Placenta previa during pregnancy what not to do. Complete placenta previa: we carry under control. How to avoid placenta previa

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The quality of pregnancy, as well as the quality labor activity largely depends on the location of the placenta. Normally, it is attached to the front or along back wall, closer to the bottom of the uterus.

But in about 1% of all pregnancies, it is found that the baby's place was implanted in an atypical place for it - too close to the internal cervical os. In such a situation, doctors talk about his presentation and raise the question of the advisability of natural delivery.

What it is? Placenta previa is a pregnancy pathology that involves the attachment of the placenta in such a way that it partially or completely blocks the exit to the cervical canal. Such localization children's place not only is an obstacle to normal labor activity, but also poses a threat to the life and health of the child and mother.

The main reason why the fetal egg is implanted incorrectly is pathological changes in the structure of the endometrium of the uterus, which are caused by the following factors:

Inflammatory diseases of the uterus, especially their chronic forms.
Violation of the structure of the endometrium and myometrium, in particular, endometriosis, fibroids.
Congenital anomalies in the development of the body of the uterus (for example, bicornuity)
Mechanical trauma of the uterine cavity (curettage, history of caesarean section)
Availability multiple pregnancy.
A history of more than 4 births.

Whatever the reason leads to the pathology of the structure of the endometrium, the fetal egg does not have the opportunity to implant into the wall of the uterus in time, therefore it is attached in the lower segment of the reproductive organ.

What threatens placenta previa (danger)

IN currently doctors already know about presentation by the end of the pregnancy, so most women have a caesarean section to avoid unnecessary risks associated with natural childbirth.

But if future mother is not observed by a gynecologist and does not monitor the state of her pregnancy in any way, then with a full presentation, she has a high risk of dying if she allows natural birth.

Placenta previa is also dangerous for the fetus. Starting from the second trimester, a woman may be disturbed by recurrent bloody issues from the vagina, which provokes detachment of part of the child's place.

In addition, improper attachment of the placenta can cause hypoxia in the fetus and provoke premature birth.

Placenta previa during pregnancy does not go unnoticed either for the mother or for the attending physician. The first trimester can be relatively calm, but as the child's place matures and the size of the uterus increases, a woman may notice the following symptoms:

Bloody issues. They are recurrent in nature, may appear suddenly, even if the patient is on bed rest.
Anemia. It is the result of frequent bleeding.
Exacerbation of STDs. It is associated with a general weakening of the body's defenses, which regularly experiences blood loss.

Studies complement the clinical picture characteristic of placenta previa. analysis, palpation and ultrasonography discover the following signs pathologies:

Fetal hypoxia
Partial placental abruption
Smoothing the cervix
Incorrect position of the fetus in the third trimester
Presence of ascending genital tract infections

Already in the second trimester of pregnancy, it becomes clear whether the placenta will be present, so if a woman is registered with a gynecologist, then by the time of delivery, doctors will try to minimize the risks for her and the baby.

Partial, low and central placenta previa

With an atypical location of the child's place, a caesarean section is not always indicated. If such types of localization of amniotic tissues, in which it is possible for a pregnant woman to go into natural childbirth.

central presentation placenta

Central placenta previa - sometimes called complete. It involves the absolute overlap of the internal os of the cervix. Such a position of the child's place is observed in approximately 22 - 25% of cases from the number of all presentations.

If the birth takes place naturally, then both the mother and the child will die, therefore, in this case, the only safe delivery is a caesarean section, and carried out before the end of the pregnancy (most often at 36 weeks).

Partial placenta previa

Partial placenta previa - suggests that the internal cervical os is not completely blocked. Doctors distinguish two types of this pathology: lateral and marginal placenta previa (usually along the back wall).

In the first case, the child's place covers about half of the cervical canal, and doctors do not always risk letting such a pregnant woman go into natural childbirth.
In the second case, the child's place blocks the cervical canal by a third - this makes it possible for normal delivery through the natural birth canal.

Low location of the placenta

The low location of the placenta - suggests that the child's place is at a distance of 5 - 6 cm to the internal pharynx of the cervix. In some pregnant women with an increase in the term membranes can stretch and be close to the bottom of the uterus (just such clinical picture observed normally).

This is one of the mildest forms of pathology, but medical supervision is still necessary, because low presentation placenta during pregnancy threatens with frequent bleeding and increased tone uterus.

Tactics of pregnancy management

Atypical location of a child's place is quite rare, but requires special approach for such a pregnancy. From the moment the pathology is discovered, the expectant mother should visit the gynecologist not once every 14 days, but once a week.

In addition, she will have to take more tests and undergo more examinations. In order for the pregnancy to end successfully, the gynecologist must adhere to a certain technique.

Palpation of the uterus outside the hospital is highly undesirable. She can provoke heavy bleeding and subsequent anemia in the patient.
Regular fetal cardiotocography (CTG) to exclude hypoxia, or to conduct timely medical events when it is discovered.
Regular ultrasound examination to monitor the condition of the placenta.
Providing a pregnant woman with complete rest in a hospital at a gestational age of 30 weeks with severe bleeding.

The decision on how the birth will take place is taken only by the doctor, without taking into account the opinion of the woman herself, since the situation obliges doctors to follow the path of reducing the risks of maternal and infant mortality.

Delivery with placenta previa

An atypical placement of a baby site may allow a natural birth, but only if the doctor does not see the potential risk of death for the mother and fetus. In all other cases, a caesarean section is performed.

natural childbirth- possible with incomplete presentation placenta and partial overlap of the internal os of the cervix in the absence of severe bleeding.

Also, delivery through the genital tract can be carried out using special forceps in the presence of a dead fetus. But at the same time, the child must have either a breech or head presentation.

C-section- indicated with complete occlusion of the cervical canal, with partial occlusion, as well as in the presence of severe bleeding.

The dead fetus is also removed abdominally, if its exit through natural ways dangerous to the life of the mother. In this case, the child seat must be quickly separated manually.

Placenta previa - consequences for the child

Timely medical intervention can largely correct the severity of bleeding in placenta previa, but in about 20% of cases, the child somehow suffers from an atypical location of the child's place. This is indicated by the following factors:

congenital anemia
Prolonged hypoxia
Anomalies in the development of the fetus
Hypotrophy

Often, severe bleeding can lead to the death of the fetus, as well as to the death of the mother herself, if urgent Care not delivered on time.

As a prevention of placenta previa, treatment of STDs and chronic inflammatory diseases of the uterus can be advised. At the planning stage, it is necessary to monitor the state of the endometrium and its physiological changes during at least two cycles with the help of ultrasound, depending on the change in the first and second phases.

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 yet a complete list.

Finally, the placenta is a kind of "watchman" that takes from the mother's blood useful material(for example, some antibodies that provide the baby with immune protection from birth) and keep harmful ones out.

” 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 when it comes to the anterior 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 is released from fallopian tube into the body of the uterus, it naturally ends up at its very top, where the exits from the tubes are located. Usually attachment gestational sac 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 bleeds saturated blood vessels wall of the uterus. 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 are no regular heavy bleeding, in the first half of pregnancy, a woman can stay at home and do simple household things.

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 bleeding, fall blood pressure, critical indicators of hemoglobin - all these are direct indications for an emergency caesarean section.

Also, caesarean section is performed in the presence of scars on the uterus, multiple pregnancy and wrong position 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: both the correct positioning of the child, and the cessation of bleeding under fetal pressure, and high degree maturity of the cervix, and active labor activity.

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 of the reproductive organs on time and to the end;

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 carry and give birth healthy child, the main thing is calmness and exact observance of all medical recommendations!

Prepared by Anna Pervushina

Pregnancy is very important period in a woman's life. And it was during pregnancy that she first encountered such a meaning as "placenta". It also includes presentation, which does not leave expectant mothers indifferent. When such a diagnosis is made to a pregnant woman, one must have at least the slightest idea of what it is.

The placenta is the organ that appears during pregnancy and connects the mother's body to the growing body of her baby. The placenta plays a very important role in the development of the child. The final formation of the placenta occurs at the 16th week of pregnancy and thanks to it the baby receives everything necessary for his full development.

If no complications occur during pregnancy, then the placenta is located on the back wall of the uterus, where the blood supply is much better. And placenta previa is called its attachment to the lower segment of the uterus. Of course, such a complication is very rare. But due to the fact that the number of abortions has increased significantly, this complication has become much more common. There is complete and incomplete placenta previa.

Couples who are expecting a child have to undergo intensive training in medical terminology. Because, no matter how the pregnancy develops, at each appointment a woman will have to understand what the doctor is talking about, what is the essence of certain problems that may arise in the process of bearing a child.

IN Lately Increasingly, pregnant women are being diagnosed with incomplete placenta previa. Not all young mothers decide to find out from the doctor what this means.

But first, it is worth recalling that the placenta develops into female body during pregnancy. In fact, this is the organ inside which the fetus develops. The condition of the child also depends on the state of the placenta, because through it he eats, breathes and excretes metabolic products. Ideally, the placenta should be attached to the back wall of the uterus. But it happens that for a number of reasons the placenta is attached in such a way that it closes or covers the cervix of the uterus. Zev is, in fact, the opening of the uterus.

So, it is considered normal when the placenta lies at the bottom of the uterus. Previa - when the placenta is fixed in the uterus a little higher, in the area of \u200b\u200bthe lower segment, that is, it is not located where it is needed. Doctors call presentation - the pathology of the location. Distinguish between complete and incomplete. That is, all situations when the cervix of the uterus is fixed higher and thereby does not completely close the pharynx of the uterus is considered an incomplete presentation. It can be lateral or marginal - depending on which part of the pharynx the placenta covers.

What can cause an incomplete placenta previa?

To detachment of the placenta much earlier than the term. And this means that the child in this case will be deprived of oxygen and nutrition, which means that the probability of his death in the womb is high. For mothers, presentation is dangerous with bleeding that occurs due to exfoliation of the placenta. Moreover, in the most difficult cases, when bleeding cannot be stopped, they can even resort to removing the uterus. Naturally, one should not be careless about such a diagnosis in any case.

What can cause an incomplete placenta previa?

The cause of incomplete placenta previa is not yet fully understood. Some gynecologists claim that this anomaly is associated with the pregnant woman's body (certain changes in the uterine mucosa due to abortions or operations on the uterus), while others, on the contrary, are with the fetal egg (occurs during developmental delay).

Incomplete placenta previa in most cases is accompanied by bleeding, which usually begins already in the later stages of pregnancy. Since the uterus begins to contract intensively, such bleeding can often be quite intense.

Also, bleeding can occur due to placental abruption, but at the same time, blood flows out of the uterus itself, and the fetus remains safe, except for oxygen starvation. There are many reasons why bleeding can occur: taking a hot bath, strenuous exercise, a doctor's examination, or saturated sex life.

The reasons for presentation can still be, firstly, abortions, caesarean sections, or any other operations on the uterus. This is due to the fact that their consequence may be a violation of the mucous membrane of the uterus, and this, in turn, is one of the causes of placenta previa.

Among the reasons of a different nature, rather, hormonal - they call the underdevelopment of the fetal egg, which can also attach in the area of the pharynx.

Bleeding with placenta previa. Why and how dangerous?

With an increase in the fetus, the walls of the uterus are constantly stretched, and this can provoke exfoliation of the placenta and bleeding. As a rule, they are preceded by pain in the lower abdomen or in the lumbar region. At first, such bleeding can occur intermittently, but in late pregnancy, they can occur much more often - both during physical exertion and even during pregnancy. gynecological examination.

Frequent bleeding can cause anemia, and hence oxygen starvation of the baby in the womb. As a result, dizziness and pressure drop can often occur. All this, of course, is reflected in the development of the child.

If by the time of delivery the position of the placenta has not changed, and it still closes the entrance to the uterus, in other words, the cervix of the uterus, a caesarean section is almost inevitable. Natural way it will not be possible to give birth to a child, since when the birth canal is opened, the exit and sharp exfoliation of the placenta may begin, which means that both the life of the child and the life of the mother may be in jeopardy.

What to do with incomplete placenta previa? How to prevent?

Problems with the placenta can also be seen on examination by a doctor, but in most cases it is determined by ultrasound. Using modern methods diagnosis, it can be done very easily. Due to a problem with the placenta, uterine tone may also occur, some symptoms of a threatened abortion.

In order to avoid such terrible complications, the doctor attributes sedatives. Most often it is valerian or motherwort. It is also worth reducing or completely abandoning any physical activity. It is necessary to devote more time to walks and sleep at least eight hours a day. Also, a very important point in placenta previa remains a diet, during which the main emphasis should be placed on foods that contain a large number of gland. In order for this microelement to be better absorbed by the body, it should be combined with protein foods.

We also recommend regular visits to the gynecologist. If you have been diagnosed with incomplete placenta previa, in each trimester, and more often if necessary, the doctor prescribes an ultrasound examination. It, in turn, allows you to track the dynamics of the development of pregnancy and the position of the placenta.

As a rule, when the situation worsens, a woman is admitted to a hospital, a course of antispasmodics is prescribed. In some cases, hormone therapy.

If test results indicate anemia, iron supplements are prescribed. It makes sense to adjust the menu accordingly. Among the foods rich in iron are beets, buckwheat, pomegranates. Protein foods are also helpful.

In order to safely bear a child, even if you have been diagnosed with such a diagnosis as placenta previa, you must, firstly, follow all the doctor's instructions, and secondly, be less nervous and be more on fresh air, and thirdly, avoid excessive physical exertion.

In case of incomplete placenta previa, you should be prepared for premature birth. But very often in such cases, natural childbirth becomes more complicated and then there is no other option, as soon as surgical intervention. Also, sometimes bleeding develops after childbirth. Then the woman must be under the constant supervision of doctors, because carelessness in this situation can end very badly. With any complications, doctors can remove the uterus in order to save the patient's life.

Of course, such consequences do not happen as often as it might seem at first glance. In order to reduce the risk, it is enough to monitor your health, nutrition and not give up daily walks in the fresh air.

As for childbirth with a similar diagnosis. Even in this case, natural childbirth is possible. But the doctor makes the final decision on this matter when the uterus opens up to 5-6 cm and the position of the placenta can be accurately assessed. In any case, until the last moment, you just need to take care of yourself and your baby, do everything in order to avoid undesirable consequences, and then there is every chance for a successful outcome.

Successful gestation depends on many factors. One of them is the place of attachment of the fetal bladder. In case of deviations, placenta previa occurs during pregnancy. To prevent complications, it is necessary to identify the pathology and determine the causes of its occurrence.

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What is placenta previa

Often, when examining a condition in a pregnant woman, placenta previa is diagnosed. There is a need to study what it is and how it manifests itself.

Note! The fetal bladder plays an important role in the life support of the gestating fetus.

The bubble provides interaction between the body of the mother and the child. This body performs the following features:

gas exchange;
nutritional;
immunoprotective;
hormonal.

The physiological location of the fetal egg suggests its location on:

the bottom of the uterus;
posterior and lateral walls of the body of the uterus.

This area is the least affected. It is also the area of the best vascularization.

Attachment to the back wall guarantees the protection of the embryo from unforeseen damage. When the bubble is attached from the side of the pharynx, then a violation occurs.

Placenta previa is pathological location fetal bladder.

As a result, the embryo develops in the wrong place. It should be borne in mind that this condition directly affects the outcome of labor activity.

The danger of pathology lies in the limitation of delivery. Since the organ is located in the lower part of the uterus, the birth canal overlaps.

This state poses a threat to fetal development. Subject to detection of pathology increased likelihood:

prematurity of the child;
fetoplacental insufficiency;
premature delivery;
perinatal death;
maternal death (against the background of blood loss and hemorrhagic shock).

This disorder is more commonly diagnosed in the early stages pregnancy. Closer to the 40-week period, the number of pathological cases decreases. This is due to "bubble migration". With the development of the fetus, the uterus is stretched, which leads to the displacement of the embryo from the cervical region.

Causes of placenta previa

Until now, there is no consensus on what affects the appearance of pathology. There is also no way to influence the placental formation. Generally causes of presentation placenta can be divided into the following categories:

Aspects of embryonic development.
Aspects that determine the health of a pregnant woman.

To features embryonic structure accepted to refer to:

trophoblast implantation failure;
weakly expressed enzymatic action;
delay in the development of the fetal egg.

The presence of these factors makes it impossible to implant the fetus in the upper section.

The state of the mother's body is determined by such phenomena:

inflammation in the endometrium (often);
processes of endometrial atrophy;
diseases of an infectious nature;
stagnant processes V reproductive organs(are a consequence chronic pathologies cardiovascular and endocrine system, as well as slow blood supply);
surgical intervention in the uterus;
cases of the gestation period;
complications after previous labor activity;
abnormal structure uterus;
detection of endometriosis and uterine fibroids;
underdevelopment of the uterus;
the presence of isthmic-cervical insufficiency;
the presence of endocervicitis;
pathological processes in the cervical region;
neuro-endocrine disorders;
previously diagnosed facts of pathological location;
susceptibility to addictions (systematic use of nicotine, alcohol-containing liquids and narcotic substances);
multiple pregnancy;
hormonal imbalance.

These causes of placenta previa affect the formation of the mucosa in the uterus. With its underdevelopment, an acceptable place is Bottom part cavities.

Placenta previa: types

In medical practice, it is customary to distinguish different kinds violations . Their classification is based on the following factors:

determination of the location of the fetal egg using transvaginal ultrasound;
identification of the location of the ovum during labor (the condition for fulfillment is the presence of a 4-centimeter opening of the cervix or more).

The results of transvaginal examination allow the division of pathology into the following types:

complete;
incomplete;
low.

The data obtained during delivery determine the existence the following types violations:

central;
lateral;
edge.

Complete placenta previa

Full presentation presented in the form of a thorough overlap of placental tissue of the cervix of the uterus.

This position of the fetal bladder creates restrictions for natural delivery. Even with full cervical dilatation, the fetus won't be able to continue movement along the birth canal.

Full presentation is also known as the central position.

Its peculiarity is the need for . Other types of pathology do not exclude the possibility that the fetal bladder will move. In the case of the central type, there is no such outcome of events.

Central placenta previa dangerous with the following consequences:

complete placental abruption long before labor;
the occurrence of embryonic hypoxia;
slow development of the child;
increment of the fetal egg;
early rupture of the membranes.

This attachment provides for complete exclusion of intimacy and minimizing physical stress.

Incomplete placenta previa

An incomplete placenta previa is partial overlap internal opening of the cervix. With this arrangement, a small area remains free.

An incomplete placenta previa is also known as a partial. A subspecies of this pathology is the marginal and lateral location.

Marginal location determines the presence of the lower part of the fetal egg near the edge of the internal opening of the cervix. At the same time, it can be both along the front wall and along the posterior arch. A single level is noted for the cervix and placental margin. With a lateral arrangement, there is a partial overlap.

This violation determines the impossibility of passing the child's head into the neck. This feature makes it possible to caesarean section.

marginal presentation placenta can be diagnosed by the anterior wall.

Attachment of the placenta along the anterior wall is an option gynecological norm. Such a case is not usually classified as pathological attachment.

This is due to the possibility of stretching the uterus under the weight of the fetus and its further advance along the anterior wall.

The marginal placenta previa along the posterior wall is usually classified as low or incomplete attachment of the fetal bladder. It manifests itself in the form of being in the back fornix.

This option is less dangerous than the location on the front wall. This is due to the difference in the load on the uterus. However, they may bleeding occurs.

Low placenta previa

What is low placenta previa during pregnancy, what threatens the condition of the expectant mother and child, are aspects of interest for study.

The low position implies that the amniotic sac is at the level less than 7 cm from the beginning of the cervical canal. There is no overlap of the placenta with the internal os of the cervix.

This position not considered a contraindication to natural childbirth. Among existing pathologies it is considered the most favorable for the period of gestation and childbirth.

There is the following classification of low location:

1 degree (distance to the cervical canal - 3 cm);
2 degree (there is a fixation of the fetal egg near the beginning of the cervical canal without blocking the entrance);
3 degree (partial or complete overlap is noted, as well as placental displacement along the arch);
4 degree (expressed complete blocking).

With the first two degrees, natural delivery is possible. The last degrees involve surgical intervention.

Danger of low presentation

Often, experts diagnose low placenta previa during pregnancy. What threatens this condition is the main issue in pregnant women.

Among the complications that arise against the background of such an arrangement, it is customary to single out:

Risk of spontaneous abortion(occurs as a result of partial placental abruption; accompanied by increased tone in the uterus, systemic bleeding and lack of nutrient intake).
Decreased blood pressure (accompanied by headaches, dizziness, fatigue).
Anemia (due to blood loss; is the root cause of hemorrhagic shock).
Incorrect attachment of the embryo (a response to insufficient space in the lower part of the organ).
and risk retarded development child (impaired blood flow causes a limitation of oxygen volume and nutrients supplied to the fetus).
The risk of placental displacement during natural labor with the impossibility of normal delivery.

The low location determines the importance of systematic monitoring of the course of pregnancy.

Cesarean section in pathology

C-section placenta previa is performed if:

anamnesis in the form of diseases with a pronounced inflammatory nature;
detection of polycystic or uterine fibroids;
previous abortive termination gestation period;
multiple pregnancy;
gestation at a later age;
early surgical intervention with violation of the integrity of the uterus;
systematic blood loss in excess of 0.2 l;
complete low position fetal bladder;
foot or pelvic fetal position.

The above aspects serve as the basis for the planned surgical intervention. If there are no indications for a caesarean section with placenta previa, natural delivery occurs. If there is a threat to the life of the expectant mother or child, emergency intervention.

Note! It should be remembered that after the operation, the woman retains the possibility of subsequent childbearing.

Useful video: types of placenta previa

Conclusion

The gestation period may be accompanied by various anomalies. One of these pathologies is the placental location. This condition is diagnosed as a result of a vaginal examination. Timely detection of pathology allows you to choose the best method of delivery.

placenta previa- this is an atypical location of the placenta (children's place), when it is attached in the lower uterine segment and is actually in the way of the fetus during childbirth.

To understand the essence of this pathology, it is necessary to recall the main anatomical and physiological concepts. Conventionally, the uterus can be compared with an inverted triangle, its base is its bottom, and the top facing down is its neck. At correct formation In pregnancy, the placenta develops where the embryo is attached - in the area of \u200b\u200bthe base of the triangle (uterine fundus). They talk about presentation in situations where the child's place is shifted downward and ends up in a narrower part of the uterus - the lower segment, which can freely “miss” only the fetus itself during childbirth, and the placenta that is there prevents its birth.

The placenta is formed at the site of embryo implantation as an independent organ in order to provide proper development future fetus. It functions exactly as long as it lasts, and leaves the uterus after outpouring amniotic fluid following the fetus during childbirth.

Initially, the placenta is formed with the participation of the villous (chorion) and decidua membranes of the embryo. Chorion forms villi-like outgrowths that are tightly attached to the uterine wall, forming a placental platform - the place of attachment of the future placenta to the mucous layer of the uterine wall. In this zone, the placenta is connected with the mother's body, so all the most important for developing fetus processes. The placental site is more often located in the uterine fundus with a transition to one of the walls, usually the back.

The umbilical cord connects the placenta with the fetus, it looks like a rope, one end of which is attached to the center of the child's place, and the other to the abdominal wall of the fetus (navel). Vessels and special ducts lie inside the umbilical cord, connecting the intestines and bladder embryo with placenta.

Fully all the functions of the placenta begin to be realized after the 16th week of pregnancy, these include:

- Nutrition. Actively developing embryo it is necessary to constantly receive enough nutrients, vitamins, minerals and other sources of development. Everything necessary for development is delivered to him by the placenta. In the zone of the placental platform between the chorionic villi there are special spaces in which the mother's blood enriches the blood of the placenta with everything necessary, and then the placenta delivers it to the fetus.

- Breath. Not a single important function of a living organism can do without the participation of oxygen. The fetus begins to breathe on its own only after birth, and until that time the placenta "breathes" for it: it transports oxygen from the mother's blood to the fetus and takes carbon dioxide from it.

- Protective. The fetus does not have its own immunity, therefore, the placenta, with the help of the antibodies of the mother's body, protects the developing organism from negative effects.

- Secretion of hormones. The placenta also has the functions of a hormonal gland. The hormone progesterone is responsible for maintaining pregnancy. The placenta secretes human chorionic gonadotropin (hCG), which helps progesterone stay at the right level. The placental lactogen produced by the placenta is involved in the preparation of the mammary glands for the upcoming function of lactation.

Thus, intrauterine life The fetus is completely dependent on the placenta.

The topography of the placenta during presentation is very diverse. Sometimes it is located in such a way that it completely blocks the exit of their uterus (internal os), and the birth of a child. natural way becomes impossible. In other situations, the placenta moves only slightly, and natural ones are quite possible. The location of the placenta is well visualized during the ultrasound scan.

Placenta previa is diagnosed more often in the early stages (up to 5-10%), and by 37-40 weeks it is found much less frequently (up to 3%). What is the reason for this statistic? It should be noted that the placenta is able to “migrate” during the development of pregnancy, when, as the size of the uterus increases, the baby’s place shifts upward, that is, moves away from the internal pharynx. Therefore, any statement of placenta previa in the early stages of gestation is not a definitive diagnosis.

The term "migration" in relation to the placenta is very arbitrary, since it does not mean that the baby's place "crawls" to another place in the uterus. In fact, the placenta is formed after the introduction of the fetal egg into the mucous membranes and remains in place until the moment of birth. But the uterus itself, as the gestation period grows, stretches, therefore, at later dates, the placenta often turns out to be located above the original location. In addition, along with pregnancy, the placenta itself grows. As a rule, its volume increases from the side where there are more vessels and more “calm” muscle fibers, that is, from the side of the uterine fundus. The "migration" of the placenta can be monitored using an ultrasound scan.

There is a huge confusion in terms and definitions of the location of the placenta in the uterus. Unfortunately, this is often facilitated by incorrectly formulated conclusions of ultrasound diagnostics specialists or numerous forums where pregnant women communicate. In fact, it is not at all necessary for pregnant women to understand all the intricacies of the formulated diagnosis. To correctly understand the essence of the pathology of placenta previa, you need to know a few simple facts:

1. Normally, the placenta is attached in the area of the uterine fundus, its partial transition to one of the uterine walls is also one of the options for normal placentation, so the terms "placenta previa on the posterior wall" and "placenta previa on the anterior wall" are incorrect;

2. In the pathology of presentation, it is important that the placenta is located in such a way that it prevents the child from moving outward in childbirth, and sometimes does not allow to be born at all;

3. Any presentation variant is evaluated according to two criteria:

- how high is the placenta from the internal pharynx, more precisely, its lowest edge;

- to what extent the placenta blocks the exit from the uterus.

4. There are two main classifications of placenta previa, one is used during pregnancy, the other - in childbirth.

5. Delivered in early dates the diagnosis of previa does not mean that the placenta will remain in the "wrong" place until delivery. But if the pathology is detected at a later date, changes are less likely.

6. The term "previa" means that the placenta is localized in the lower uterine segment. All other variants of its attachment are not presentations and are considered as variations of the norm with a slight deviation.

Placenta previa provokes the main, and sometimes the only, symptom - bleeding. In the lower uterine segment, increased muscle activity is observed, and the placenta does not “know how” to contract, therefore it exfoliates and bleeds. Bleeding with placenta previa in its intensity depends on the location of the child's place.

In the bottom of the uterus, where the placenta is usually located, there are all conditions for its best functioning. If the topography of the placenta changes, its working conditions worsen, and this can affect both the placenta itself and the fetus. In addition, due to high risk complications natural childbirth with most options for presentation are excluded.

Placenta previa - what is it?

They speak of presentation only when the placenta is not only displaced relative to the place of localization accepted as the norm, but also is an obstacle to the fetus during childbirth. The physiologically located baby place is always attached above the fetus (in the uterine fundus) and comes out after it at birth. If the placenta is located not in the bottom of the uterus, but in its lower segment, then the presenting part of the fetus (usually the head) is above the child's place.

All presentation options are listed in two classifications, one of which states the location of the placenta in pregnant women, and the second - in women in childbirth, that is, in childbirth.

In pregnant women, the type of placentation is ascertained during an ultrasound scan. Echographically distinguish:

1. Full presentation. The child is too high and cannot go down to the birth canal, since the child's place completely blocks the exit from the uterus from the inside.

2. Incomplete, partial placenta previa. Either the lower edge of the placenta is in contact with the boundaries of the internal os, or partially overlaps it.

3. Separately, the so-called "low" presentation is distinguished, which is diagnosed before the 26-week period. In fact, it is not truly pathological, since more often it ends with the migration of the placenta from the “dangerous” place by the time of delivery. If the placenta located too low does not move up, then its localization, due to the high extensibility of the lower uterine segment, more often allows a child to be born without serious consequences.

Another, outdated, but still sometimes used, classification of placenta previa provides for the location of the child's place in childbirth, when the internal os is 4 cm open. It was used at a time when ultrasound examination was not performed in parturient women, and the location of the placenta was determined manually. On palpation, there were:

1. Central presentation. The area of the internal pharynx is completely closed by the placenta, and the fetal membranes cannot be "groped".

2. Lateral presentation. In the area of the internal pharynx, only a part of the child's place is located, and the membranes of the fetus are determined next to it.

3. Marginal placenta previa. In the area of the internal pharynx, only the membranes of the fetus are located, and the placenta is adjacent to its borders only from the edge.

This classification has lost its relevance, since at present it is possible to diagnose the location of the placenta during the development of pregnancy using ultrasound scanning in order to prevent the pathology of the separation of the child's place during childbirth.

It should be recalled once again that the localization of the placenta can change as the uterus grows with the growth of pregnancy, and directly in childbirth. The task of the obstetrician is to adequately assess the situation in order to avoid possible complications.

Causes of placenta previa

After fertilization, the ovum descends through the fallopian tubes into the uterine cavity, “finds” the most favorable place for the development of the embryo in the endometrium and is implanted (introduced) into it. The most favorable for the embryo is the area of the uterine fundus, since:

- this place is the most spacious;

- it is better supplied with blood, therefore, the embryo will "properly" eat and breathe;

- the muscles of the uterine fundus are not prone to strong cuts, unlike those in the lower uterine segment, so the threat of premature rejection of the placenta and embryo is minimal.

All causes of the atypical location of the placenta are conditionally divided into uterine and fetal (embryonic).

1. Uterine causes of placenta previa.

If, due to pathological causes, the mucous membranes of the fundus of the uterus are regarded by the embryo as "unsuitable", implantation takes place in a different place. This happens if a dystrophic process develops in the endometrium against the background of a chronic infectious and inflammatory process (), depletion of the mucous membranes by repeated childbirth and curettage.

Also among uterine causes placenta previa are located:

The presence of one or more of these signs suggests that the placenta is outside the uterine fundus, however, for a final reliable diagnosis, it is necessary to more accurately determine the nature of the pathology.

A vaginal examination is not performed if placenta previa is suspected, since it can not only provoke another bleeding, but also cause uterine contractions, which means -. Instead, an ultrasound scan is performed, which is the most important and accurate diagnostic method. Only after analyzing the results of the ultrasound, the specialist decides on the possibility of a vaginal examination. The categorical refusal of a vaginal examination of a pregnant woman is indicated with full presentation, with other options for the location of the placenta, it is possible, but with great care. The head of the fetus and the placenta are significantly different to the touch, therefore, with a vaginal examination, their location can be clearly determined. If the placenta blocks the exit from the uterus completely, instead of a hard fetal head, a soft, slightly testy structure is palpated. With incomplete presentation, both the placenta and the head of the child are determined.

Sometimes placenta previa does not bother the pregnant woman, and is diagnosed during routine control (screening) ultrasound examinations, which are carried out for everyone without exception at 12, 20 and 30 weeks.

Ultrasound - diagnostics allows you to determine the thickness, area and structure of the placenta, clarify the type of presentation, and also see the existing areas of detachment. The technique allows you to track the "migration" of the placenta, if the presentation is diagnosed early, and the child's place has every chance to move further from the "dangerous" zone. As a rule, scans are carried out at intervals of one / three weeks to determine. If the placenta is displaced, conventional (via natural birth canal) childbirth is planned.

According to data obtained from transvaginal echography, placenta previa is not classified into four degrees:

- I degree: the lower edge of the child's place, which is localized in the lower segment, reaches the internal pharynx, but does not come into contact with it, as it is 3 cm higher.

– II degree: placenta bottom edge touches the internal os, but does not cover it.

- III degree: the internal os is blocked by the placenta, but it is located asymmetrically - mostly on one of the walls of the uterus (anterior or posterior).

- IV degree: placenta, as in III degree, overlaps the internal pharynx, but is located in such a way that over internal os its central part is located, that is, symmetrically.

Ultrasound scanning is also performed during childbirth to determine the likelihood of bleeding and deliver the patient before it starts.

very rare and dangerous pathology is the cervical (cervical-isthmus) placenta. Pathology is formed when the tissues of the child's place grow into the cervical canal. It is difficult to diagnose such an anomaly, which exacerbates the degree of its danger.

In addition to placenta previa, there is a rarer pathology - an increment of a child's place. It can also be complete and incomplete, but has nothing to do with presentation. With an increment in the process of forming a child's place, the chorionic villi do not just sink into the endometrium, they literally grow firmly into the uterine wall, sometimes reaching the muscle layer. If the placenta adheres to the uterus with the entire surface, the increment is classified as complete, with an incomplete increment, the placenta has only small plot growing into the uterine wall.

Unfortunately, it is not always possible to diagnose an increment before the onset of labor. If an ultrasound scan does not detect a pathology, it manifests itself in childbirth, when after the birth of the fetus, the placenta cannot separate on its own.

Placenta previa: treatment

Placenta previa is a structural pathology, so it cannot be eliminated. The method of therapy is reduced to the prevention of possible complications and the choice correct option delivery.

Why is placenta previa dangerous? There are some of the most unfavorable potential complications of "incorrect" placentation, namely:

1. Consequences during gestation:

- Gestosis. Previa affects not only the state of the vessels of the placenta, it also provokes changes in the coagulation system, which, in turn, “trigger” the late one.

- Bleeding. Massive bleeding provokes only complete detachment located at the uterine pharynx of the placenta, and more often it occurs either shortly before childbirth, when “false contractions” begin, or already in childbirth. More often, during presentation, only a piece of the placenta is separated from the uterine wall, and bleeding is not heavy, but is repeated periodically. Against the background of constant blood loss, anemia develops in a pregnant woman - a lack of hemoglobin, which transports the necessary oxygen to the tissues of both the mother and the fetus.

- . Oxygen is involved in almost all processes of fetal development, its deficiency provokes a slow development of the fetus, as a result, a child with severe underdevelopment of tissues and organs (hypotrophy) may be born.

- Arterial hypotension. A decrease in blood pressure is observed in 25 - 35% of pregnant women.

2. Consequences in childbirth:

- Bleeding. Unlike presentation during gestation, the placenta exfoliates completely during childbirth, so the bleeding is threatening.

- Anomalies of labor activity, namely, weakness. The presence of a placenta in the lower segment often prevents the fetus from being born. The lower segment in childbirth receives a "signal" about the beginning of intense contractions from the lowered fetal head. The placenta in structure cannot be compared with the hard head of a child, therefore it is unable to provoke sufficiently strong contractions. Another factor is the high location of the fetus.

- Incorrect position of the fetus in the uterine cavity. Due to incorrect localization of the child's place, the fetus cannot unfold in the uterus as usual, instead its activity is limited. Therefore, in childbirth, it may be located in such a way (for example, across) that it cannot leave the uterus on its own.

— Acute hypoxia a newborn fetus that threatens his life.

All ongoing therapeutic measures are aimed at the prevention of these complications.

First of all, pregnant women with presentation are concerned about the possibility independent childbirth and the risks they entail. If the pathology of placentation is diagnosed in late dates, and there is no hope for natural migration of the placenta, the tactics of management are consistent with the data of ultrasound scanning. With a low presentation or marginal localization of the placenta, when the birth canal is practically free, and there are no signs, you can wait for the onset of independent labor.

If during the onset of full-fledged labor activity (contractions) the placenta begins to exfoliate (bleeding occurs), the amniotic sac is opened () so that the outflowing amniotic fluid"carried away" the fetus, and his head firmly pressed the placenta in order to stop the bleeding.

An absolute contraindication to natural childbirth is the complete presentation of the child's place, and the technique of caesarean section always changes depending on the location of the placenta.

Often, pregnant women require answers from the doctor to all their questions related to bearing and upcoming birth against the background of presentation. However, they should be aware that not one, even the most competent, specialist will be able to reliably predict absolutely all the nuances of the behavior of the placenta, the child and the mother's body as a whole. Each pregnancy, like every childbirth, is essentially unique, so it is important to properly monitor them and prevent possible complications in a timely manner.

It is logical to assume that the prevention of presentation should begin not at the moment when it was seen on the echogram, but long before the onset of pregnancy. As you know, most episodes of placenta previa are associated with endometrial pathology, so the most effective preventive measures are:

- adequate contraception to prevent abortion;

– treatment of chronic inflammatory and infectious processes (colpitis, endometritis, adnexitis and the like);

- exclusion of unreasonable intrauterine measures (aspiration, curettage, and so on).