placenta in pregnant women. What is a placenta? Low implantation of the placenta

The placenta, or baby's place, is an amazing organ of the female body that exists only during pregnancy. It plays an invaluable role in the development of the fetus, ensuring its growth, development, nutrition, respiration and excretion of processed metabolic products, as well as protecting the fetus from all kinds of harmful effects. Inside this organ, which looks somewhat reminiscent of a cake, there is a unique membrane - "customs and border service" between the two circulatory systems of the mother and fetus.

Development of the placenta

Already on the 7th day after fertilization, implantation begins - the introduction of the fetus into the wall of the uterus. In this case, special enzymes are released that destroy a section of the uterine mucosa, and some of the external cells gestational sac starts to form hairs. These villi are turned into cavities - lacunae that occur at the site of the collapse of the vessels of the inner layer of the uterus. The lacunae are filled with maternal blood, from where the embryo will receive all the nutrients. This is how extra-embryonic organs (chorion, amnion, yolk sac) begin to form, the intensive formation of which is called placentation and lasts 3-6 weeks. And, although tissues and organs of the unborn baby are not formed from them, the further development of the embryo without them is impossible. The chorion after some time will turn into a placenta, and the amnion will become fetal bladder. By 12 weeks, the placenta is already shaped like a round cake or a disk thinned along the edge, and by the 16th week, the formation of the placenta is already fully completed. As the gestational age increases, there is an increase in the mass of the placenta, the density of the tissues of the placenta changes. This so-called “ripening” is a natural process that allows you to meet the constantly changing needs of the fetus in time and fully. The degree of maturity is determined by ultrasound (ultrasound). Ultrasound compares data regarding the thickness of the placenta and the accumulation of calcium salts with the duration of the baby's gestation. Doctors differentiate four stages of placental maturity, including zero, which is often found at 30 weeks. Next comes the first stage, which appears from 27 to 36 weeks, from 34 to 39 the second and last, after 36 weeks of pregnancy.

Placental Developmental Disorders

The nature and rate of maturation of the placenta are genetically programmed and may vary slightly in the norm.
An ultrasound diagnosis of premature aging of the placenta is made if the 2nd degree of maturity appears before 32 weeks and the 3rd degree of maturity before 36-37 weeks of pregnancy. Accelerated maturation of the placenta can be uniform and uneven. Uneven accelerated maturation of the placenta often is based on circulatory disorders in its individual areas. Most often this happens with long-term late toxicosis, in pregnant women with metabolic disorders.
Despite the fact that there is no convincing evidence of an association between an ultrasound diagnosis of premature aging and impaired placental function, a course of prevention of placental insufficiency is recommended for pregnant women with accelerated maturation of the placenta.

The structure of the placenta

The name of the body comes from lat. placenta- cake, cake, pancake. The placenta has a lobular structure. These lobules are called cotyledons. Cotyledons are separated from each other by partitions - septa. Each lobule of the placenta contains many small vessels. Two systems converge in this organ blood vessels. One of them (maternal) connects the placenta with the vessels of the uterus, the other (fetal) is covered with amnion. Vessels run along this membrane, which combine into larger ones, which eventually form the umbilical cord. The umbilical cord is a cord-like structure that connects the fetus and the placenta. There are three vessels in the umbilical cord. Despite the apparent discrepancy, the vessel, which is called venous, carries arterial blood, and venous blood flows in two arterial vessels. These large vessels are surrounded by a special preservative substance.
Between the two vascular systems is a barrier membrane (one layer of cells), thanks to which the blood of the mother and fetus does not mix.

Violations of the structure of the placenta

A change in the size (diameter and thickness) of the placenta, detected by ultrasound, does not always indicate that the pregnancy is unfavorable. Most often, such "deviations" are only an individual feature and do not affect the development of the fetus. Only significant deviations deserve attention.

Small placenta, or placental hypoplasia. Such a diagnosis is valid only with a significant decrease in the size of the placenta. The cause of this condition is most often genetic abnormalities, while the fetus often lags behind in development and has other malformations.

thin placenta a child's place with insufficient weight is considered with a generally normal size. Sometimes a thin placenta accompanies placental insufficiency and therefore is a risk factor for intrauterine growth retardation and serious problems in the neonatal period.

Increasing the thickness and size of the placenta can also be a consequence of the pathological course of pregnancy. Most common causes increase in the size of the placenta are: swelling of its villi, due to inflammation ( placentitis or chorioamnionitis). Chorioamnionitis can be caused by the penetration of microorganisms from the external genital organs into the placenta (with STIs - chlamydia, mycoplasmosis, herpes, gonorrhea) or with blood flow (with influenza, SARS, inflammation of the kidneys, toxoplasmosis, rubella). Placentitis is accompanied by dysfunction of the placenta (placental insufficiency) and intrauterine infection of the fetus.

In addition to inflammation, thickening of the placenta can be observed with anemia (decreased hemoglobin) and diabetes in the mother, as well as with a conflict in Rh or blood type. It is very important to identify true reason thickening of the placenta, since each case requires its own approaches to the treatment and prevention of complications in the fetus.

Changes in the lobular structure of the placenta
Such anomalies include bilobed, tripartite placentas, as well as cases where the child's place has additional slice, standing as if "mansion".
During childbirth, an additional lobule can break away from the main one and serve as a source of bleeding in postpartum period. That is why obstetricians always examine the placenta in detail after its birth.

As in any other organ, sometimes there are tumors in the placenta. The most common tumor chorioangioma- pathological proliferation of blood vessels in any part of the placenta. Choriangioma is a benign tumor that never metastasizes to other organs.

The location of the placenta in normal and pathological conditions

Usually the placenta is located closer to the bottom of the uterus along one of the walls of the uterus. However, in some women in the early stages of pregnancy, the placenta forms closer to the lower part of the uterus, often reaching the internal uterine os. In this case, they talk about the low location of the placenta. On ultrasound low-lying count the placenta bottom edge which is located at a distance of not more than 6 cm from the internal pharynx of the cervix. Moreover, in the fifth month of pregnancy, the frequency of detecting a low location of the placenta is about 10 times higher than before childbirth, which is explained by the “migration” of the placenta. The tissues of the lower part of the uterus with an increase in the duration of pregnancy are pulled up, as a result of which the lower edge of the placenta also shifts and takes correct position. Ultrasound in dynamics allows you to get an idea of the migration of the placenta with a high degree of accuracy.

placenta previa- a much more serious diagnosis, while the placenta completely or partially blocks the internal opening of the cervical canal. The placental tissue does not have great extensibility, it does not have time to adapt to the rapidly stretching wall of the lower uterine segment, as a result, at some point, its detachment occurs, which is accompanied by bleeding. Such bleeding begins suddenly, they are painless, repeated with the growth of pregnancy, and it is impossible to guess when and what the next bleeding will be in terms of strength and duration. Bleeding with placenta previa threatens the life of both the woman and the child. Even if the bleeding has stopped, the pregnant woman remains under the supervision of the hospital doctors until the due date.

Functions of the placenta

Already from the moment of laying the placenta "tirelessly" works for the benefit of the baby. The placental barrier is impenetrable to many harmful substances, viruses, bacteria. At the same time, oxygen and substances necessary for life pass from the mother's blood to the child without problems, as well as waste products from the fetus's body easily enter the mother's blood, after which they are excreted through her kidneys. The placental barrier performs an immune function: it passes the protective proteins (antibodies) of the mother to the child, providing its protection, and at the same time delays the cells of the mother's immune system that can cause a rejection reaction of the fetus, recognizing a foreign object in it. In addition, the placenta produces hormones that are important for successful pregnancy, and enzymes that destroy harmful substances.

The hormones secreted by the placenta are chorionic gonadotropin(hCG), progesterone, estrogens, placental lactogen, somatomammotropin, mineralocorticoids. To assess the hormonal function of the placenta, a test is used to determine the level of estriol in the urine and blood of a pregnant woman. If the placenta works poorly, then the level of this hormone decreases.

placental dysfunction

With an unfavorable pregnancy, placental function may be impaired. There is a so-called placental insufficiency, in which the uteroplacental and fetal-placental blood flow decreases, gas exchange and metabolism in the placenta are limited, and the synthesis of its hormones decreases. According to medical statistics, placental insufficiency develops in approximately 24% of pregnant women. There are primary and secondary placental insufficiency.

Primary (early) placental insufficiency develops before 16 weeks of pregnancy, occurs during the formation of the placenta. Its causes are more often pathology of the uterus: endometriosis, uterine fibroids, malformations of the uterus (saddle, small, bicornuate), previous abortions and hormonal and genetic disorders. In some cases, primary placental insufficiency turns into a secondary one.

Secondary (late) placental insufficiency, as a rule, occurs against the background of an already formed placenta, after 16 weeks of pregnancy. In the occurrence of late placental insufficiency great importance have infections, late toxicosis, the threat of abortion, as well as various diseases of the mother ( arterial hypertension, dysfunction of the adrenal cortex, diabetes mellitus, thyrotoxicosis, etc.).

About change respiratory function placenta indicate symptoms of fetal hypoxia. Chronic hypoxia fetus and violation of the nutritional function of the placenta leads to a delay in its intrauterine development. The fetus, the development of which occurs in conditions of placental insufficiency, is much more at risk of trauma during childbirth and morbidity during the neonatal period.

Currently, unfortunately, it is not possible to cure the placental insufficiency completely. Therefore, it is very important to carry out prophylaxis in women with risk factors for the development of placental insufficiency. All therapeutic measures for placental insufficiency are aimed at maintaining the existing function of the placenta and, if possible, prolonging the pregnancy until the optimal delivery date. If the indicators worsen during treatment, an emergency delivery is performed by caesarean section, regardless of the gestational age.

Diagnosis of the state of the placenta

During pregnancy, the state of the placenta and its functions - the subject close observation doctor. After all, the success of pregnancy and the health of the unborn baby depend on this organ.

The position, development and structural features of the placenta allows you to evaluate ultrasonography(ultrasound) At the same time, the localization and thickness of the placenta, the correspondence of the degree of maturity of the placenta to the gestational age, the volume of amniotic fluid, the structure of the umbilical cord, and possible pathological inclusions in the structure of the placenta are determined. In addition, they study the anatomical structure of the fetus to identify abnormalities in its development, respiratory and motor activity of the fetus.

To diagnose the function of the placenta, in addition to ultrasound, the following are used:

A) laboratory methods- based on determining the level of placental hormones (estriol, human chorionic gonadotropin, placental lactogen), as well as the activity of enzymes (oxytocinase and thermostable alkaline phosphatase) in the blood of pregnant women.

B) assessment of fetal cardiac activity. In addition to simply listening with an obstetric stethoscope, the most accessible and common method for assessing fetal cardiac activity is cardiotachography, which is based on recording changes in the fetal heart rate depending on uterine contractions, the action of external stimuli, or the activity of the fetus itself.

IN) dopplerometry- This is a variant of an ultrasound study, in which the blood flow velocity in the vessels of the uterus, umbilical cord and fetus is assessed. Allows you to directly assess the state of blood flow in each of the vessels.

Placenta at birth

During the first (period of contractions) and the second (pulling) period of childbirth, the placenta remains the main organ of the life support of the child until his birth. Within half an hour after the birth of the child, the last (third) period of labor passes, during which the placenta and fetal membranes that make up the child's place or afterbirth are normally separated. This period is completely painless, but the woman is still in the delivery room, her condition is monitored, her pressure and pulse are measured. Because it's crowded bladder prevents uterine contraction, it is emptied with a catheter. After some time, a woman may feel weak contractions that last no more than a minute. This is one of the signs of separation of the placenta from the walls of the uterus. Not all women feel such contractions.

Therefore, obstetricians use other signs of separation. With the separated placenta, the bottom of the uterus rises above the navel, deviates to the right, a protrusion appears above the bosom. When pressed with the edge of the hand above the bosom, the uterus rises, and the segment of the umbilical cord hanging from the birth canal is not drawn into the vagina. If there are signs of separation of the placenta, the woman is asked to push, and the placenta is born without any difficulties.

The placenta is a spongy organ, oval or semicircular in shape. With a normal full-term pregnancy and a fetal weight of 3300-3400 g, the diameter of the placenta is from 15 to 25 centimeters, the thickness is 2-4 centimeters, and the weight is 500 grams.

After the birth of the placenta, it is placed on the table with the maternal side up and the placenta and membranes are examined for integrity. There are two surfaces of the placenta: the fruit, facing the fetus, and the maternal, adjacent to the wall of the uterus. The fruit surface is covered with amnion - a smooth, shiny shell of a grayish color; the Umbilical Cord is attached to its central part, from which the vessels diverge radially. Maternal surface of the placenta dark brown, divided into several (10-15) lobules.

After the birth of the placenta, the uterus becomes dense, rounded, located in the middle, its bottom is located between the navel and the womb.

Disorders of the placenta

If within 30-60 minutes there are no signs of separation of the placenta, then they try to isolate it with special methods of uterine massage. If this does not happen, talk about tight attachment or partial accretion of the placenta. In this case, under general anesthesia, the doctor enters the uterine cavity with his hand and tries to manually separate the placenta from the walls. If this fails, then one speaks of complete (true) placenta accreta, transport the woman to the operating room and perform immediate surgical operation. With a true placenta increment, in the vast majority of cases, there is only one way out - surgical removal uterus.

To recognize the increment and dense attachment of the placenta (and to distinguish them from each other), unfortunately, is possible only in childbirth. With a dense attachment of the placenta, bleeding develops (due to detachment of areas of the placenta), with placenta accreta, there is no bleeding. The reason for the violation of the separation of the placenta is the deep penetration of the chorionic villi into the thickness of the uterus, which extends beyond the uterine mucosa, and sometimes even into the entire thickness of the uterine wall. Dense attachment of the placenta differs from the increment by a smaller depth of germination of the chorionic villi into the uterine wall.

If the placenta was born on its own, but during its examination, afterbirth defects or bleeding continues, then a manual or instrumental examination of the uterine cavity is performed with the removal of the remaining piece.

Premature detachment of a normally located placenta. Sometimes the placenta begins to separate not in the third stage of labor, but earlier. The cause of premature detachment in childbirth may be excessive labor activity (with wrong positions fetus, mismatch between the size of the pelvis and the fetus, or excessive medical stimulation). In very rare cases, placental abruption occurs before delivery, usually as a result of a fall injury. Placental abruption is one of the most formidable obstetric complications, it leads to significant blood loss to the mother and threatens the life of the fetus. With placental abruption, the fetus stops receiving blood from the umbilical cord, which is attached to the placenta, and the supply of oxygen and nutrients from the mother's blood to the fetus stops. Fetal death is possible. Symptoms of placental abruption are not the same in different occasions. There may be severe bleeding from the genitals, or it may not be at all. Perhaps the absence of fetal movements, severe persistent pain in the lumbar spine and abdomen, a change in the shape of the uterus. Ultrasound is used to diagnose placental abruption. Upon confirmation of the diagnosis, immediate delivery by caesarean section is indicated.

Prevention of placental problems

The placenta is an amazingly complex system, a well-coordinated mechanism, a whole factory that performs many functions. But, unfortunately, any system, even the most perfect, sometimes fails. By virtue of the most various reasons on different terms pregnancy, deviations in the development and functioning of the placenta occur.

The leading place in prevention is the timely treatment of chronic diseases and the rejection of bad habits, which are often the cause of disorders in the placenta. It is also important to observe the appropriate regimen: proper rest for at least 10-12 hours a day (preferably sleep on the left side), elimination of physical and emotional stress, exposure to fresh air 3-4 hours a day, rational balanced nutrition, maximum protection of the pregnant woman from encounter with infection. The course of prevention includes multivitamins, iron preparations and other minerals.

Placenta(Latin placenta, "cake") - an embryonic organ in all female placental mammals, which allows the transfer of material between the circulatory systems of the fetus and mother; In mammals, the placenta is formed from the embryonic membranes of the fetus (villous, chorion, and urinary sac - allantois (allantois)), which fit snugly against the wall of the uterus, form outgrowths (villi) protruding into the mucous membrane, and thus establish close connection between the embryo and the mother's body, serving for the nutrition and respiration of the embryo. The umbilical cord connects the embryo to the placenta. The placenta, together with the membranes of the fetus (the so-called placenta), leaves the human genital tract 5-30 minutes (depending on the tactics of childbirth) after the birth of the child.

Placentation

The placenta is formed most often in the mucous membrane of the posterior wall of the uterus from the endometrium and cytotrophoblast. Layers of the placenta (from uterus to fetus - histologically):

Decidua - transformed endometrium (with decidual cells rich in glycogen),
Fibrinoid (Langans layer),
Trophoblast, covering the gaps and growing into the walls of the spiral arteries, preventing their contraction,
Holes filled with blood
Syncytiotrophoblast (polynuclear symplast covering the cytotrophoblast),
Cytotrophoblast (individual cells that form syncytium and secrete BAS),
Stroma (connective tissue containing blood vessels, Kashchenko-Hofbauer cells - macrophages),
Amnion (on the placenta synthesizes more amniotic fluid, extraplacental - adsorbs).

Between the fetal and maternal part of the placenta - the basal decidua - there are depressions filled with maternal blood. This part of the placenta is divided by decidual sects into 15-20 bowl-shaped spaces (cotyledons). Each cotyledon contains a main branch, consisting of fetal umbilical blood vessels, which branches further into many chorionic villi that form the surface of the cotyledon (indicated as Villus in the figure). Due to the placental barrier, the blood flow of the mother and fetus is not communicated with each other. Materials are exchanged by diffusion, osmosis or active transport. From the 4th week of pregnancy, when the baby's heart begins to beat, the fetus is supplied with oxygen and nutrients through the "placenta". Up to 12 weeks of pregnancy, this formation does not have a clear structure, up to 6 weeks. - is located around the entire fetal egg and is called the chorion, "placentation" takes place in 10-12 weeks.

Where is the placenta located and what does it look like?

In a normal pregnancy, the placenta is located in the body of the uterus, developing most often in the mucous membrane of its posterior wall. The location of the placenta does not significantly affect the development of the fetus. The structure of the placenta is finally formed by the end of the first trimester, but its structure changes as the needs of the growing baby change. From 22 to 36 weeks of pregnancy, an increase in the mass of the placenta occurs, and by 36 weeks it reaches full functional maturity. A normal placenta by the end of pregnancy has a diameter of 15-18 cm and a thickness of 2 to 4 cm.

Functions of the placenta

Gas exchange function of the placenta Oxygen from the mother's blood enters the fetus's blood simple laws diffusion, carbon dioxide is transported in the opposite direction.
Nutrient supply Through the placenta, the fetus receives nutrients, metabolic products return, which is the excretory function of the placenta.
Hormonal function of the placenta The placenta plays the role of an endocrine gland: chorionic gonadotropin is formed in it, which maintains the functional activity of the placenta and stimulates the production of large amounts of progesterone corpus luteum; placental lactogen playing important role in the maturation and development of the mammary glands during pregnancy and in their preparation for lactation; prolactin responsible for lactation; progesterone, which stimulates the growth of the endometrium and prevents the release of new eggs; estrogens, which cause endometrial hypertrophy. In addition, the placenta is able to secrete testosterone, serotonin, relaxin and other hormones.
Protective function of the placenta The placenta has immune properties - it passes the mother's antibodies to the fetus, thereby providing immunological protection. Part of the antibodies pass through the placenta, protecting the fetus. The placenta plays a role in the regulation and development of the immune system of the mother and fetus. At the same time, it prevents the emergence of an immune conflict between the organisms of the mother and the child - the mother's immune cells, recognizing a foreign object, could cause rejection of the fetus. However, the placenta does not protect the fetus from certain drugs, drugs, alcohol, nicotine, and viruses.

human placenta

Human placenta - placenta discoidalis, hemochorial type placenta: maternal blood circulates around thin villi containing fetal capillaries. In the domestic industry since the 30s, prof. V. P. Filatov and produced drugs placental extract and placental suspension. Placenta preparations are actively used in pharmacology. Stem cells are sometimes obtained from cord blood and stored in hemabanks. Stem cells could theoretically be used later by their owner to treat serious diseases such as diabetes, stroke, autism, neurological and hematological diseases. In some countries, the placenta is offered to be taken home in order, for example, to make homeopathic medicines or to bury it under a tree - this custom is common in various regions of the world. In addition, the placenta, which is a valuable source of protein, vitamins and minerals, can be used to make nutritious meals.

What do doctors want to know about the placenta?

There are four degrees of placental maturity. Normally, up to 30 weeks of pregnancy, the zero degree of placental maturity should be determined. The first degree is considered acceptable from 27 to 34 weeks. The second - from 34 to 39. Starting from the 37th week, the third degree of placental maturity can be determined. At the end of pregnancy, the so-called physiological aging of the placenta occurs, accompanied by a decrease in the area of its exchange surface, the appearance of areas of salt deposition. Place of attachment of the placenta. It is determined using ultrasound (see above for the location of the placenta in uncomplicated pregnancy). The thickness of the placenta, as already mentioned, continuously grows up to 36-37 weeks of pregnancy (by this time it ranges from 20 to 40 mm). Then its growth stops, and in the future the thickness of the placenta either decreases or remains at the same level. Why is it important for doctors to know all these parameters characterizing the location and condition of the placenta? The answer is simple: because a deviation from the norm of at least one of them may indicate an unfavorable development of the embryo.

Problems related to the placenta

Low implantation of the placenta. Low attachment of the placenta is a fairly common pathology: 15-20%. If the low location of the placenta is determined after 28 weeks of pregnancy, they speak of placenta previa, since in this case the placenta at least partially overlaps the uterine os. However, fortunately, only 5% of the placenta remain in a low position until 32 weeks, and only a third of these 5% remain in this position by 37 weeks.

placenta previa. If the placenta reaches the internal os or overlaps it, they speak of placenta previa (that is, the placenta is located in front of the presenting part of the fetus). Placenta previa is most common in re-pregnant women, especially after previous abortions and postpartum diseases. In addition, placenta previa is promoted by tumors and anomalies in the development of the uterus, low implantation of the fetal egg. The definition of placenta previa on ultrasound in early pregnancy may not be confirmed at a later date. However, this location of the placenta can cause bleeding and even premature birth, and therefore is considered one of the most serious types of obstetric pathology.

placenta accreta. Chorionic villi in the process of placental formation "introduce" into the mucous membrane of the uterus (endometrium). This is the same shell that is torn off during menstrual bleeding - without any damage to the uterus and to the body as a whole. However, there are cases when the villi grow into the muscle layer, and sometimes into the entire thickness of the uterine wall. Placenta accreta is also facilitated by its low location, because in the lower segment of the uterus, the chorionic villi “deep” into the muscle layer much more easily than in the upper sections.

Tight attachment of the placenta. In fact, the dense attachment of the placenta differs from the increment by a smaller depth of germination of the chorionic villi into the uterine wall. In the same way as placenta accreta, tight attachment often accompanies presentation or low location placenta. To recognize the increment and dense attachment of the placenta (and to distinguish them from each other), unfortunately, is possible only in childbirth. With a dense attachment and increment of the placenta in the afterbirth period, the placenta does not spontaneously separate. With a dense attachment of the placenta, bleeding develops (due to detachment of the placenta); placenta accreta does not bleed. As a result of accretion or tight attachment, the placenta cannot separate in the third stage of labor. In the case of tight attachment, they resort to manual separation of the placenta - the doctor who takes delivery inserts his hand into the uterine cavity and separates the placenta.

Placental abruption. As noted above, placental abruption can accompany the first stage of labor with a low location of the placenta or occur during pregnancy with placenta previa. In addition, there are cases when premature detachment of a normally located placenta occurs. It's heavy obstetric pathology observed in 1-3 out of a thousand pregnant women. Manifestations of placental abruption depend on the area of detachment, the presence, magnitude and rate of bleeding, the reaction of the woman's body to blood loss. Small detachments may not manifest themselves in any way and can be detected after childbirth when examining the placenta. If placental abruption is insignificant, its symptoms are mild, with a whole fetal bladder in childbirth, it is opened, which slows down or stops placental abruption. Expressed clinical picture and increasing symptoms of internal bleeding - indications for caesarean section (in rare cases, you even have to resort to removing the uterus - if it is saturated with blood and does not respond to attempts to stimulate its contraction). If, with placental abruption, childbirth occurs through the natural birth canal, then a manual examination of the uterus is mandatory.

Early maturation of the placenta. Depending on the pathology of pregnancy, placental insufficiency in its excessively early maturation is manifested by a decrease or increase in the thickness of the placenta. Thus, a “thin” placenta (less than 20 mm in the third trimester of pregnancy) is characteristic of late toxicosis, a threat of abortion, fetal malnutrition, while in hemolytic disease and diabetes mellitus, a “thick” placenta (50 mm or more) indicates placental insufficiency. . Thinning or thickening of the placenta indicates the need for therapeutic measures and requires a second ultrasound examination.

Late maturation of the placenta. It is observed rarely, more often in pregnant women with diabetes mellitus, Rhesus conflict, and also with birth defects fetal development. Delayed maturation of the placenta leads to the fact that the placenta, again, does not adequately perform its functions. Often, late maturation of the placenta leads to stillbirths and mental retardation in the fetus. Reducing the size of the placenta. There are two groups of reasons leading to a decrease in the size of the placenta. Firstly, it may be the result of genetic disorders, which is often combined with fetal malformations (for example, with Down's syndrome). Secondly, the placenta may "fall short" in size due to the impact of various adverse factors (severe preeclampsia in the second half of pregnancy, arterial hypertension, atherosclerosis), which ultimately leads to a decrease in blood flow in the vessels of the placenta and to its premature maturation and aging. In both cases, the "small" placenta can not cope with the duties assigned to it to supply the baby with oxygen and nutrients and rid him of metabolic products.

Enlargement of the placenta. Placental hyperplasia occurs with Rhesus conflict, severe course anemia in a pregnant woman, diabetes mellitus in a pregnant woman, syphilis and other infectious lesions of the placenta during pregnancy (for example, with toxoplasmosis), etc. No special meaning list all the causes of an increase in the size of the placenta, however, it must be borne in mind that when this condition is detected, it is very important to establish the cause, since it is she who determines the treatment. Therefore, one should not neglect the studies prescribed by the doctor - after all, the same placental insufficiency is the result of placental hyperplasia, leading to a delay in intrauterine development of the fetus.

Which doctors to contact for examination of the Placenta:

What diseases are associated with the Placenta:

What tests and diagnostics need to be done for the Placenta:

Sonographic fetometry

Placentografia

Dopplerography of the IPC and FPC

Cardiotocography

Cardiointervalography

The content of the article:

Already on the most early stages pregnancy in female body the formation of the system - "mother-placenta-fetus" begins. This system develops and actively operates until the end of the child's gestation period. The placenta, its integral element, is a complex organ that plays a vital role in the formation and further development of the embryo. In appearance, the placenta is a round flat disk on the maternal side, which is connected with the help of vessels to the wall of the uterus, and on the fruiting side with the fetus through the umbilical cord. In a normal location, the placenta is located on the bottom of the uterus along the anterior or posterior wall, while its lower edge is at a distance of 7 cm or higher from the internal os.

Functions of the placenta

The main task of this body is to maintain the normal course of pregnancy and ensure the full growth of the fetus. It performs several necessary functions, these include:

Protective;

Endocrine;

The function of breathing;

power function;

selection function.

The placenta is formed on the basis of decidual tissue, as well as embryoblast and trophoblast. The main component in its structure is called a pile tree. The placenta completes its formation at the 16th week of pregnancy.

Through the placenta, the child is supplied with oxygen and all the necessary nutrients, but at the same time, the fetal blood does not mix with the mother's blood due to the presence of protection (placental barrier), this plays an important role in the formation of the Rh conflict between mother and fetus.

When the pregnancy proceeds safely, the increase in weight and size of the placenta depends on the growth of the fetus. At first (up to about 4 months), the rate of growth of the placenta is slightly higher than the rate of development of the embryo. If for some reason the embryo dies, then the placenta stops its development. Instead, dystrophic changes are rapidly growing in it.

When everything is in order, the placenta approaches its maximum maturity at a later date (about 40 weeks or a little earlier), and only then villi and blood vessels stop forming in it.

The placenta that has reached maturity has a disc-shaped structure. Its thickness ranges from 2.5 to 3.5 cm, while the average diameter is about 20 cm. The organ usually weighs no more than 600 g. The side of the placenta facing the pregnant uterus is called the maternal surface. The other side is directed towards the child, and therefore is called the fruiting surface. Both sides are somewhat different in their structure. Thus, the maternal surface is formed on the basis of the basal component of the decidua and is rough. The fruit surface is covered with a special layer - amniotic. Under it, blood vessels are clearly visible, directed from the edge of the placenta to the area where the umbilical cord is attached.

The structure of the fruit side is represented by cotyledons (combinations of villi). One such structure consists of a stem villus that has ramifications that include the vessels of the embryo. Conventionally, cotyledon can be represented as a tree. In it, villi of the 2nd level (branches) and the next level (small branches) depart from the main villus (or trunk), and the terminal villi can be compared with leaves. When the placenta becomes mature, there are several dozen such formations in it (usually from 30 to 50). Each of the cotyledons is separated from the surrounding septa - special partitions that come from the basal plate.

The chorionic plate and the villi attached to it form the intervillous space (on the fruiting side). At the same time, on the maternal side, it is limited by the basal plate and the decidua, from which septa-septa extend. Among the villi there are anchor ones, they are attached to the decidua. Thus, the placenta is connected to the wall of the uterus. The remaining villi (and there are many more of them) are freely immersed in the intervillous space. They are bathed in their mother's blood.

The uterus of a pregnant woman is fed from the ovary, as well as from uterine artery. The terminal branches of these vessels are called "spiral arteries". They open into the intervillous space. Thanks to this, a constant supply of oxygen-enriched blood from the mother's body is maintained. The pressure in the maternal arteries is higher than the pressure in the intervillous space. That is why the blood from the mouths of these vessels enters the villi and, having washed them, is sent to the chorionic plate. And from there, through the partitions, the blood enters the maternal veins. It is important to note that the bloodstreams of the fetus and mother are completely separated. And this means that the baby's blood will not mix with the mother's.

During the contact of the villi with the mother's blood, various substances are exchanged (nutrient components, gases, metabolic products). Contact occurs with the participation of the placental barrier. This barrier includes the epithelial layer of the villus, its stroma, and the wall of the capillary (which exists within each villus). Fetal blood moves through the capillaries, enriched with oxygen, and then enters the large vessels leading to the umbilical vein. From this vein it enters developing fetus, gives it vital components, takes away carbon dioxide and other metabolic products. Its outflow from the fetus occurs through the umbilical arteries. In the placenta, these vessels are divided according to the number of cotyledons. And in the cotyledons, the vessels branch further, the blood again enters the capillaries of the villi, where it is again enriched with the components that the fetus needs. That is, the cycle begins anew.

So, oxygen and nutrition (protein, fats, carbohydrates, enzymes, as well as vitamins and minerals) enter the growing fetus through the placental barrier. At the same time, the products of its metabolism are excreted from the fetus. Thus, the placenta performs its main tasks (respiration, nutrition, excretory function). Another important function of this organ is to protect the fetus from the penetration of substances that are undesirable for it. This function is realized with the help of a special natural mechanism - the placental barrier, which is characterized by selective permeability. In a situation where pregnancy develops without pathologies, its permeability continues to grow until approximately 34 weeks of gestation. Then it starts to decrease.

But it should be borne in mind that the placental barrier will not be able to provide complete protection for the fetus. There are substances that easily penetrate through it. First of all, we are talking about nicotine with alcohol. Also, many medical devices are dangerous and chemical substances. Some types of pathogenic microorganisms can also enter the fetus through the placenta, which threatens the development of infection. The danger is aggravated by the fact that the influence of these adverse factors reduces the protective ability of the placenta.

In the mother's body, the fetus is surrounded by an aqueous membrane - the amnion. This thin membrane covers the placenta (its fruiting surface) and then passes to the umbilical cord. In the umbilical region, it connects with skin child. Amnion is structurally related to the placenta, promotes the exchange amniotic fluid, participates in some metabolic processes and, in addition, has a protective function.

The fetus is attached to the placenta through a special organ - the umbilical cord. It looks like a cord, and there are blood vessels (a vein, two arteries) in it. Through a vein, the child is supplied with blood and oxygen. Giving up oxygen blood is coming arteries to the placenta. All umbilical vessels are in a special substance that has a gelatinous consistency. They call it "Wharton's jelly." Its task is to nourish the walls of blood vessels, protect them from adverse effects and maintain the umbilical cord in an elastic state. The umbilical cord is usually attached in the central part of the placenta, but sometimes also to the membrane or side. The length of the organ (when the pregnancy is full-term) reaches 50 cm.
The combination of the membranes of the fetus, placenta and umbilical cord is called the afterbirth. It comes out of the uterine cavity after the baby is born.

The placenta (from lat. placenta - "cake"), or a child's place, is an organ that develops in the uterus during pregnancy, making a connection between the mother's body and the fetus. Complex biological processes occur in the placenta that ensure the normal development of the embryo and fetus, gas exchange, hormone synthesis, protection of the fetus from harmful factors, immune regulation, etc. After fertilization, a cavity, or gap, is formed in the wall of the uterus, filled with maternal blood, in which the embryo is located , receiving nutrients directly from the tissues of the mother's body. The trophoblast cells surrounding the embryo intensively divide, forming a kind of branched membrane around the embryo, “permeated” with lacunae. Vessels of the embryo grow into each branch of this shell. As a result, an exchange is established between the mother's blood, which fills the gaps, and the blood of the fetus. This is the beginning of the formation of the placenta - an organ that equally "belongs" to both mother and baby. After the birth of the fetus, the placenta is expelled from the uterine cavity.

The structure of the placenta

There are two surfaces of the placenta: the fruit, facing the fetus, and the maternal, adjacent to the wall of the uterus. The fruit surface is covered with an amnion - a smooth, shiny, grayish shell; an umbilical cord is attached to its central part, from which the vessels diverge radially. The maternal surface of the placenta is dark brown in color, divided into 15-20 lobules - cotyledons, which are separated from each other by placental septa. From the umbilical arteries, the fetal blood enters the vessels of the villi (fetal capillaries), carbon dioxide from the fetal blood passes into the maternal blood, and oxygen from the maternal blood passes into the fetal capillaries. Oxygenated fetal blood from the cotyledons collects towards the center of the placenta and then enters the umbilical vein. Maternal and fetal blood do not mix, there is a placental barrier between them. The structure of the placenta is finally formed by the end of the first trimester, but its structure changes as the needs of the growing baby change. From the 22nd to the 36th week of pregnancy, an increase in the mass of the placenta occurs, and by the 36th week it reaches full functional maturity. By the end of pregnancy, a normal placenta has a diameter of 15-18 cm and a thickness of 2 to 4 cm. After childbirth (the placenta, together with the membranes of the fetus - the placenta, is normally born within 15 minutes after the birth of the child), the placenta must be examined by the doctor who took delivery . Firstly, it is very important to make sure that the whole placenta was born (that is, there are no damages on its surface, there is no reason to believe that pieces of the placenta remained in the uterine cavity). Secondly, according to the state of the placenta, one can judge the course of pregnancy (whether there was an abruption, infectious processes, etc.). There are three degrees of placental maturity. Normally, up to 30 weeks of pregnancy, the zero degree of placental maturity should be determined. The first degree is considered acceptable from the 27th to the 34th week. The second - from the 34th to the 39th. Starting from the 37th week, the third degree of placental maturity can be determined. At the end of pregnancy, the so-called physiological aging of the placenta occurs, accompanied by a decrease in the area of its exchange surface, the appearance of areas of salt deposition. According to ultrasound, the doctor determines the degree of maturity of the placenta, evaluating its thickness and structure. Depending on the compliance with the gestational age and the degree of maturity of the placenta, the doctor chooses the tactics of conducting pregnancy. This information also affects the tactics of delivery.

Functions of the placenta

Its functions are multifaceted and aimed at maintaining pregnancy and the normal development of the fetus. Gas exchange occurs through the placenta: oxygen penetrates from the maternal blood to the fetus, and carbon dioxide is transported in the opposite direction. Respiratory The function of the placenta is carried out by transferring oxygen from maternal to fetal blood and carbon dioxide from fetal to maternal blood, depending on the needs of the fetus. The fetus receives nutrients through the placenta and gets rid of its waste products. The placenta has immune properties, that is, it passes the antibodies (protective proteins) of the mother to the child, providing its protection, and at the same time delays the cells of the mother's immune system, which, having penetrated to the fetus and recognizing a foreign object in it, could trigger fetal rejection reactions, She plays the role of an endocrine gland And synthesizes hormones. Placental hormones (chorionic gonadotropin, placental lactogen, progesterone, estrogens, etc.) provide normal course pregnancy, regulate the most important vital functions of the pregnant woman and the fetus, participate in the development of the birth act. The activity of metabolic processes in the placenta is especially high in the third trimester of pregnancy.

In addition, the placenta performs protective function. In it, with the help of enzymes, the harmful substances formed both in the body of the mother and in the body of the fetus are destroyed. Barrier the function of the placenta depends on its permeability. The degree and rate of transition of substances through it are determined by various factors. With a number of pregnancy complications, various diseases carried by pregnant women, the placenta becomes more permeable to harmful substances than during a normal pregnancy. In this case, the risk of intrauterine pathology of the fetus increases sharply, and the outcome of pregnancy and childbirth, the condition of the fetus and newborn depend on the degree and duration of the damaging factor and on the preservation of the protective function of the placenta.

Where is the placenta located? In a normal pregnancy, the placenta is most often located in the mucous membrane of the anterior or posterior wall of the uterus. The location of the placenta is determined by ultrasound. The thickness of the placenta continuously grows up to 36-37 weeks of pregnancy (by this time it is from 2 to 4 cm). Then its growth stops, and in the future the thickness of the placenta either decreases or remains at the same level.

Low attachment of the placenta. In the early stages of pregnancy, the placenta often reaches the internal uterine os - the exit from the uterus, but in most women in the future, with the growth of the uterus, it rises. Only 5% of the placenta remain in a low position until the 32nd week, and only a third of these 5% of the placenta remain in this position by the 37th week. With a low location of the placenta, doctors decide on the method of delivery, because. in this situation, placental abruption may occur before the birth of the fetus, and this is dangerous for mother and baby.

Placenta previa. If the placenta reaches or overlaps the internal os, it is called placenta previa. It is most common in re-pregnant women, especially after previous abortions and postpartum diseases (in this case, the inner layer of the uterus is damaged, the placenta is attached to the intact area). In addition, placenta previa is promoted by tumors and anomalies in the development of the uterus. The definition on ultrasound of placenta previa in early pregnancy may not be confirmed later. However, such an arrangement of the placenta can provoke bleeding and even premature birth. This situation is necessarily controlled in dynamics by ultrasound, i.e. with an interval of 3-4 weeks, and always before childbirth.

Placenta accreta. The chorionic villi in the process of placental formation “introduce” into the uterine mucosa (endometrium). This is the same shell that is torn off during menstrual bleeding - without any damage to the uterus and to the body as a whole. However, there are cases when the villi grow into the muscle layer, and sometimes into the entire thickness of the uterine wall. This situation is extremely rare, it threatens the development of bleeding after the birth of the fetus, which can only be stopped by surgery, when the placenta has to be removed along with the uterus.

Tight attachment of the placenta. In fact, the dense attachment of the placenta differs from the increment by a smaller depth of germination of the chorionic villi into the uterine wall. In the same way as placenta accreta, placenta accreta often accompanies placenta previa or low placenta. Unfortunately, placenta accreta and placenta accreta can only be recognized (and distinguished from each other) during childbirth. In the case of tight attachment, they resort to manual separation of the placenta - the doctor who takes delivery inserts his hand into the uterine cavity and separates the placenta.

Placental abruption. As noted above, placental abruption can accompany the first stage of labor with a low location of the placenta or occur during pregnancy with placenta previa. In addition, there are cases when premature detachment of a normally located placenta occurs. This is a severe obstetric pathology, observed in 1-3 out of a thousand pregnant women,

With this complication, the woman must be hospitalized. Manifestations of placental abruption depend on the area of detachment, the presence, magnitude and rate of bleeding, the reaction of the woman's body to blood loss. Small detachments may not manifest themselves in any way and be detected after childbirth when examining the placenta. If placental abruption is insignificant, its symptoms are mild, with a whole fetal bladder in childbirth, it is opened, which slows down or stops placental abruption. A pronounced clinical picture and increasing symptoms of internal bleeding (increased heart rate, lower blood pressure, fainting, pain in the uterus) are indications for caesarean section (in rare cases, you even have to resort to removing the uterus - if it is saturated with blood and does not respond to attempts to stimulate it reduction).

Changes in the thickness and size of the placenta

Depending on the pathology of pregnancy, placental insufficiency in its excessively early maturation is manifested by a decrease or increase in the thickness of the placenta. So "thin" placenta(less than 20 mm in the third trimester of pregnancy) is characteristic of gestosis (a complication that is more often manifested by an increase in blood pressure, the appearance of edema, protein in the urine), the threat of abortion, malnutrition (growth retardation) of the fetus, while with hemolytic disease (when in the body of a Rh-negative pregnant woman, antibodies are produced to Rh-positive fetal erythrocytes, fetal erythrocytes are destroyed) and diabetes mellitus indicates placental insufficiency as a “thick” placenta (50 mm or more). Thinning or thickening of the placenta indicates the need for therapeutic measures and requires a second ultrasound examination.

Reducing the size of the placenta- in this case, its thickness can be normal, and the area is reduced. There are two groups of reasons leading to a decrease in the size of the placenta. Firstly, it may be the result of genetic disorders, which is often combined with fetal malformations (for example, with Down's syndrome). Secondly, the placenta may “fall short” in size due to the influence of various adverse factors (severe preeclampsia in the second half of pregnancy, increased arterial pressure, as well as genital infantilism - underdevelopment, the small size of the genital organs of a woman, ultimately leading to a decrease in blood flow in the vessels of the placenta and to its premature maturation and aging). In both cases, the “small” placenta cannot cope with the duties assigned to it to supply the baby with oxygen and nutrients and rid him of metabolic products. The fetus lags behind in development, does not gain weight, and after birth, the baby recovers for a long time to achieve normal age indicators. Timely treatment of emerging pathologies can significantly reduce the risk of fetal underdevelopment.

An increase in the size of the placenta. Placental hyperplasia occurs with Rh conflict, severe anemia (decreased hemoglobin), diabetes mellitus, syphilis and other infectious lesions of the placenta during pregnancy (for example, with toxoplasmosis), etc. Various infectious diseases suffered during pregnancy also significantly affect the placenta and amniotic fluid. It makes little sense to list all the reasons for the increase in the size of the placenta, however, it must be borne in mind that when this condition is detected, it is very important to establish the cause, since it is she who determines the treatment. Therefore, one should not neglect the studies prescribed by the doctor, because the placental hyperplasia is still the same placental failure leading to intrauterine growth retardation.

Developmental anomalies, dystrophic and inflammatory changes in the placenta can lead to placental insufficiency. This condition on the part of the placenta is manifested in the lag of the fetus from the gestational age, lack of oxygen and nutrients. The child is more difficult to endure the birth itself, since during this period he experiences a lack of oxygen and nutrients. Placental insufficiency is diagnosed using ultrasound and CTG (cardiotocography) and dopplerometry (the state of blood flow in the vessels). Therapy of this pathology is carried out with the help of drugs that improve uteroplacental blood flow, nutrient solutions and vitamins.

Placental integrity

A few minutes after the birth of the child, subsequent contractions begin: the entire muscles of the uterus contract, including the area of attachment of the placenta, which is called the placental site. The placenta does not have the ability to contract, so it is displaced from the place of attachment. With each contraction, the placental area decreases, the placenta forms folds that protrude into the uterine cavity, and, finally, exfoliate from its wall. Violation of the connection between the placenta and the uterine wall is accompanied by rupture of the uteroplacental vessels in the area of the separated placenta. The blood that has poured out of the vessels accumulates between the placenta and the wall of the uterus and contributes to the further separation of the placenta from the place of attachment. Usually, fetal membranes with a placenta are born after the birth of a child. There is an expression: “born in a shirt”, so they say about a happy person. If there is no rupture during childbirth membranes, which is extremely rare, then the child is born in the fetal membrane - the “shirt”. If the baby is not released from it, he will not be able to start breathing on his own and may die.

After the placenta is isolated from the uterine cavity, the placenta is carefully examined, measured, weighed, and, if necessary, its histological examination is carried out. If there is any doubt that the placenta or membranes have been completely expelled, a manual check of the uterine cavity is performed, since parts of the placenta remaining in the uterus can cause bleeding and inflammation. This manipulation is performed under anesthesia.

Thanks to modern methods studies, features of the structure, functioning and location of the placenta can be detected in a timely manner and effectively treated. This is possible if future mom will undergo all necessary examinations.

Many young women only at the stage of gestation learn what the placenta is, what function it performs. This temporary organ is not only a link between the mother's body and the fetus, but also transports useful substances and oxygen. Violation of the placenta negatively affects the condition of the fetus.

What is the placenta and what is its function?

Talking about what the placenta is in pregnant women, doctors often call this organ common. It is already formed gradually, the rudiments appear in the first weeks of pregnancy. In appearance, the placenta resembles a large cake, from which the umbilical cord departs. It is attached to the uterine wall, forming an extensive network of blood vessels. Directly through them, oxygen and nutrients are transported from the mother's body to the fetus and carbon dioxide and metabolic products in the opposite direction.

The structure of the placenta

The placenta during pregnancy almost constantly grows and increases mass. By the time of delivery, this organ normally has a diameter of 15–18 cm, and its mass is 500–600 g. In the structure of the placenta, it is customary to distinguish two surfaces that have differences in the organization of the structure:

maternal - adjacent to the uterine wall;
fruit - facing the fetus.

The fruit surface is covered with amnion - a smooth, shiny shell of a grayish tint. The umbilical cord is attached to the central part of the amnion, from which the vessels depart. The maternal part of the placenta brown shade and divided into small lobules (cotyledons). There are 15-20 of them in total. Between the lobules there are placental septa. Blood from the umbilical arteries enters the villi.

Carbon dioxide from the fetal blood passes into the maternal blood, and oxygen is sent from the mother's blood to the fetal capillaries. As a result, oxygen-enriched blood from the cotyledons is collected to the central part of the placenta, from where it is directed to the umbilical vein. Thanks to this unique placental barrier, the blood of mother and child never mixes.

Functions of the placenta

Young mothers, not knowing what the placenta is and its functions, address a similar question to the gynecologist leading the pregnancy. Among the main functions of the placenta, doctors put forward gas exchange in the first place. This temporary organ is directly involved in the delivery of oxygen from maternal blood to the fetus throughout the entire gestation period. Other important functions of the placenta include:

Trophic. The fetus through the placenta receives the nutrients and trace elements necessary for the proper development of its internal organs and systems.
Protective. The placental barrier prevents the penetration of harmful substances, viruses and pathogenic microorganisms into the small body.
Hormonal. Children's place is an organ that, throughout the entire gestation period, synthesizes hormones important for maintaining pregnancy: chorionic gonadotropin, lactogen, estrogens.
Immune. The placenta, like a barrier, separates two genetically alien organisms, preventing the development of an immune conflict.

placenta is normal

While a woman is carrying a baby, performing an ultrasound, doctors, explaining what the placenta is, pay attention to the condition and degree of its development. Directly on this organ, one can judge the course of pregnancy, the degree of development of the baby. This organ is actively changing at the initial stages of gestation, finally forming by the end of the 1st trimester. The structure changes as the needs of the baby change.

In the period from the 22nd to the 36th week, there is an increase in the mass of the placenta, its volume. The organ reaches full functionality by the 36th week of pregnancy. When assessing the state of the organ, attention is paid to the following parameters of the placenta norm:

location (place of attachment);
thickness;

Location of the placenta

At the site of introduction of the fetal egg into the wall of the uterus, after a while, the placenta begins to form. According to the observations of doctors, the placenta is more often fixed along the back wall. This option is recognized as the norm, exactly like the attachment of the placenta along the anterior wall. You can determine the exact localization of the child's place using ultrasound.

Separately, it is necessary to say about such a phenomenon as placental migration - a change in the localization of an organ with an increase in the gestational age. Normally, as gestation progresses, the placenta shifts from the lower uterus to the upper. The organ takes its final location closer to the 32nd week. At this time, an ultrasound scan is performed to determine the exact localization of the organ, to exclude placenta previa.

Placenta thickness

Thickness is determined by ultrasound. After the exact place of attachment of the organ is established, the doctor looks for the area where the placenta has the maximum thickness. Directly this zone is diagnostically important. As the fetus grows and develops, the thickness of the placenta also increases. It reaches its maximum by the 36-37th week. Normally, this indicator varies between 20-40 mm. Doctors in dynamics observe how the thickness of the placenta changes by weeks of pregnancy (a table with norms is given below).

The degree of maturity of the placenta

As noted above, the placenta grows, increases in size along with the fetus. With the help of an ultrasound machine, doctors determine such an indicator as the degree of maturity of the placenta. It directly depends on the degree of density of the determined structures of the placenta. Based on these parameters, 4 degrees of maturity are distinguished:

0 degree - determined up to 30 weeks of pregnancy;
1 degree - is fixed from the 27th to the 34th week;
2 degree - from the 34th inclusive to the 37th;
Grade 3 - is determined from the 37th week and later.

To assess the maturity of the placenta by week of pregnancy (a table of normal values is given below), doctors conduct several planned ultrasound. It should be noted that the inconsistency of the parameters with the terms may indicate complications of pregnancy:

Violation of the placenta

Pathologies of the placenta Negative influence on the process of intrauterine development of the fetus. In some cases, failures in the work of this body cause abortion. Given this fact, doctors pay special attention to the state of the placenta and its functional indicators with each ultrasound. Timely detection small deviations allows you to keep the pregnancy.

Placental abruption

Even those women who have no idea what a placenta is have heard of such a complication as abruption. The term is used by doctors when an organ leaves its attachment site earlier. due date. As a result, the process of gas exchange is disrupted: the fetus receives less oxygen, against which hypoxia develops. Detachment of the placenta is fraught with a failure in the development process, and with a significant degree of severity - the death of the unborn child.

In case of extensive detachment, an emergency C-section. Placental abruption to early dates pregnancy often leads to fetal death, miscarriage. Normally, the placenta should separate from the wall of the uterus in the first stage of labor. However, with low placentation, when the edge of the child's place is close to the pharynx of the uterus, there is a risk of premature detachment. In this case, the woman is hospitalized. The very symptomatology of the violation is due to the degree, the area of the exfoliated placenta. Pregnant women notice:

the appearance of blood from the genital tract;
pain in the lower abdomen;
deterioration of well-being: dizziness, headache, lowering blood pressure.

However, placental abruption in the early stages is not always accompanied by vaginal discharge. Internal bleeding is characterized by the appearance of the following group of symptoms:

increased heart rate;
fainting state;
blanching of the skin;
cold sweat.

Placenta previa during pregnancy

When one of the edges of the placenta reaches the internal os of the uterus or partially overlaps it, doctors make a diagnosis of placenta previa. Depending on how much the child's place blocks the exit from the uterus, the following violations are distinguished:

Marginal placenta previa - one of the edges of the organ partially overlaps the internal uterine os.
Partial - the pharynx is less than half covered.
Complete presentation - the placenta completely overlaps the cervix of the uterus. Delivery is carried out by caesarean section.

According to doctors, presentation is more often recorded in multiparous women who have previously undergone an abortion or surgery on the uterus. Increase the risk of developing a violation of placentation of the tumor and anomalies in the development of the uterus. The very presence of presentation is a reason for monitoring the pregnant woman. Once every 3 weeks, the expectant mother undergoes an ultrasound scan. Previa can cause complications such as:

uterine bleeding;
premature birth;
spontaneous abortion (for short periods).

Fetoplacental insufficiency

Fetoplacental insufficiency during pregnancy is associated with impaired blood circulation between the uterus and placenta, fetus and placenta. This pathology of pregnancy is accompanied by a limitation of the process of gas exchange, metabolism in the placenta. Often there is a decrease in the synthesis of hormones, which adversely affects the process of gestation. Depending on the time of occurrence of FPI, there are:

primary form- occurs before 16 weeks, at the stage of formation of the placenta. Children's place is formed incorrectly. More often, the cause of primary placental insufficiency is the pathology of the uterus (myoma, endometriosis, malformations of the reproductive organ).
Secondary- develops already with the formed placenta. The provoking factors are infections, toxicosis, preeclampsia, various chronic diseases pregnant women (adrenal gland dysfunction, arterial hypertension, diabetes mellitus).

Premature aging of the placenta

The term "placental aging" is used to denote an irreversible process, accompanied by a decrease in the functional ability of the organ. It happens gradually. If the process occurs sooner, doctors state premature aging. Such a diagnosis is made on the basis of ultrasound if the placenta has a second degree of maturity before the 32nd week or a third before 36-37 weeks of gestation. With accelerated aging of the placenta, doctors recommend the prevention of placental insufficiency.

placenta ingrown

What is an ingrown placenta, most pregnant women do not know. This pathology is recorded when the villi are embedded deep into the uterine mucosa. In some cases, they can reach the muscle layer or grow into the entire thickness of the uterine wall. This situation causes an increase in the placenta, which makes it difficult to discharge in the postpartum period. Pathology is dangerous by the development of bleeding, which can only be stopped surgically. In the most severe cases, it may be necessary to remove the placenta along with the uterus.

Retained placenta

Even mothers who know what the placenta is do not always imagine when it normally leaves. After the birth of the baby, the 3rd stage of childbirth begins - the afterbirth. It is accompanied by the discharge of the placenta, membranes, umbilical cord, which together form the afterbirth. Normally, the delivery of the placenta occurs within half an hour from the moment the baby is born. Retained placenta may be due to the following disorders:

hypotension of the uterus;
placenta accreta;
anomaly in the structure and location of the placenta (attachment in the lower uterine segment, corners of the uterus).