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Whether placental. Premature aging of the placenta. Low attachment and placenta previa

Placentation

Placenta structure

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

  1. Decidua - transformed endometrium (with decidual cells rich in glycogen),
  2. Rohr's fibrinoid (Lanthans layer),
  3. Trophoblast, covering the lacunae and growing into the walls of the spiral arteries, preventing their contraction,
  4. Blood-filled gaps
  5. Syncytiotrophoblast (multinucleated symplast covering the cytotrophoblast),
  6. Cytotrophoblast (individual cells that form syncytium and secrete biologically active substances),
  7. Stroma (connective tissue containing blood vessels, Kaschenko-Hofbauer cells - macrophages),
  8. Amnion (on the placenta synthesizes more amniotic fluid, extraplacental - adsorbs).

Between the fetal and maternal part of the placenta - the basal decidua - there are recesses filled with maternal blood. This part of the placenta is divided by decidual septa into 15-20 cup-shaped spaces (cotyledons). Each cotyledon contains a main branch, consisting of the umbilical blood vessels of the fetus, which branches further into the set of chorionic villi that form the surface of the cotyledon (in the figure, indicated as Villus). Due to the placental barrier, the blood flow of the mother and the fetus does not communicate with each other. The exchange of materials takes place using diffusion, osmosis or active transport. From the 3rd week of pregnancy, when the baby's heart begins to beat, the fetus is supplied with oxygen and nutrients through the "placenta". Until 12 weeks of pregnancy, this formation does not have a clear structure, up to 6 weeks. - is located around the entire ovum and is called chorion, "placentation" takes place in 3-6 weeks.

Functions

Placenta forms hematoplacental barrier, which is morphologically represented by a layer of fetal vascular endothelial cells, their basement membrane, a layer of loose pericapillary connective tissue, a basement membrane of a trophoblast, layers of cytotrophoblast and syncytiotrophoblast. The vessels of the fetus, branching into the placenta to the smallest capillaries, form (together with supporting tissues) chorionic villi, which are immersed in lacunae filled with maternal blood. It determines the following functions of the placenta.

Gas exchange

Oxygen from the mother's blood enters the fetal blood according to simple diffusion laws; carbon dioxide is transported in the opposite direction.

Trophic and excretory

Through the placenta, the fetus receives water, electrolytes, nutrients and minerals, vitamins; also the placenta is involved in the removal of metabolites (urea, creatine, creatinine) through active and passive transport;

Hormonal

Human placenta

Human placenta a few minutes after childbirth

Human placenta - placenta discoidalis, placenta of the hemochorial type: maternal blood circulates around the thin villi containing the fruit capillaries.

In the domestic industry since the 30s, prof. V.P. Filatov and placenta extract and placenta suspension are produced. Placenta drugs are actively used in pharmacology.

Umbilical cord blood and placenta can be used to obtain stem cells stored in cord blood banks. Stem cells could theoretically be later used by their owner to treat serious diseases such as diabetes, stroke, autism, neurological and hematological diseases.

Placental extracts also have antibacterial and antiviral effects. The action of the drug from the placenta is combined with the provision of the body with the necessary substrates (vitamins, amino acids), which allows the body to be stimulated without depleting its energy, plastic and other resources. The presence of amino acids, enzymes, microelements and unique biologically active substances in the placenta, especially regulatory proteins, allows preparations from the placenta to activate the "dormant" cells of an adult body, which leads to their reproduction, renewal of the cellular composition, and ultimately to rejuvenation.

In some countries, the placenta is offered to be taken home to be buried under a tree - this custom is common in various regions of the world.

Animal placenta

Sheep afterbirth

There are several types of placenta in animals. In marsupials - an incomplete placenta, which causes such a short period of pregnancy (8-40 days). Artiodactyls - placenta diffusa epitheliochorial type, placenta zonaria in predators (endotheliochoral type), placenta discoid(hemochorial type) in rodents and humans and placenta cotyledonaria or multiplex in ruminants.

Most female mammals, including herbivores (cows and other ruminants), eat their afterbirth immediately after licking a newborn. They do this not only to eliminate the smell of blood that attracts predators, but also to provide themselves with the vitamins and nutrients they need after giving birth.

Literature

  • Gavorka E. Human Placenta, 1970.
  • Milovanov A.P. Pathology of the mother-placenta-fetus system: A guide for doctors. - Moscow: "Medicine". 1999 - 448 p.
  • Tissue therapy. Under. ed. acad. Academy of Medical Sciences of the USSR N.A.Puchkovskaya. Kiev, "Zdorovya", 1975, 208 p.
  • Filatov V.P. Tissue therapy (the doctrine of biogenic stimulants).
  • Transcript of public lectures given to doctors at the Central Lecture Hall of the Society in Moscow (third edition, revised). - M .: Knowledge, 1955 .-- 63 p.
  • Tsirelnikov N.I.Histophysiology of the placenta, 1981.
  • Shirshev S.V. Mechanisms of immune control of reproductive processes. Ekaterinburg: Publishing house of the Ural Branch of the Russian Academy of Sciences, 1999.381 p.
  • Sapin M.R., Bilich G.L. Human Anatomy: a textbook in 3 volumes - ed. 3rd rev., Add. - M .: GEOTAR-Media, 2009 .-- T. 2.- 496 p.

Notes (edit)


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Synonyms:

Immediately after childbirth, cleansing the newborn and getting rid of the smell of blood, to which predators come running. Also, the female needs to restore the supply of nutrients in abundance contained in the placenta. Should women do the same?

Eating the placenta is a stellar trend

An amazing trend is gaining popularity among Western and domestic show business stars.

Tom Cruise

    For the first time, placentophagy was massively talked about in 2006, when Tom Cruise decided to eat the placenta of his wife Katie Holmes. "I thought it would do me good.", - the actor explained his unusual desire. - "She's very nutritious."... Indeed, the placenta contains many biologically active substances, amino acids and enzymes that are not present in the body of an adult. It is also known for its antibacterial and antiviral properties. It is not known for certain whether Cruz managed to try the "child's place", but then many recognized this news as shocking.

Alicia Silverstone

    Actress Alicia Silverstone tasted dried placenta after giving birth to her son in 2011. Miracle capsules influenced Alicia's mood so much that her husband called them "pills of happiness."

January jones

    In 2013, Mad Men star January Jones spoke about the benefits of the placenta. The actress is convinced that all young mothers should try this remedy as prevention and fatigue.

Mayim Bialik

    The placenta in capsules was also taken by Mayim Bialik, who played the role of Amy Fowler in The Big Bang Theory. Defending Alicia Silverstone and January Jones, Mayim stated: “Eating the placenta is normal for mammals. We have evolved because of this. "

    In December 2015, eating the placenta was again talked about thanks to the ubiquitous Kim Kardashian. On her blog, the socialite wrote: “When I say“ eat the placenta, ”I mean that it will first be sublimated and then made into pills. And not at all fried like a steak. Although some do. Every time I take a pill, I feel energized and feel really healthy and vigorous. I highly recommend anyone who is just thinking to give it a try! "

    Domestic stars are trying to keep up with Western ones. Ex-soloist of the "Demo" group Sasha Zvereva in her Instagram shared a smoothie recipe, which includes fruits, berries and placenta.

You will be interested in:

Is it really good to eat the placenta?

Proponents of placentophagy argue that the placenta awakens "dormant" cells in the mother's body, helps them renew, and the body - to look younger and stay healthy. Scientists are skeptical about the stellar trend.

In the summer of 2015, an article was published in the scientific journal Archives of Women 's Mental Health (USA), the authors of which denied the ability of the placenta to rid women of postpartum depression. Cynthia Coyle, a neurophysiologist at Boston University, is convinced that the placenta does not in any way affect the concentration of hormones and useful trace elements in the blood.Moreover, it can be dangerous, since many clinics that process the placenta do not comply with the standards of its storage and preparation.

Previously, it was believed that the placenta is a sterile organ, but scientists have debunked this myth as well. It contains just as much bacteria as a woman's mouth, and some of them can be harmful. The researchers associate an improvement in the physical condition and mood of patients taking drugs with a placenta with. Dr. Coyle recommends that women in labor should refrain from eating the placenta, and that journalists are better off checking the information they publish.

Maria Nitkina

” №6/2014 06.06.16

Everyone has heard of the placenta at least once in their life. But not everyone understands what it is, where it comes from and what function it performs during pregnancy. Nevertheless, during the period of waiting for the baby, great attention is paid to this organ, it is examined in detail by special methods, and the outcome of pregnancy largely depends on it.

From their "seasoned" girlfriends, expectant mothers often hear various stories about the placenta: “I had a presentation. I was afraid, I won't give birth "," And I was put on premature aging of the placenta "... Let's find out what really lies behind all these terms and is it really so scary.

1. What is the placenta?

The name of the organ comes from lat. placenta - pie, flatbread, pancake. The placenta formed during pregnancy consists of lobules, in each of which many small vessels pass. In this organ, two circulatory systems converge - the mother and the fetus. Small vessels combine into larger ones and as a result, the umbilical cord is formed - a cord-like formation connecting the baby and the placenta.

2. What functions does the placenta perform during pregnancy?

The placenta is a unique and very important organ that is temporary, that is, it forms and functions only during pregnancy. It is the placenta that ensures the normal functioning of the fetus. This is the bond between mom and baby. Through it, the transfer of nutrients to the baby takes place. During pregnancy, the placenta transports oxygen to the baby and takes carbon dioxide from it. In addition, it produces some essential hormones. The placenta also carries out an important protective function - it plays the role of the so-called placental barrier, which “chooses” which substances can penetrate to the baby, and for which “entry is prohibited”.

3. How should the placenta be located during normal pregnancy?

Usually, the placenta during pregnancy is located closer to the bottom of the uterus (this is the name of the upper convex part of the uterus) along one of its walls. However, in some expectant mothers in the early stages of pregnancy, the placenta during pregnancy is formed closer to the lower part of the uterus. Then we are talking about its low location. But if the doctor told you about such a not very correct position of the placenta, you should not be upset. After all, the situation may well change. The fact is that the placenta during pregnancy can move (as doctors say, "migrate"). Of course, she does not move in the literal sense of the word. It's just that the tissues of the lower part of the uterus stretch upward with increasing gestational age, as a result of this, the placenta also shifts during pregnancy and takes the correct position.

4. What is "placenta previa" during pregnancy?

Placenta previa is a much more serious diagnosis than low placement. This is a situation when the placenta during pregnancy completely or partially closes the exit from the uterus. Why is such an incorrect dislocation of this organ dangerous? The tissue of the placenta is not very elastic and does not have time to adapt to the rapidly expanding wall of the lower part of the uterus, as a result, at some point, its detachment occurs and bleeding begins. It is usually painless and begins suddenly against the background of complete well-being. Bleeding recurs with the development of pregnancy, and it is impossible to predict when it will happen and what the next will be in strength and duration. It is dangerous for the life of both mother and child, and hospitalization is necessary.

Even if the bleeding has stopped, the pregnant woman remains in the hospital under the supervision of doctors until the very birth. They diagnose placenta previa during pregnancy using ultrasound, and the final diagnosis can be made only after 24 weeks - before that there is a chance that the placenta will independently change its position and move higher.

The reasons for the occurrence of placenta previa during pregnancy can be changes in the mucous membrane of the uterus as a result of repeated abortions, inflammations or genital infections, previously complicated labor. In the case of complete placenta previa, childbirth must be carried out using a cesarean section, since other delivery routes are impossible.

5. What is placental insufficiency?

If during pregnancy the placenta does not fully perform its work, then fetoplacental insufficiency (FPI) develops - a violation of blood circulation in the "mother-placenta-fetus" system. If these violations are insignificant, then they do not have a negative effect on the baby. But it can also happen that FPN becomes the cause of fetal hypoxia (lack of oxygen), as a result of which the baby may lag behind in growth and development. By the time of birth, these babies are often very weak and can be injured during childbirth. And even after birth, they are more susceptible to various diseases. It is almost impossible to determine FPI "by eye". To diagnose this complication during pregnancy, three main methods are used - ultrasound, Doppler and cardiotocography (CTG). At any slightest suspicion of FPI, all these examinations are mandatory.

At present, unfortunately, it is not possible to completely cure the placental insufficiency that has arisen during pregnancy. But doctors try to keep the placenta working and, if possible, prolong the pregnancy until the optimal time for delivery. If even with the treatment of this complication, the baby's condition worsens, then an emergency caesarean section is performed, regardless of the gestational age.

6. What does premature aging of the placenta mean during pregnancy?

Another pathology of the placenta is its early maturation or, as this condition is often called, premature aging of the placenta. The placenta goes through several stages of development: formation (0 degree: up to 30 weeks of pregnancy), growth (I degree: from 27 to 34 weeks), maturity of the placenta (II degree: from 34 to 39 weeks) and from 39 onwards - III degree. Premature aging of the placenta is the appearance of changes in it ahead of pregnancy. The reason is most often the transferred colds, smoking, toxicosis and the threat of termination of pregnancy, diseases of the respiratory and cardiovascular systems of the expectant mother.

Signs of premature aging of the placenta during pregnancy are determined by ultrasound. You do not need to be afraid of this diagnosis, but you need to undergo a thorough examination: dopplerometry, which will give additional information about the state of the uteroplacental blood flow, CTG and be tested for possible infections. After the examination, the doctor will prescribe the necessary treatment.

Usually, a woman is recommended to rest, walk in the fresh air, vitamins and drugs for the prevention of placental insufficiency during pregnancy. If the latter cannot be avoided, then the issue of early delivery is decided.

7. How is the state of the placenta determined during pregnancy?

During pregnancy, the condition of the placenta and its work are the subject of close medical supervision. The position, development and structural features of this organ can be assessed by ultrasound. At the same time, the localization and thickness of the placenta, the correspondence of the degree of its maturity 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.

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

  • laboratory methods- they are based on determining the level of placental hormones (estriol, chorionic gonadotropin, placental lactogen), as well as the activity of enzymes (oxytocinase and thermostable alkaline phosphatase) in the blood of pregnant women.
  • assessment of fetal heart function... In addition to simple listening with an obstetric stethoscope, cardiotocography (CTG) is performed, 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 baby himself.
  • dopplerometry- This is a variant of an ultrasound study, in which the speed of blood flow in the vessels of the uterus, umbilical cord and fetus is determined. n

Expert opinion

Tatiana Panova. K. m. N., Obstetrician-gynecologist of the highest category

The placenta during pregnancy is an amazingly complex system, a well-coordinated mechanism, a whole factory that performs many different functions. But, unfortunately, any system, even the most perfect, sometimes fails. For a variety of reasons, at different stages of pregnancy, deviations in the development and work of the placenta occur. Therefore, it is important for the prevention of violations of its functions to carry out timely treatment of chronic diseases and abandon bad habits, which often provoke problems associated with this organ. It is also important to observe the correct daily regimen: proper rest for at least 8-10 hours a day (sleep on the left side is preferable - in this position, blood flow to the placenta improves), elimination of physical and emotional stress, daily walks in the fresh air, balanced nutrition. You need to try to protect yourself from possible infection with viral infections, as well as take multivitamins for expectant mothers.

Ekaterina Podvigina

"

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, outwardly somewhat reminiscent of a cake, is a unique membrane - "customs and border guard" between the two circulatory systems of the mother and the fetus.

Placental development

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 the area of ​​the mucous membrane of the uterus, and part of the outer cells of the ovum begins to form villi. These villi are turned into cavities - lacunas that arise 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 fetus will receive all the nutrients. This is how extraembryonic organs begin to form (chorion, amnion, yolk sac), the intensive formation of which is called placentation and lasts 3-6 weeks. And, although the tissues and organs of the unborn baby are not formed from them, the further development of the embryo is impossible without them. Chorion after a while will turn into a placenta, and the amnion will become a fetal bladder. By 12 weeks, the placenta already resembles a round cake in shape or a disc thinned along the edge, and by the 16th week, the formation of the placenta is already completely completed. As the gestation period increases, the mass of the placenta increases, the density of the placenta tissues changes. This so-called “ripening” is a natural process that allows timely and fully meet the constantly changing needs of the fetus. The degree of maturity is determined by ultrasound examination (ultrasound). An ultrasound scan verifies the data regarding the thickness of the placenta and the accumulation of calcium salts with the period of bearing the baby. Doctors differentiate four stages of placental maturity, including zero, which is often found at 30 weeks. This is followed by the first stage, appearing from 27 to 36 weeks, from 34 to 39, the second and last, later than 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 appeared before 32 weeks and the 3rd degree of maturity before 36-37 weeks of pregnancy. Accelerated maturation of the placenta can be even and uneven. Uneven accelerated maturation of the placenta is often 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 a connection between ultrasound diagnosis of premature aging and impaired placental function, pregnant women with accelerated maturation of the placenta are recommended a course of prevention of placental insufficiency.

Placenta structure

The name of the organ comes from lat. placenta- pie, flatbread, pancake. The placenta has a lobular structure. These lobules are called cotyledons. Cotyledons are separated by septa - septa. Each lobule of the placenta contains many small vessels. In this organ, two systems of blood vessels converge. One of them (maternal) connects the placenta with the vessels of the uterus, the other (fruit) is covered with amnion. Vessels go along this membrane, which combine into larger ones, which ultimately form the umbilical cord. The umbilical cord is a cord-like formation 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.
A barrier membrane (one layer of cells) is located between the two vascular systems, due to which the blood of the mother and the fetus does not mix.

Disorders of the structure of the placenta

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

Small placenta, or placental hypoplasia... Such a diagnosis is legitimate 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.

Increase in the thickness and size of the placenta can also be a consequence of the pathological course of pregnancy. The most common reasons for an 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 into the placenta from the external genital organs (with STIs - chlamydia, mycoplasmosis, herpes, gonorrhea) or with blood flow (with influenza, SARS, kidney inflammation, toxoplasmosis, rubella). Placentitis is accompanied by impaired placental function (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 mellitus in the mother, as well as with a conflict over rhesus or blood group. It is very important to identify the true cause of the 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 two-lobed, three-lobed placentas, as well as cases when a child's place has additional lobule, standing as if "apart".
During childbirth, the additional lobule can break off from the main one and serve as a source of bleeding in the postpartum period. That is why obstetricians always examine the placenta in detail after birth.

As with any other organ, tumors are sometimes found in the placenta. The most common tumor is chorioangioma- pathological proliferation of blood vessels in any part of the placenta. Choriangioma refers to benign tumors, never metastases to other organs.

Placenta location in norm and pathology

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 pharynx. In this case, they talk about the low location of the placenta. With ultrasound examination low-lying consider the placenta, the lower edge of which is located at a distance of no more than 6 cm from the internal os 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 stretch upward with increasing gestational age, as a result of this, the lower edge of the placenta also shifts and takes the correct position. Ultrasound in dynamics allows you to get an idea of ​​placental migration with a high degree of accuracy.

Placenta previa- a much more serious diagnosis, with the placenta completely or partially blocking the inner opening of the cervical canal. The tissue of the placenta does not have great extensibility, it does not have time to adapt to the rapidly expanding wall of the lower segment of the uterus, as a result, at some point its detachment occurs, which is accompanied by bleeding. Such bleeding begins suddenly, it is painless, it recurs 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.

Placenta functions

Already from the moment the placenta was laid "tirelessly" works for the good of the baby. The placental barrier is impervious to many harmful substances, viruses, bacteria. At the same time, oxygen and substances necessary for life easily pass from the mother's blood to the child, 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 allows the mother's protective proteins (antibodies) to pass to the child, ensuring his protection, and at the same time detains the cells of the mother's immune system that can cause a reaction of rejection of the fetus, recognizing a foreign object in it. In addition, the placenta produces hormones that are important for a successful pregnancy, and enzymes that destroy harmful substances.

The hormones secreted by the placenta include 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 does not work well, then the level of this hormone decreases.

Placental dysfunction

With an unfavorable pregnancy, the function of the placenta 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 about 24% of pregnant women. Distinguish between primary and secondary placental insufficiency.

Primary (early) placental insufficiency develops up to 16 weeks of pregnancy, occurs during the formation of the placenta. Its causes are more often the pathology of the uterus: endometriosis, uterine fibroids, malformations of the uterus (saddle, small, two-horned), previous abortions and hormonal and genetic disorders. In some cases, primary placental insufficiency becomes secondary.

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, infections, late toxicosis, the threat of termination of pregnancy, as well as various diseases of the mother (arterial hypertension, dysfunction of the adrenal cortex, diabetes mellitus, thyrotoxicosis, etc.) are of great importance.

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

At present, unfortunately, it is not possible to completely cure the placental insufficiency that has arisen. Therefore, it is very important to carry out prevention in women who have 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, prolong the pregnancy until the optimal time of delivery. If the indicators deteriorate during treatment, emergency delivery is performed by caesarean section, regardless of the gestational age.

Diagnostics of the state of the placenta

During pregnancy, the state of the placenta and its functions are the subject of close medical supervision. After all, it is on this organ that the success of pregnancy and the health of the unborn baby depend.

The position, development and structural features of the placenta allow us to evaluate ultrasound (ultrasound). At the same time, the localization and thickness of the placenta, 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, the anatomical structure of the fetus is studied to identify abnormalities in its development, respiratory and motor activity of the fetus.

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

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

B) fetal cardiac assessment... In addition to simple 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, external stimuli, or the activity of the fetus itself.

V) dopplerometry- This is a variant of an ultrasound study, in which the velocity of blood flow 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 in labor

During the first (period of contractions) and the second (forced) period of labor, the placenta remains the most important organ of the child's life until his birth. Within half an hour after the birth of the child, the last (third) period of childbirth passes, during which the placenta and membranes, which make up the baby'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 blood pressure and pulse are measured. Because an overflowing bladder prevents the uterus from contracting, it is emptied using a catheter. After a while, 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 experience these contractions.

Therefore, obstetricians also use other signs of separation. When the placenta is separated, 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 up, and the segment of the umbilical cord hanging from the birth canal is not pulled into the vagina. If there are signs of separation of the placenta, the woman is asked to push, and the afterbirth 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 15 to 25 centimeters, thickness is 2-4 centimeters, weight is 500 grams.

After the birth of the placenta, it is placed on the table with the mother's side up and examined for the integrity of the placenta and membrane. There are two surfaces of the placenta: the fruit, facing the fetus, and the mother, adjacent to the wall of the uterus. The fruit surface is covered with amnion - a smooth, shiny grayish shell; the Umbilical cord is attached to its central part, from which the vessels radiate radially. The maternal surface of the placenta is 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 bosom.

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 techniques of massage of the uterus. 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 they talk about complete (true) placental accretion, transport the woman to the operating room and perform immediate surgery. With true placenta accretion, in the overwhelming majority of cases, there is only one way out - surgical removal of the uterus.

To recognize the increment and dense attachment of the placenta (and to distinguish them from each other), unfortunately, is only possible during childbirth. With a tight attachment of the placenta, bleeding develops (due to detachment 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, extending beyond the mucous membrane of the uterus, and sometimes into the entire thickness of the uterine wall. Dense attachment of the placenta differs from the increment in a shallower depth of germination of chorionic villi into the uterine wall.

If the afterbirth was born independently, but upon examination it was revealed placenta 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 during childbirth may be excessive labor activity (with incorrect fetal positions, a discrepancy between the size of the pelvis and the fetus, or excessive drug stimulation). In very rare cases, premature placental abruption occurs before delivery, usually as a result of an injury from a fall. 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. Death of the fetus is possible. The symptoms of placental abruption are not the same in different cases. There may be severe bleeding from the genitals, or it may not be at all. Perhaps the absence of fetal movement, severe persistent pain in the lumbar spine and abdomen, a change in the shape of the uterus. When diagnosing placental abruption, ultrasound is used. When the diagnosis is confirmed, 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. For a variety of reasons, at different stages of 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 abnormalities in the placenta. It is also important to observe the appropriate regimen: good rest for at least 10-12 hours a day (preferably sleeping on the left side), elimination of physical and emotional stress, stay in the fresh air for 3-4 hours a day, rational balanced nutrition, maximum protection of the pregnant woman from meeting with an infection. The course of prevention includes multivitamins, iron and other minerals.

What is the placenta? It is a unique organ that only exists in women and only during pregnancy. However, despite such a short period of functioning, the placenta, also known as the placenta and placenta, is of great importance for the development of the fetus, and for the course of pregnancy, and for successful childbirth. Which one - we will find out further.

Organ structure

The name "placenta" reflects the appearance of the organ and is translated from Latin as "cake". The afterbirth actually resembles a cake or flat disc with a specific diameter. This organ develops in the uterus directly during pregnancy. The beginning of the growth of a child's place is correlated with conception: an average of 7 days pass between these two events. By about the beginning of the second trimester, the placenta is almost completely formed, however, during the entire period of bearing the baby, it will change its structure more than once, adjusting to the needs of the growing baby. At the same time, it goes through 4 stages of maturity - 0, 1, 2, 3. For a period of up to 30 weeks, the organ usually has a zero degree of maturity, from 30 to 34 - the first, after 34 - the second. Shortly before childbirth, the functions of the child's place fade away, and the aging of the organ is clearly traced on ultrasound. This means that the placenta is in the last stage of maturation, and the organisms of the mother and baby are fully prepared for childbirth. By the way, it is possible to identify the degree of maturity of an organ only with an ultrasound examination.

The structure of the placenta is also unique. It consists of lobules, which are separated by partitions. The lobules are dotted with a huge number of small blood vessels. In this case, the placenta combines 2 circulatory systems: one belongs to the mother, the other to the child. The placenta is designed in such a way that the blood flow of the mother and the child does not intersect in it: there is a cell membrane between these two systems. In one part, the organ is attached to the wall of the uterus (usually to the back, but attachment to the anterior wall is also often found). The other side of the placenta is connected to the fetus using the umbilical cord. On this part of the placenta is also the amnion - the watery membrane of the fetus.

The most important indicators of the normal development of a child's place in pregnant women are the weight and size of the organ. In the first trimester, the placenta grows much faster than the fetus. For example, at 12 weeks, it weighs about 30 g, while the child weighs only 4 g. At the final stage of pregnancy, the mass of the placenta is about 600 g, the diameter is 16-18 cm, the thickness is 2-3 cm. For a certain period of pregnancy, there are their norms for the size of the placenta. Thickness is of the greatest importance for determining the state of an organ. It can be determined by ultrasound diagnostics after 20 weeks of the prenatal period.

The role of the placenta in pregnancy

The placenta plays a huge role throughout the entire period of intrauterine development of the fetus. What are its functions?

  • respiratory (gas exchange) - provides a continuous supply of oxygen to the baby through the mother's bloodstream and the removal of carbon dioxide. This process can be compared to gas exchange in the lungs of an adult;
  • barrier - protects the fetus from the effects of pathogenic microorganisms and some harmful substances. This function, however, is somewhat limited: for example, the body cannot retain nicotine and alcohol, which is why giving up bad habits for pregnant women is mandatory. In the last weeks of pregnancy, the permeability of the placenta increases significantly;
  • trophic - allows the child to receive all the substances necessary for growth and development;
  • endocrine - promotes the production of hormones that are of particular importance for pregnancy (hCG, prolactin, estrogens, and others). These hormones are involved in metabolic processes, in the work of the uterus and mammary glands, and also affect the growth and development of the fetus.

Despite the fact that the mother and the child are considered one whole, at the genetic level, these are two organisms alien to each other. In this case, an immune conflict between them is inevitable. However, the child's seat acts as a barrier and prevents the occurrence of a conflict, due to which there is no rejection of the fetus (with a normal pregnancy).

In the process of natural childbirth, the afterbirth leaves the uterine cavity a few minutes after the birth of the baby. And even after the placenta has left the woman's body, it still has some meaning. It is by the condition of the placenta that doctors determine how the pregnancy and childbirth proceeded, whether there were any complications, and whether there was a need to free the uterus from placenta residues. In addition, the child's place is sent for additional research if the birth ended in the death of the baby or in the case when neoplasms of an unclear nature were found in the afterbirth.

Disorders in the placenta

During the period of bearing a child, a woman undergoes many studies. At the same time, doctors pay attention not only to the development and well-being of the fetus, but also to the state of the placenta. Violations in the work of the organ can cause serious deviations in the course of pregnancy - up to miscarriage and premature birth.

Experts identify the following most common problems associated with the functions of the placenta:

  1. Detachment. With this violation, premature partial or complete separation of the placenta from the uterine wall occurs. Detachment can occur at any time, and the treatment of pathology will depend on the specific circumstances. In the early stages, the placenta is in the growth stage, so it is possible to restore its function. In the last weeks of pregnancy, detachment of the placenta is, as a rule, an indication for an emergency caesarean section.
  2. Placenta previa. It occurs when the placenta is located in the lower part of the uterus and partially or completely closes the birth canal. In this case, the birth of a child becomes problematic. However, with the proper approach, even with such a violation, childbirth can be quite successful, while a woman can give birth naturally.
  3. The increment of the placenta means a strong ingrowth of its vessels into the walls of the uterus. Due to ingrowth, separation of the placenta at the final stage of labor is difficult, and the risk of uterine bleeding increases.
  4. A delay in the separation of the placenta occurs when it does not leave the uterine cavity for more than 60 minutes after the birth of the child. This condition threatens the woman in labor with various complications and requires compulsory medical intervention.
  5. Fetoplacental insufficiency is a complex of various disorders in the work of the placenta, characterized by a decrease in the nutritional and respiratory function of the organ and capable of causing various abnormalities in the development of the fetus. Treatment of placental insufficiency in each case requires an individual approach and depends on the severity of the disorder.

Doctors are in a hurry to reassure pregnant women: modern medicine allows timely identification of pathologies in the development of the placenta, therefore, in most cases, any of the above diagnoses is not an obstacle to the successful completion of pregnancy. The most important thing in such a situation is to be attentive to your condition, to seek medical help in a timely manner and to clearly follow all the recommendations of specialists.