscopy, during which polypectomy was performed;
uterine neoplasms - polyps, fibromyomas, fibromas, especially when they reach a significant size;
multiple pregnancy;
malformations of the uterus - saddle deformity, bicornuate uterus.

Actually, the main prevention of low placentation, carried out before pregnancy, is the prevention of abortion, the implementation of curettage only for strict health reasons, as well as the timely detection of malformations.

How does the low location of the placenta manifest itself and what threatens

Until the placenta, as it develops, reaches the internal uterine os, clinical manifestations this condition may not be - the pregnant woman has no complaints at all, and low placentation is diagnosed only during an ultrasound examination.

It is for the timely detection of pregnancy complications, including - and for the detection of features of the location of the placenta, that each pregnant woman must, while waiting for the child visit three mandatory ultrasound (at 11-12 weeks, at 20-21 or 22-24 weeks, at 32-33 weeks normal pregnancy).

Each pregnancy is individual, so there are no norms for the location of the placenta by week. It is important to undergo an ultrasound in a timely manner and be attentive to the advice of your gynecologist.

Even if at the first ultrasound the doctor detects a tendency to low placentation, in the absence of a woman's complaints and symptoms threatened miscarriage (increased tone uterus, bleeding from the genital tract, pain in the abdomen and lower back) no treatment is prescribed. If a woman has any of these signs, the same treatment is prescribed as with the threat of termination of pregnancy.

During pregnancy, it is important to pay attention to the appearance of signs of any, even minimally pronounced bleeding - if it occurs, the expectant mother must be hospitalized in the gynecological department or the pregnancy pathology department.

Upon detection low attachment placenta necessarily restriction of physical activity for a pregnant woman- any work related to lifting weights is prohibited (if necessary, an appropriate conclusion of the VKK is issued for transfer to light labor), it is recommended to reduce motor activity and sexual life is limited until the threat of termination of pregnancy disappears.

How is childbirth

It has been proven that in the vast majority of cases, by 35-36 weeks of gestation, low placentation spontaneously stops and by the time of delivery, the placenta takes its normal position along the anterior or posterior surface of the uterus. Actually, to diagnose "placenta previa", which is an absolute indication for a planned caesarean section, the doctor can only by this date.

If low placentation disappears and the woman has no other indications for operative delivery through C-section, then there is no need to refuse childbirth through the natural birth canal.

Placenta previa is dangerous pathology pregnancy and often leads to the development of complications in the fetus and mother. The most common complication is bleeding.

What is a placenta?

The placenta is formed in a woman during pregnancy, whose main purpose is to connect the blood circulation of the fetus and mother. Due to the placenta, oxygen, proteins, fats, carbohydrates, vitamins, hormones and many other substances come from the mother to the unborn child, while the placenta is designed in such a way that maternal and fetal blood do not mix.

Vessels of the fetus branch in the placenta to the smallest capillaries and in this form are immersed in gaps - "lakes" in which the mother's blood is located.

This is where gas exchange takes place. exchange nutrients , the release of toxins (after all, while in the uterus, the child does not form urine, so urea and creatinine enter the mother's blood and are excreted through the kidneys).
The placenta produces hormones that determine growth and development the child itself, as well as changes in the body of a woman, preparing her for normal childbirth.
Fetal immunity is also controlled by the placenta: since the child's own immune cells are still immature at this stage of development, he receives part of the protective factors (for example, antibodies) from the mother.

Normally, the placenta is attached in those places of the uterus where the uterine vascular network is most developed. This is either the bottom of the uterus (the highest part of the uterus), or its back wall.

attachment of the placenta to back wall- the most physiological, because in this position, the placenta is most protected from injury. Sometimes, but much less often, the placenta can be located on the front wall or on the side walls of the uterus.

The anterior wall during pregnancy changes to a much greater extent than the posterior one, so this location of the placenta is less beneficial, although it is considered normal.

What is placenta previa?

Presentation - the most important indicator relationship between mother and fetus. The word "previa" is used to describe the part of the fetus or placenta that is located in the lowest part of the uterus, just before exiting the pelvis. For example, cephalic presentation means that at the exit from the small pelvis (and, accordingly, from the uterus) is the head of the fetus, breech presentation - the pelvis of the child, foot - his legs.

The presenting part of the fetus is born first, the outcome and course of childbirth largely depend on it.

Very dangerous phenomenon observed during pregnancy is placenta previa - a pathology in which not the fetus, but the placenta is located in the lower uterus.

At the same time, it partially or completely closes the exit from the uterus - its internal os. At similar situation the placenta interferes with the normal birth of the fetus.

According to statistics, placenta previa is observed in 0.1 - 1% of cases. To date, placenta previa is an unresolved problem in obstetrics. Although modern medicine has in its arsenal a number of methods that provide relatively safe delivery in this pathology, placenta previa is still accompanied by the development a large number complications, the most dangerous of which is bleeding at different stages of pregnancy or directly during childbirth.

Placenta previa happens full when it completely covers the internal os, and incomplete, or marginal, when the exit from the uterus is only partially blocked.
Less dangerous, but very close phenomenon is low location of the placenta. In this case, the placenta can be attached to any of the walls of the uterus (anterior, posterior or lateral), but its bottom edge at the end of pregnancy is located very close to the internal uterine os (5 cm or less). With this arrangement, the placenta can also create certain obstacles to the fetus being born.

According to various sources, fetal mortality in placenta previa ranges from 7 to 25%, and maternal mortality with the development of bleeding reaches 3%.

Why is placenta previa dangerous?

The main danger of placenta previa is bleeding.

Since the site of attachment of the placenta is not physiological, during pregnancy, as doctors say, it exfoliates, i.e. partially loses contact with the uterus. The resulting bleeding can be profuse and life-threatening for the mother. At the same time, the body can perceive placental abruption as a signal for the onset of labor activity - this is how premature birth occurs.

With complete placental presentation, the fetus cannot be born naturally, because it completely “blocks” the exit from the uterus. Delivery is possible only by caesarean section.

Underdevelopment of the fetus and the development of respiratory disorders.

Since the placenta is attached in an unfavorable place during previa, its vessels do not penetrate well into the uterus. As a result, the fetus receives less oxygen and important nutrients from the mother's blood. nutritional components. This phenomenon is called in medicine feto-placental insufficiency. The consequence of such insufficiency is the underdevelopment of the fetus and the development of respiratory disorders, i.e.

because the lungs in such children are also underdeveloped.

Preeclampsia.

In addition, the placenta itself during presentation also receives less oxygen and nutrition. She tries by all means to increase blood flow in her own tissues and does this by releasing a number of hormone-like substances that increase blood pressure. Therefore, one more common complication pregnancy with placenta previa is a condition in which the main symptoms are high blood pressure, edema, and large loss of protein in the urine. According to modern medical nomenclature, preeclampsia is called preeclampsia.

Incorrect position and presentation of the fetus.

The placenta previa can interfere with the normal location of the fetus in the uterus - because it occupies that part of it where the fetal head should be located. Therefore, placenta previa is very common various options incorrect position and presentation of the fetus - gluteal, oblique, transverse, extensor. Read more about the position and presentation of the fetus.

Causes of placenta previa

The most common cause of atypical fixation of the placenta is pre-pregnancy changes in the inner wall of the uterus, which is called the endometrium.

The endometrium changes with inflammation due to frequent curettage(abortions, diagnostic curettage), previous operations or multiple births, especially complicated ones. Almost always, the endometrium changes with inflammatory diseases female genital area.
In addition, some other diseases of the uterus that change its shape can cause improper localization of the placenta. This myoma uterus, changes in the cervix, underdevelopment of the genital organs, incl. uterus, etc.
Placenta previa is very common in multiple pregnancy.
It has also been established that this pathology is about three times more common in women who have given birth repeatedly than in primiparas.
endometriosis - important reason formation of placental presentation. With endometriosis, endometrial cells enter and become fixed in the abdominal cavity during menstruation.
Violations menstrual cycle mothers can also contribute to the formation of placental presentation. The fact is that after the fetal egg enters the uterus, it should normally be fixed in its upper part - at the bottom or on the walls. But in case of menstrual irregularities and hormonal imbalance a situation may occur when the endometrium is not yet ready to "accept" the fetal egg. In this case, it can attach to the uterus only after a few days. During this time, the fetal egg will descend from top to bottom, and attachment will occur only in the lower part of the uterus - placenta previa will occur.

Symptoms and signs of placenta previa

The main manifestation of placental presentation is bleeding from the birth canal, which is repeated several times.

They can be seen on different terms, but most characteristic of the second half of pregnancy. As the pregnancy progresses, bleeding becomes more intense.

The reason is simple: a growing or shrinking uterus changes its size and shape, and it does this at the expense of its lower part - where the placenta is attached. Unlike the uterine wall, the placenta cannot stretch. There is its detachment and bleeding. In this case, the blood of the mother is lost, but not the fetus.

The amount of bleeding and the type of presentation do not always correspond to each other, although bleeding is usually most dangerous with full presentation. Bleeding has the following traits:

suddenness;
External discharge of scarlet blood;
No apparent external cause;
Painless;
Repetitive (required!);
Sudden stop;
Often occurs at rest, especially at night

Due to blood loss, another hallmark placental presentation is anemia of varying severity.

Anemia negatively affects both the mother and the unborn child, causing a delay in its development. Read more about anemia during pregnancy

All other signs of placenta previa are formed by emerging complications and are not permanent. For example, with the development of gestosis against the background of presentation, there will be promotion blood pressure, proteinuria, edema. Possibility of detection breech presentation, transverse oblique positions of the fetus. If there will be feto-placental insufficiency, it is possible to detect corresponding changes in the fetus.

Diagnosis of placenta previa

The tissue of the placenta previa can be palpated during a digital examination. You can also listen to the sound of blood passing through the placental vessels, in the lower part of the uterus. However, the main method modern diagnostics placenta previa - ultrasonography (ultrasound), which allows you to see the presentation and determine its type, as well as the presence or absence of detachment.

In this case, a very interesting phenomenon is observed, which is called placenta migration. The fact is that in the second trimester of pregnancy, placenta previa can be seen about 10 times more often than before childbirth. It seems that during pregnancy the placenta migrates from bottom to top. In fact, the site of the primary attachment of the placenta does not change in any way, just the growth of the uterus on later dates pregnancy is observed due to a change in the size of its lower segment, and the growth of the placenta occurs upward, towards the uterus, richer in blood vessels.

Therefore, the term "migration of the placenta" is always taken in quotation marks - this is not a true migration, but only an illusion of movement.

The course of pregnancy with placenta previa

In the absence of bleeding, the first half of pregnancy, a woman is allowed to stay at home with a lifestyle that excludes stress, physical activity, sexual life. However, upon reaching 24 weeks of pregnancy, observation and treatment is carried out only in a hospital!

The insidiousness of placental presentation lies in the suddenness, unexpectedness of the onset of bleeding and its abundance.

In the hospital, women are prescribed drugs for the treatment of anemia, drugs that prevent uterine contractions, vitamins and symptomatic drugs. The goal of therapy is to prolong the pregnancy to as long as possible, when a viable fetus can be born.

The course of childbirth with placenta previa

With placental presentation, a woman can enter into labor both for emergency indications and in a planned manner - if she managed to reach 37-38 weeks of pregnancy.

emergency delivery carried out only through caesarean section. It is indicated if the pregnant woman has profuse bleeding, or bleeding is repeated too often and leads to severe anemia. In this case, it makes no sense to prolong the pregnancy, as this can be dangerous for both the mother and the fetus.
As planned delivery is most often also carried out using a caesarean section. The indications for it are:

Complete placenta previa;
incomplete placental presentation if concomitant complications also occur in parallel:

Scar on the uterus;
transverse or oblique position fetus;
Breech presentation;
Multiple pregnancy;
Narrow pelvis;
The age of the primipara is over 30 years.

If a woman, against the background of incomplete placenta previa, has no bleeding and no associated complications, then delivery is possible through the natural birth canal.

It should be said that in a planned manner, a caesarean section is used in about 80% of women with placental previa, that is, in the vast majority of cases. This is due to the fact that the outcome and course of natural childbirth with this pathology is to a certain extent unpredictable: at any moment, bleeding, including heavy bleeding, can begin from the contracting uterus.

For a successful delivery through the natural birth canal, a very favorable combination of many circumstances is necessary: head presentation, good generic activity, mature cervix, stop bleeding after opening the fetal bladder. That's why caesarean section is the most popular method for placenta previa.

Management of pregnant women with placenta previa not an easy task, because even with the right tactics and adequate medication, there remains an element of surprise and unpredictability of bleeding that occurs.

Prevention of this complication- This

formation healthy lifestyle life in women, namely the prevention of abortion, early detection and diagnosis of inflammatory diseases of the uterus, diagnosis and treatment of hormonal disorders.