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Placenta previa during pregnancy - complete, low, central, posterior. What does it mean and what threatens placenta previa during pregnancy

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 condition poses a threat to the development of the fetus. 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 in the reproductive organs (they are the result of chronic pathologies of the cardiovascular and endocrine systems, 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 the lower part of the cavity.

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.

Data obtained during delivery determine the existence of the following types of disorders:

central;
lateral;
edge.

Complete placenta previa

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

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 placenta previa 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 the 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 interruption of the 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 location of the fetal bladder;
foot or pelvic fetal position.

The above aspects serve as the basis for 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 during pregnancy is considered one of the serious complications during childbearing and subsequent childbirth. The fact is that the situation when the placenta completely or partially covers the uterine os, and this is placenta previa, is irreparable - there is no way to correct this state of affairs with medication, although there is always a chance that it will move out of the lower uterus on its own.

The only symptoms that may indicate placenta previa during pregnancy are painless bleeding. They occur, as a rule, closer to the second half of pregnancy against the background of complete well-being.

Causes of placenta previa

Placenta previa is diagnosed by ultrasound, and the final diagnosis can be made after 24 weeks - before that there is a chance that the placenta will change position on its own. In addition to the fact that ultrasound determines the final diagnosis of "placenta previa", this method also makes it possible to determine the options for presentation, the size and area of the placenta, the degree of detachment.

The reasons for the occurrence of placenta previa during pregnancy can be changes in the mucosa of the inner wall of the uterus as a result of repeated abortions, inflammations or genital infections, previously complicated childbirth.

The disposition to such a pathology is more inherent in women with deformities of the uterine cavity, caused by congenital anomalies or acquired (for example, as a result of uterine fibroids).

The cause of placenta previa can even be diseases of the heart, liver or kidneys, accompanied by congestion in the pelvic organs (including the uterus).

In addition, placenta previa is three times more common in women who give birth for the first time.

Depending on the location of the placenta, there are low presentation (attachment) of the placenta, complete (central) or partial presentation (may be lateral or marginal).

Low placenta previa

In the normal course of pregnancy, the placenta is located along the bottom or body of the uterus, along the anterior (less often posterior) wall with the transition to the lateral walls. Low placenta previa is characterized by a situation where the placenta is located in close proximity to the internal os of the cervix - at a distance of 6 cm or even less.

Such a pathology is most often determined in the second trimester of pregnancy during the next ultrasound. But at the same time, if low placenta previa was still diagnosed in this period, there is a possibility that over time, as the pregnancy develops, the placenta will take a “normal position”.

Conventionally, this state of affairs is called "migration", and the movement of the placenta is caused by stretching and stretching of the tissues of the uterus. So, as the fetus develops, the elastic tissues of the lower part of the uterus gradually rise upwards. At the same time, there is also some upward movement of the placenta, due to which its location becomes normal. Therefore, if the low location of the placenta was found in the second trimester of pregnancy, there is a fairly high probability of its movement by the end of pregnancy and the normalization of the situation.

Marginal placenta previa

Partial, or incomplete placenta previa, is its location, in which the internal os of the uterus is blocked by the placenta, but not completely. One type of partial placenta previa is marginal placenta previa.

With the marginal location of the placenta, its lower edge is at the level of the edge of the internal os, while the outlet of the uterus is closed by the tissue of the placenta by about a third.

Usually, marginal placenta previa is diagnosed in the second trimester of pregnancy with the help of ultrasound, against the background of complaints of a pregnant woman about constant bleeding. If marginal placenta previa has been determined, the woman needs careful medical supervision and all necessary studies. As needed, iron-containing preparations can be prescribed - in order to avoid bleeding and the development of anemia due to a decrease in hemoglobin levels.

Complete placenta previa (central placenta previa)

Complete placenta previa is probably the most serious pathology associated with the incorrect location of the placenta. Full presentation is said when the placenta completely closes the internal pharynx, during the vaginal examination, placental tissue is determined everywhere, the fetal membranes are not palpable. If, in addition, it is possible to establish that the center of the placenta is located at the level of the pharynx, a diagnosis of central placenta previa is made.

Partial placenta previa is diagnosed with a frequency of 70-80% of the total number of presentations. At the same time, full presentation accounts for 20-30% of cases, and this, unfortunately, is not a small indicator at all.

With complete placenta previa, a woman, even in the absence of bleeding, must be sent to a hospital. Diagnosed central presentation is a serious pathology in which a pregnant woman must be provided with constant qualified medical supervision.

Treatment of placenta previa

If a presentation was detected, the doctor will determine the treatment regimen and follow-up actions based on the specifics of placenta previa. But be that as it may, in the case when a pregnant woman was diagnosed with placenta previa, she will need constant monitoring by specialists.

If bleeding is not observed, the expectant mother may be allowed to be observed on an outpatient basis. At the same time, she needs to avoid stress - both physical and emotional, exclude sexual contact, sleep at least 8 hours a day and walk as much as possible. You will also need a special diet that involves the consumption of foods rich in iron, protein and vitamins. A diet is necessary to maximize the intake of useful substances into the body of a pregnant woman: with placenta previa, part of it does not participate in gas exchange, which can provoke. In the meantime, mommy may experience anemia or, which also become a consequence of placenta previa during pregnancy.

If, after 24 weeks, the pregnant woman has periodic bleeding, she will be offered to go to the hospital, where she can always be provided with emergency care in case of possible complications. In this case, doctors are recommended to be observed permanently until the end of pregnancy. If the bleeding is minor, and the woman's health has not worsened, they resort to conservative methods of treatment: the pregnant woman is prescribed bed rest, complete rest, drugs that lower the tone of the uterus and improve blood circulation. If found in a future mother, she is prescribed drugs to increase hemoglobin levels, as well as means for general strengthening of the body.

Childbirth with placenta previa

Placenta previa during pregnancy is an indication for delivery by caesarean section, in the case of complete presentation, it is mandatory, since other ways of delivery are not possible. If the pregnancy was saved, then a caesarean section is carried out for a period of 38-39 weeks.

With incomplete placenta previa, childbirth is also possible, but they are associated with a certain risk. In addition, for natural childbirth with incomplete placenta previa, obligatory cessation of bleeding after opening of the fetal bladder, a mature cervix, good labor activity and head presentation of the fetus become mandatory conditions. In other cases, if the birth proceeds naturally, there is a high risk of complete detachment of the placenta, which will lead to very heavy bleeding. And this is fraught with serious complications - even death for both the mother and the baby.

Especially for- Tatyana Argamakova

presentation placenta(placenta praevia - lat.) is a term used in obstetrics, which refers to various options for the location of the organ in the cervical region. This means that the placenta is located in the lower part of the uterus and overlaps the birth canal. It is the location on the way of the fetus that is born reflects the Latin designation of presentation - placenta praevia, where the word "praevia" consists of two: the first preposition "prae" and the second root "via". "Prae" means "before" and "via" means path. Thus, the literal translation of the term placenta praevia means literally "the placenta located in the way of the fetus."

Placenta previa currently refers to the pathology of pregnancy, and at 37–40 weeks of gestation it occurs in 0.2–3.0% of cases. At earlier stages of pregnancy, placenta previa is noted more often (up to 5 - 10% of cases), however, as the fetus grows and develops, the uterus stretches, and its child's place moves further from the cervical region. Obstetricians call this process "migration of the placenta."

To understand the essence of the pathological location of the placenta, called previa, it is necessary to imagine the structure of the uterus, which is conventionally divided into the body, bottom and neck. The cervix is located in the lower part of the organ, and its outer part is lowered into the vagina. The upper part of the uterus, which is a horizontal platform directly opposite the cervix, is called the fundus. And the side walls located between the bottom and the cervix are called the body of the uterus.

The cervix is a kind of tightly compressed cylinder of muscle tissue with a hole inside, which is called the cervical canal. If this cylinder is stretched in width, then the cervical canal will expand significantly, forming a hole with a diameter of 9-11 cm, through which the child can exit the uterus during childbirth. Outside of childbirth, the cervix is tightly collapsed, and the opening in it is very narrow. To visualize the physiological role of the cervix, mentally draw a bag tied with a string. It is the part tied with a rope that is the very tightly compressed cervix that keeps the contents of the bag from falling out. Now turn this bag upside down so that the part tied with the string is facing the floor. In this form, the bag completely repeats the location of the parts of the uterus and reflects the role of the cervix. The uterus in the woman's stomach is located exactly like this: the bottom is at the top, and the cervix is at the bottom.

In childbirth, the cervix opens (expands) under the action of contractions, resulting in an opening through which the baby can pass. In relation to the image of the bag, the process of opening the cervix is equivalent to simply untying the rope that tightens its opening. As a result of such an "opening" of the bag, everything that is in it will fall out of it. But if you untie the opening of the bag and at the same time substitute some kind of obstacle in front of it, then the contents will remain inside, because they simply cannot fall out. In the same way, a child will not be able to be born if there is any obstacle in its path, at the site of the opening of the cervix. It is precisely such an obstacle that the placenta located in the cervical region is. And its location, which interferes with the normal course of the birth act, is called placenta previa.

With placenta previa, high neonatal mortality is recorded, which ranges from 7 to 25% of cases, depending on the technical equipment of the maternity hospital. High infant mortality in placenta previa is due to the relatively high incidence of preterm birth, fetoplacental insufficiency and abnormal position of the fetus in the uterus. In addition to high infant mortality, placenta previa can cause a terrible complication - bleeding in a woman, from which about 3% of pregnant women die. It is because of the danger of infant and maternal mortality that placenta previa is referred to as a pathology of pregnancy.

Types of placenta previa and their characteristics

Depending on the specific features of the location of the placenta in the cervical region, there are several types of presentation. Currently, there are two main classifications of placenta previa. The first is based on determining its location during pregnancy using transvaginal ultrasound (ultrasound). The second classification is based on determining the position of the placenta during labor when the cervix is dilated by 4 cm or more. It should be remembered that the degree and type of presentation may change as the uterus grows or as the cervical dilation increases.

Based on the data of transvaginal ultrasound performed during pregnancy, the following types of placenta acclixity are distinguished:
1. Full presentation;
2. Incomplete presentation;
3. Low presentation (low position).

Complete placenta previa

Complete placenta previa (placenta praevia totalis - lat.). In this case, the placenta completely covers the internal opening of the cervix (internal os). This means that even if the cervix fully opens, the baby will not be able to get into the birth canal, because the placenta will block the way, completely blocking the exit from the uterus. Strictly speaking, childbirth in a natural way with full placenta previa is impossible. The only option for delivery in this situation is a caesarean section. This location of the placenta is noted in 20 - 30% of the total number of cases of presentation, and is the most dangerous and unfavorable in terms of the risk of complications, child and maternal mortality.

Incomplete (partial) placenta previa

With incomplete (partial) presentation (placenta praevia partialis), the placenta covers the internal opening of the cervix only partially, leaving a small area free of its total diameter. Partial placenta previa can be compared to a plug that covers part of the diameter of a pipe, preventing water from moving as fast as possible. Also referred to incomplete presentation is the location of the lower part of the placenta on the very edge of the cervical opening. That is, the lowest edge of the placenta and the wall of the internal opening of the cervix are at the same level.

With incomplete placenta previa in the narrow part of the lumen of the cervix, the baby's head, as a rule, cannot pass, therefore, natural childbirth in the vast majority of cases is impossible. The frequency of occurrence of this type of presentation is from 35 to 55% of cases.

Low (inferior) placenta previa

In this situation, the placenta is located at a distance of 7 centimeters or less from the perimeter of the entrance to the cervical canal, but does not reach it. That is, the area of the internal pharynx of the cervix (the entrance to the cervical canal) with a low presentation is not captured and does not overlap with part of the placenta. Against the background of low placenta previa, natural childbirth is possible. This variant of the pathology is the most favorable in terms of the risk of complications and pregnancy.

According to the results of ultrasound, in recent years, for clinical practice, obstetricians have increasingly resorted to determining not the type, but the degree of placenta previa during pregnancy, which are based on the amount of overlap of the internal opening of the cervix. Today, according to ultrasound, the following four degrees of placenta previa are distinguished:

I degree- the placenta is located in the region of the opening of the cervix, but its edge is at least 3 cm away from the pharynx (conditionally corresponds to low placenta previa);
II degree- the lower part of the placenta is located literally on the edge of the entrance to the cervical canal, but does not overlap it (conditionally corresponds to incomplete placenta previa);
III degree- the lower part of the placenta blocks the entrance to the cervical canal completely. In this case, most of the placenta is located on any one wall (anterior or posterior) of the uterus, and only a small area closes the entrance to the cervical canal (conditionally corresponds to complete placenta previa);
IV degree- the placenta is completely located on the lower segment of the uterus and blocks the entrance to the cervical canal with its central part. At the same time, identical parts of the placenta are located on the anterior and posterior walls of the uterus (conditionally corresponds to complete placenta previa).

The listed classifications reflect the variants of placenta previa during pregnancy, determined by the results of ultrasound.

In addition, the so-called clinical classification of placenta previa has been used for a long time, based on determining its location during childbirth when the cervix is dilated by 4 cm or more. Based on the vaginal examination during childbirth, the following types of placenta previa are distinguished:

Central placenta previa (placenta praevia centralis);
Lateral presentation of the placenta (placenta praevia lateralis);
Marginal placenta previa (placenta praevia marginalis).

Central placenta previa

In this case, the entrance to the cervical canal from the side of the uterus is completely blocked by the placenta, when feeling its surface with a finger inserted into the vagina, the doctor cannot determine the fetal membranes. Natural childbirth with a central placenta previa is impossible, and the only way to bring a child into the world in such a situation is a caesarean section. Relatively speaking, the central presentation of the placenta, determined during the vaginal examination during childbirth, corresponds to the complete, as well as III or IV degree according to the results of ultrasound.

Lateral placenta previa

In this case, during a vaginal examination, the doctor determines the part of the placenta that closes the entrance to the cervical canal, and the rough fetal membranes located next to it. Lateral placenta previa, determined by vaginal examination, corresponds to the results of ultrasound incomplete (partial) or II-III degree.

Marginal placenta previa

During a vaginal examination, the doctor determines only the rough membranes of the fetus protruding into the lumen of the cervical canal, and the placenta is located at the very edge of the internal pharynx. Marginal placenta previa, determined by vaginal examination, corresponds to the results of ultrasound incomplete (partial) or I-II degree.

Posterior placenta previa (placenta previa on the posterior wall)

This condition is a special case of incomplete or low presentation, in which the main part of the placenta is attached to the back wall of the uterus.

Anterior placenta previa (placenta previa on the anterior wall)

This condition is also a special case of incomplete or low presentation, in which the main part of the placenta is attached to the anterior wall of the uterus. Attachment of the placenta to the anterior wall of the uterus is not a pathology, but reflects a variant of the norm.

In most cases, anterior and posterior placenta previa is determined by the results of ultrasound up to 26-27 weeks of pregnancy, which can migrate within 6-10 weeks and return to its normal position by the time of delivery.

Placenta previa - causes

The placenta is formed in the part of the uterus where the fetal egg is attached. Therefore, if the egg is attached to the lower wall of the uterus, then the placenta will form in this part of the organ. The place for attachment is "chosen" by the fetal egg, and it looks for such a part of the uterus where there are the most favorable conditions for its survival (good thick endometrium, absence of neoplasms and scars, etc.). If for some reason the best endometrium ended up in the lower segment of the uterus, then the fetal egg will attach there, and subsequently this will lead to placenta previa.

The reasons for the attachment of the fetal egg in the lower segment of the uterus and the subsequent formation of placenta previa are due to various factors, which, depending on the initial nature, can be divided into two large groups:
1. Uterine factors (depending on the woman);
2. Fetal factors (depending on the characteristics of the fetal egg).

Uterine factors- these are various pathological changes in the mucous membrane of the uterus (endometrium), formed during inflammatory diseases (endometritis, etc.) or intrauterine manipulations (abortions, diagnostic curettage, caesarean section, etc.). Fetal factors are a decrease in the activity of enzymes in the membranes of the fetal egg, which allow it to be implanted in the uterine mucosa. Due to the lack of enzyme activity, the fetal egg "slips" past the bottom and walls of the uterus and is implanted only in its lower part.

Currently, the uterine causes of placenta previa include the following conditions:

Any surgical interventions on the uterus in the past (abortions, caesarean sections, removal of fibroids, etc.);
Childbirth that proceeded with complications;
Anomalies in the structure of the uterus;
Underdevelopment of the uterus;
Isthmic-cervical insufficiency;
Multiple pregnancy (twins, triplets, etc.);
Endocervicitis.

Due to the fact that most of the causes of placenta previa appear in women who have undergone any gynecological diseases, surgical interventions or childbirth, this complication in 2/3 of cases is observed in re-pregnant women. That is, women who are pregnant for the first time account for only 1/3 of all cases of placenta previa.

For fruitful reasons placenta previa include the following factors:

Inflammatory diseases of the genital organs (adnexitis, salpingitis, hydrosalpinx, etc.);

Considering the listed possible causes of placenta previa, the following women are included in the risk group for the development of this pathology:

Burdened obstetric history (abortions, diagnostic curettage, difficult births in the past);
Transferred in the past any surgical interventions on the uterus;
Neuro-endocrine disorders of the regulation of menstrual function;
Underdevelopment of the genital organs;
Inflammatory diseases of the genital organs;
uterine fibroids;
endometriosis;
Pathology of the cervix.

Diagnosis of placenta previa

Diagnosis of placenta previa may be based on characteristic clinical manifestations or on the results of objective studies (ultrasound and bimanual vaginal examination). Signs of placenta previa are as follows:

Bloody discharge from the genital tract of a bright scarlet color with a completely painless and relaxed uterus;
High standing of the bottom of the uterus (the indicator is greater than that which is typical for a given period of pregnancy);
Incorrect position of the fetus in the uterus (breech presentation of the fetus or transverse position);
The noise of blood flow through the vessels of the placenta, clearly distinguishable by the doctor during auscultation (listening) of the lower segment of the uterus.

If a woman has any of the listed symptoms, then the doctor suspects placenta previa. In such a situation, a vaginal examination is not performed, since it can provoke bleeding and premature birth. To confirm the preliminary diagnosis of placenta previa, the gynecologist sends the pregnant woman to an ultrasound scan. Transvaginal ultrasound allows you to accurately determine whether a given woman has placenta previa, as well as to assess the degree of overlap of the uterine os, which is important for determining the tactics of further pregnancy management and choosing a method of delivery. Currently, it is ultrasound that is the main method for diagnosing placenta previa, due to its high information content and safety.

If it is impossible to do an ultrasound, then the doctor performs a very gentle, accurate and careful vaginal examination to confirm the diagnosis of placenta previa. With placenta previa, the gynecologist feels the spongy tissue of the placenta and rough fetal membranes with the fingertips.

If a woman does not have any clinical manifestations of placenta previa, that is, the pathology is asymptomatic, then it is detected during screening ultrasound studies, which are mandatory at 12, 20 and 30 weeks of pregnancy.

Based on the ultrasound data, the doctor decides whether it is possible to perform a vaginal examination in this woman in the future. If placenta previa is complete, then a standard two-handed gynecological examination cannot be performed, under any circumstances. With other types of presentation, you can only very carefully examine the woman through the vagina.

ultrasound diagnostics

Ultrasound diagnosis of placenta previa is currently the most informative and safest method for detecting this pathology. Ultrasound also allows you to clarify the type of presentation (full or partial), measure the area and thickness of the placenta, determine its structure and identify areas of detachment, if any. To determine the various characteristics of the placenta, including presentation, ultrasound should be performed with moderate filling of the bladder.

If placenta previa is detected, then periodically, with an interval of 1 to 3 weeks, an ultrasound scan is performed in order to determine the rate of its migration (movement along the walls of the uterus is higher). To determine the position of the placenta and assess the possibility of conducting natural childbirth, it is recommended to perform ultrasound at the following stages of pregnancy - at 16, 24 - 25 and 34 - 36 weeks. However, if there is an opportunity and desire, then ultrasound can be done weekly.

Placenta previa - symptoms

The main symptom of placenta previa is recurrent painless bleeding from the genital tract.

Bleeding with placenta previa

Bleeding with placenta previa can develop at different times of gestation - from 12 weeks to the very birth, but most often they occur in the second half of pregnancy due to the strong stretching of the walls of the uterus. With placenta previa, bleeding up to 30 weeks is observed in 30% of pregnant women, in terms of 32-35 weeks also in 30%, and in the remaining 30% of women they appear after 35 weeks or at the beginning of labor. In general, with placenta previa, bleeding during pregnancy occurs in 34% of women, and during childbirth - in 66%. During the last 3 to 4 weeks of pregnancy, when the uterus contracts especially strongly, bleeding may increase.

Bleeding with placenta previa is due to its partial detachment, which occurs as the uterine wall stretches. With detachment of a small area of the placenta, its vessels are exposed, from which bright scarlet blood flows.

Various factors can provoke bleeding with placenta previa, such as excessive exercise, severe coughing, vaginal examination, sauna visits, sexual intercourse, bowel movements with strong straining, etc.

Depending on the type of placenta previa, the following types of bleeding are distinguished:

Sudden, profuse and painless bleeding, often occurring at night, when a woman wakes up literally "in a pool of blood" is characteristic of complete placenta previa. Such bleeding may stop as suddenly as it began, or it may continue in the form of a scanty discharge.
The onset of bleeding in the last days of pregnancy or in childbirth is characteristic of incomplete placenta previa.

The intensity of bleeding and the amount of blood loss does not depend on the degree of placenta previa. In addition, bleeding with placenta previa can be not only a symptom of pathology, but also become its complication if it does not stop for a long time.

Given the recurring episodes of bleeding with placenta previa, pregnant women with this pathology almost always have severe anemia, a lack of circulating blood volume (BCC) and low blood pressure (hypotension). These nonspecific signs can also be considered symptoms of placenta previa.

Also, the following signs are considered indirect symptoms of placenta previa:

Incorrect presentation of the fetus (oblique, transverse, gluteal);
High standing of the bottom of the uterus;
Listening to the noise of blood in the vessels at the level of the lower segment of the uterus.

What threatens placenta previa - possible complications

Placenta previa can threaten the development of the following complications:

The threat of termination of pregnancy;
Iron-deficiency anemia;
Incorrect location of the fetus in the uterus (oblique or transverse);
Breech or foot presentation of the fetus;
Chronic fetal hypoxia;
Delayed fetal development;
Fetoplacental insufficiency.

The threat of abortion is due to recurrent episodes of placental abruption, which provokes fetal hypoxia and bleeding. Complete placenta previa most often ends in premature birth.

Preeclampsia in placenta previa is due to the impossibility of a full-fledged second invasion of the trophoblast into the endometrium, since in the lower segment of the uterus the mucous membrane is not dense and thick enough for additional villi to penetrate into it. That is, a violation of the normal growth of the placenta during its presentation provokes preeclampsia, which, in turn, increases the severity and increases the frequency of bleeding.

Fetoplacental insufficiency is due to the fact that the blood supply to the lower segment of the uterus is relatively low compared to the fundus or body, as a result of which insufficient blood is supplied to the placenta. Poor blood flow causes an insufficient amount of oxygen and nutrients that reach the fetus and, therefore, do not satisfy its needs. Against the background of such a chronic deficiency of oxygen and nutrients, hypoxia and fetal growth retardation are formed.

Iron deficiency anemia is caused by constantly recurring periodic bleeding. Against the background of chronic blood loss in a woman, in addition to anemia, a deficiency of circulating blood volume (BCV) and coagulation factors is formed, which can lead to the development of DIC and hypovolemic shock during childbirth.

The incorrect position of the child or its breech presentation is due to the fact that in the lower part of the uterus there is not enough free space to accommodate the head, since it was occupied by the placenta.

Placenta previa - principles of treatment

Unfortunately, there is currently no specific treatment that can change the site of attachment and location of the placenta in the uterus. Therefore, therapy for placenta previa is aimed at stopping bleeding and maintaining pregnancy as long as possible - ideally until the due date.

With placenta previa throughout pregnancy, a woman must necessarily observe a protective regimen aimed at eliminating various factors that can provoke bleeding. This means that a woman needs to limit her physical activities, not to jump and ride on bumpy roads, not to fly in an airplane, not to have sex, to avoid stress, not to lift weights, etc. In your free time, you should lie on your back with your legs up, for example, on a wall, on a table, on the back of a sofa, etc. The position "lying on your back with your legs elevated" should be adopted at every opportunity, preferring it to just sitting on a chair, in an armchair, etc.

After 24 weeks, if the bleeding is not heavy and stops on its own, the woman should receive conservative treatment aimed at maintaining the pregnancy until 37-38 weeks. Therapy of placenta previa consists in the use of the following drugs:

Tocolytic and antispasmodic drugs that improve the stretching of the lower segment of the uterus (for example, Ginipral, No-shpa, Papaverine, etc.);
Iron preparations for the treatment of anemia (for example, Sorbifer Durules, Ferrum Lek, Tardiferon, Totem, etc.);
Drugs to improve the blood supply to the fetus (Ascorutin, Curantil, Vitamin E, folic acid, Trental, etc.).

The most common conservative treatment for placenta previa due to light bleeding consists of a combination of the following drugs:

Intramuscular injection of 20 - 25% magnesia, 10 ml;
Magne B6 2 tablets twice a day;
No-shpa 1 tablet three times a day;
Partusisten 5 mg four times a day;
Sorbifer or Tardiferon 1 tablet twice a day;
Vitamin E and folic acid 1 tablet three times a day.

A woman will have to take these drugs throughout her pregnancy. When bleeding occurs, it is necessary to call an ambulance or get to the maternity hospital on your own and be hospitalized in the department of pathology of pregnant women. In the hospital, No-shpu and Partusisten (or Ginipral) will be administered intravenously in large doses in order to achieve the effect of strong relaxation of the muscles of the uterus and good stretching of its lower segment. In the future, the woman will again be transferred to tablet forms, which are taken in smaller, supportive dosages.

For the treatment of placental insufficiency and the prevention of fetal hypoxia, the following agents are used:

Trental is given intravenously or taken as a tablet;
Curantyl take 25 mg 2-3 times a day one hour before meals;
Vitamin E take 1 tablet per day;
Vitamin C take 0.1 - 0.3 g three times a day;
Cocarboxylase is administered intravenously at a dose of 0.1 g in a glucose solution;
Folic acid is taken orally at 400 mcg per day;
Actovegin take 1 - 2 tablets per day;
Glucose is administered intravenously.

Therapy for placental insufficiency is carried out in courses throughout pregnancy. If the use of these funds can prolong the pregnancy up to 36 weeks, then the woman is hospitalized in the antenatal ward and the method of delivery is chosen (caesarean section or natural childbirth).

If, during placenta previa, severe, persistent bleeding develops that cannot be stopped within a few hours, then an emergency caesarean section is performed, which is necessary to save the woman's life. In such a situation, the interests of the fetus are not thought of, since an attempt to maintain pregnancy against the background of severe bleeding during placenta previa will lead to the death of both the child and the woman. An emergency caesarean section with placenta previa is performed according to the following indications:

Recurrent bleeding, in which the volume of blood lost is more than 200 ml;
Regular meager blood loss against the background of severe anemia and low blood pressure;
One-stage bleeding, in which the volume of blood lost is 250 ml or more;
Bleeding with complete placenta previa.

Childbirth with placenta previa

With placenta previa, childbirth can be carried out both through natural routes and by caesarean section. The choice of method of delivery is determined by the condition of the woman and the fetus, the presence of bleeding, as well as the type of placenta previa.

Caesarean section with placenta previa

Caesarean section with placenta previa is currently performed in 70 - 80% of cases. Indications for caesarean section with placenta previa are the following cases:
1. Complete placenta previa.
2. Incomplete placenta previa associated with breech presentation or fetal malposition, uterine scar, multiple pregnancies, polyhydramnios, narrow pelvis, primiparous age over 30, and aggravated obstetric history (abortions, curettage, miscarriages, pregnancy losses, and previous uterine surgery) );
3. Incessant bleeding with a blood loss of more than 250 ml with any type of placenta previa.

If the listed indications for caesarean section are absent, then with placenta previa, childbirth can be carried out through natural routes.

Childbirth through natural ways

Childbirth through natural routes with placenta previa can be carried out in the following cases:

Absence of bleeding or its stop after opening the fetal bladder;
Ready for childbirth cervix;
Regular contractions of sufficient strength;
Head presentation of the fetus.

At the same time, they wait for the independent onset of labor without the use of stimulant drugs. In childbirth, the fetal bladder is opened when the cervix is dilated by 1–2 cm. If, after opening the fetal bladder, bleeding develops or does not stop, then an emergency caesarean section is performed. If there is no bleeding, then childbirth continues naturally. But with the development of bleeding, an emergency caesarean section is always performed.

Sex and placenta previa

Unfortunately, sex with placenta previa is contraindicated because frictional movements of the penis can cause bleeding and placental abruption. However, with placenta previa, not only classic vaginal sex is contraindicated, but also oral, anal, and even masturbation, since sexual arousal and orgasm lead to a short-term, but very intense contraction of the uterus, which can also provoke bleeding, placental abruption or premature birth.

Placenta previa during pregnancy is one of the terms of obstetric practice. This is how various types of fastening of this vascular disk inside the uterine cavity are designated. The designation "previa" indicates that the placenta is located in close proximity to the birth canal and, therefore, blocks them. We will talk about the options and specifics of the localization of the placenta in the expectant mother further.

When they talk about presentation, they mean a pathology that, at 36-40 weeks, manifests itself in about 0.3% of all pregnancies. Placenta previa during pregnancy at a period of 20-32 weeks is more common - in more than 5-10% of cases, but it is not always classified as a pathology. As the baby grows and the uterus stretches, the so-called placental migration occurs, when the organ is located as it was intended by nature.

To understand the essence of presentation as a pathology, let's remember how the uterus is built. In a large muscular organ, the body, bottom and neck are isolated. The cervix is at the bottom of the uterus, the bottom is at the top, and between them is the body of the uterus. The outer part of the cervix protrudes into the vagina.

When a baby is born, the cervix is stretched under pressure, the head and body of the baby pass from the uterus through the cervical canal into the vagina. In the normal state, this cavity is tightly compressed. Obviously, the baby will not break through to the light if the cervix is blocked by something. It is precisely such a “stumbling block” that the placenta becomes, occupying some space next to the opening of the cervix. If the location of the placenta interferes with the normal development of the birth process, this is regarded as a direct threat to the successful development and birth of the child.

Placenta previa during pregnancy: types of pathology and their characteristics

According to the results of the analysis of the specifics of the localization of the placenta in the cervix, several types of presentation were identified. Today, doctors use two main classifications of pathology.

Types of presentation according to the results of ultrasound

Full presentation. A round and flat baby place completely blocks the cervix. When the time is right, the cervix will open, but the baby's head will not be able to move forward. Complete placenta previa during pregnancy excludes natural childbirth - the baby will be removed by caesarean section. This type of pathology accounts for about 25 - 30% of cases of the total number of presentations. Full presentation is completely unpredictable, as it is the cause of high mortality rates for women in labor and newborns.
Partial presentation. In this case, the placenta does not completely block the exit from the cervix, while a small area remains open. The head of the child cannot squeeze through this gap, therefore, most often, doctors tend to operative delivery. Pathology occurs in 40 - 55% of pregnancies.
Low presentation. The child's place is located about 3 - 5 cm from the cervix, but does not adjoin it. it is obvious that the area of the entrance to the cervical canal remains free. Low placenta previa during pregnancy gives a woman a chance to have a baby on her own. Despite the fact that this type of pathology is considered the safest in terms of bearing a child and childbirth, however, complications are also possible here. If you delve into the question of what threatens low placenta previa during pregnancy, then you should list the most common complications:

the threat of spontaneous abortion;
anemia and low blood pressure in a woman;
malposition;
oxygen starvation and a high probability of developmental delay in the child.

Classification of presentation based on the analysis of the position of the placenta during childbirth

There is another classification of pathology that arose on the basis of determining the location of the child's place during a vaginal examination, when the cervix is open by more than 4 cm. The following types of presentation were distinguished:

Central. The opening of the cervical canal is closed by the placenta. The obstetrician diagnoses this when he inserts a finger into the vagina: the placenta can be felt, but the membranes cannot be checked. Natural delivery with this variant of the pathology is impossible, and the baby is born through a caesarean section. We also note that the central placenta previa during pregnancy corresponds to the complete placenta previa, which is determined by ultrasound.
Lateral. In this case, the obstetrician manages to probe not only the part of the placenta that overlaps the opening of the cervical canal, but also the rough surface of the membranes. Lateral presentation corresponds to partial placenta previa on ultrasound.
Regional. The obstetrician gropes for rough fetal membranes, slightly protruding into the outer opening of the cervix, as well as the placenta, which is located near the internal pharynx. Marginal presentation is correlated with the initial stages of partial according to ultrasound.
back. This pathology is a variant of partial or low presentation, when almost the entire placenta is located in the region of the posterior wall of the uterus.
Front. This condition is also considered a private variety of partial or low presentation - the placenta in this case is attached to the anterior wall of the uterus. This case is not regarded as a pathology, but is considered a variant of the norm.

Almost all cases of anterior and posterior placenta previa during pregnancy are diagnosed by ultrasound up to 26-27 weeks. As a rule, in the next 6 to 10 weeks, the placenta migrates and by the time the baby is born, it takes its place.

Reasons for the development of placenta previa

A large number of factors can provoke the development of pathology, when the fetal egg is implanted in the region of the lower segment of the uterus and placenta previa is subsequently formed at this place. Depending on the origin of these factors, they are divided into uterine and fetal.

Uterine factors in the development of placenta previa

They depend solely on the future mother. They are expressed by all sorts of abnormalities of the uterine mucosa, which appeared on the basis of inflammation (for example, endometritis) or surgical manipulations inside the uterus (for example, abortion or caesarean section).

Uterine factors include:

Surgical intervention in the uterine cavity.
Difficult childbirth.
Benign tumor in the uterus.
Endometriosis.
Underdeveloped uterus.
Congenital anomalies in the structure of the uterus.
Pregnancy with twins or triplets.
Isthmic-cervical insufficiency.
Inflammation of the cervical canal.

Most often, uterine factors concern women who are pregnant again.

Fetal factors of placenta previa

Depend on the specifics of the development of the fetal egg. Attention is paid to fetal factors with reduced enzymatic activity in the tissues of the fetal egg, due to which it attaches to the uterine mucosa. When there are not enough enzymes, the egg with the embryo is not able to implant in the shell of the bottom or walls of the uterus, therefore it is attached to its lower part.

Among the fetal factors, we note:

Inflammatory reactions in the genital area (for example, inflammation of the ovaries).
Hormonal imbalance.
Disturbed menstrual cycle.
Myoma of the uterus.
Various diseases of the cervix.
Pathological change in the inner mucous layer of the uterus.

Indicators of placenta previa during pregnancy

The main sign of the pathological location of the placenta is regular uterine bleeding, which does not cause pregnant pain. For the first time, blood discharge due to placenta previa during pregnancy may occur at a period of 12 weeks and then periodically appear until the onset of labor. But often this symptom is observed towards the end of the 2nd trimester, since the walls of the uterus by this time are already very stretched.

3 - 4 weeks before the birth of the baby, the uterus is preparing for the upcoming heavy load and from time to time it is greatly reduced. Against the background of training bouts, bleeding becomes more abundant than before. The blood appears due to partial detachment of the placenta, which is caused by stretching of the uterus. When any part of the placenta exfoliates, the vessels open, which are the source of blood.

The nature of bleeding depends on the type of placenta previa:

With complete placenta previa, bleeding is sudden, abundant and painless. It usually starts at night and the woman may wake up in a pool of her own blood. The bleeding ends as suddenly as it appeared.
With a partial presentation, the release of blood is observed mainly in the last days before childbirth or after the discharge of water.

On the basis of such episodic bleeding, expectant mothers also develop secondary signs of improper attachment of the placenta. Among them:

anemia;
insufficient volume of circulating blood;
hypotension;
breech or foot presentation of the child;
high position of the uterine fundus;
noise of blood in the vessels in the lower part of the uterus.

What is dangerous placenta previa during pregnancy

Pathology provokes the development of complications that are dangerous for the baby:

Miscarriage.
Severe toxicity.
Anemia.
Pathological location of the fetus in the uterus (pelvic or foot).
Chronic oxygen starvation of the fetus.
Slowed rates of intrauterine development of the child.
Fetoplacental insufficiency.

Treatment of placenta previa during pregnancy

There is no specific treatment that could influence the location of the placenta in the "correct" place today. Stopping frequent uterine bleeding and prolonging pregnancy (ideally until the due date of delivery) is all that doctors can offer to a patient with such a problem.

Of great importance for the successful bearing of the baby against the background of presentation is the reasonable behavior of the expectant mother. Here is what she must do in order not to cause bleeding with her careless behavior:

avoid intense physical activity;
do not jump or bounce;
avoid bumpy driving on rough roads;
refuse to fly by plane;
do not be nervous;
do not lift or carry heavy things.

During the day, a pregnant woman with placenta previa should arrange a short rest for herself. To relax, you need to lie on your back and raise your straight legs up, leaning them against the wall, closet or back of the sofa. This position should be adopted as often as possible.

When the pregnancy reaches 25 weeks, and the bleeding will be scanty and quickly passing, a program of conservative therapy will be developed for the future mother in order to keep the fetus in a normal state until the period of 37-38 weeks. So, what to do if placenta previa is diagnosed during pregnancy?

Firstly, a woman in position is required to prescribe drugs of the following drug groups:

tocolytics and antispasmodics to stimulate the stretching of the lower uterus (for example, Partusisten, No-shpa);
iron-containing drugs to eliminate anemia (Totema, Sorbifer Durules);
drugs that stimulate the blood supply to the fetus at a full level (Trombonil, Askorutin, Tocopherol acetate, Trental).

Secondly, the expectant mother is prescribed a combination of the following medications:

Magnesium sulfate 25% (intramuscular injections of 10 ml);
Magne B6 (2 tablets in the morning and evening);
No-shpa (1 tablet 3 times a day);
Partusisten (5 mg 4 times a day);
Tardiferon (1 tablet 2 times a day);
Tocopherol acetate and folic acid (tablet 3 times a day).

A pregnant woman with placental pathology will take this set of medicines until the very birth. If bleeding suddenly starts, you need to call an ambulance without any hesitation or get to the hospital on your own so as not to waste time. The expectant mother will be admitted to the department of pathology of pregnant women. There she will be prescribed the same drugs that she took at home (No-shpu, Partusisten), only they will be administered intravenously and in much larger doses than before. This is necessary in order to relieve tension of the uterus as quickly as possible and ensure its lower segment is safely stretched.

Thirdly, in the treatment of a pregnant woman with placenta previa, the intrauterine state of the baby is necessarily monitored. To eliminate placental insufficiency and prevent the development of oxygen starvation in the fetus, a pregnant woman is prescribed the following drugs:

Trental solution intravenously;
Curantil 25 mg (three times a day 1 hour before meals);
Tocopherol acetate (1 tablet per day);
ascorbic acid 0.1 - 0.3 g (three times a day);
Cocarboxylase solution intravenously;
folic acid 400 mcg (1 time per day);
Actovegin (2 tablets per day);
intravenous glucose solution.

If in this way it is possible to bring the pregnancy to a period of 36 weeks, the expectant mother is transferred to the antenatal ward and a decision is made on how she will give birth (on her own or through a caesarean section).

With the sudden development of profuse and persistent bleeding, which cannot be stopped for a long time, an emergency caesarean section is indicated for the pregnant woman, otherwise the life of the expectant mother is in great danger. Unfortunately, in such a force majeure situation, the well-being of the fetus is no longer thought of, since all efforts to maintain pregnancy with massive bleeding due to placenta previa, as a rule, lead to the death of both the mother and the child. According to statistics, today more than 70 - 80% of cases of placenta previa during pregnancy end in operative delivery.

Placenta previa during pregnancy and sexual life

Placenta previa during pregnancy excludes sexual relations. Insertion of the penis into the vagina can cause severe bleeding and placental abruption. But this is not only about vaginal sex: expectant mothers with a pathological location of the placenta are contraindicated in everything that somehow contributes to the development of sexual arousal (oral, anal, vaginal sex, masturbation). Excitation and orgasm cause short-term, but very intense contraction of the uterus, and this threatens with massive bleeding, spontaneous abortion or premature birth.

Placenta previa during pregnancy: reviews

Women who, while carrying a child, are faced with any type of presentation, speak of pathology in different ways. The problem, identified at a period of 20-27 weeks of pregnancy, in the vast majority of cases, over time, "resolved" by itself: by the time the baby was born, migration occurred, and the placenta rose from the lower segment of the uterus higher. The birth went well.

In rare cases, a low-attached placenta has retained its pathological position until delivery. Women in this case gave birth to a child by caesarean section. Pregnancy under such circumstances was relatively difficult, and future mothers had to be extremely careful not to cause a massive discharge of blood from the genital tract and not lose the baby.

All women confirmed that placenta previa during pregnancy is a real test. However, in most cases, bearing a child against the background of presentation ended in the safe birth of a healthy baby, so the main thing for a mother is to worry less and believe in the best.

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 the woman, a unique new organ appears and develops - . And the organ, by the way, is rather big - it weighs as much as half a kilo! If we talk about its functions, it becomes clear that not “whole”, but “only” a pound.

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

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

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

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

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

Location of the placenta: top, side, bottom

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

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

The lower the placenta is located (especially 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 that requires special attention of doctors and the pregnant woman herself.

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

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

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

Why does placenta previa occur?

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

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

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

inflammation;

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

neoplasms (eg, uterine fibroids)

endometriosis;

malformations of the uterus;

multiple pregnancy.

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

How is placenta previa diagnosed?

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

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

Also, factors provoking bleeding can be:

coughing or sneezing, provoking tension in the abdominal wall;

straining during bowel movements, especially with constipation;

intimacy;

gynecological examination;

bath, sauna and hot tub.

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

The development of pregnancy with placenta previa

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

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

If placenta previa persists, then the expectant mother is threatened 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. The larger the area separated from the wall of the uterus, the worse the supply of oxygen and nutrients to the baby. In extreme cases, this can lead to fetal death.

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

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

Placenta previa. What to do?

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

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

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

Treatment to prevent any uterine contractions. Periodic cramps are completely normal, 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 mother and child for the lack of oxygen and nutrients that occur due to constant placental abruption.

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

How to give birth with placenta previa

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

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

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

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

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

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

How to avoid placenta previa

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

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

treat any inflammatory diseases 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 bear and give birth to a healthy child, the main thing is calmness and strict adherence to all medical recommendations!

Prepared by Anna Pervushina

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