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What does placenta previa mean? Low previa of the placenta on the back wall. Symptoms of the low location of the placenta

In the first weeks of pregnancy, the fetus is nourished through the enlarged layer of the endometrium.

Chorionic villi penetrate into the loose mucous membrane of the uterus, densely penetrated by blood vessels, and receive the necessary nutrients from there.

A full-fledged placenta is formed only by 10-12 weeks. From this point on, the doctor can determine its position by palpation or during an ultrasound examination.

There is practically no way to influence the course of the formation of the placenta and the choice of the place of its attachment. This may be due to the pathology of the villi, when the chorion is physically unable to gain a foothold and stay in the upper lobes of the uterus.

On the mother's side, there are also some factors that, according to statistics, significantly increase the likelihood of the placenta being located in the lower segment of the uterus:

  • frequent (or chronic) endometrial inflammation and genital infections;
  • congestion in the small pelvis (due to chronic diseases of the mother);
  • postponed abortions;
  • placenta previa in previous pregnancies;
  • scar on the uterus;
  • smoking;
  • complicated previous childbirth;
  • anomalies in the structure of the uterus.

All these reasons affect the formation of the uterine lining. If it is not sufficiently developed, the blood flow is weakened, then nature itself chooses a "convenient" place for feeding the fetus - the lower part of the uterine cavity. According to the laws of physics, the blood supply to this area will always be better than in the upper lobes.

Preventive measures, such as giving up bad habits, visiting a doctor on time and treating inflammatory diseases, full physical activity, and hygiene of the genitals, significantly reduce the risk of such complications during pregnancy.

Diagnostics

If, during a routine examination at the end of the first trimester, the doctor suspects a low previa of the placenta along the back wall, an ultrasound is prescribed.

Fixation of the placenta 7 cm or less relative to the internal os for up to 26 weeks and 5 cm in the 3rd trimester is called "low presentation".

This pathology is the most harmless of all existing ones. With this arrangement, bleeding rarely occurs during pregnancy and childbirth. In addition, the low-lying placenta is prone to migration.

As the fetus grows, the uterus enlarges, stretches, and the place to which the placenta is attached can rise. With such a favorable outcome, presentation will not become an obstacle to natural childbirth.

A woman is under close medical supervision for the entire period, takes tests and undergoes ultrasound more often, regularly receives medication that supports the placenta and prolongs pregnancy.

Control of the position of the placenta is carried out with ultrasound at 16, 25 and 34 weeks of gestation.

Depending on whether the placenta has blocked the cervix and where the central part of the child's place is located, doctors distinguish 4 degrees of presentation:

  1. the placenta is 3 cm from the internal pharynx;
  2. the edge of the placenta has reached the cervix, but the internal pharynx is not blocked;
  3. one of the edges of the placenta is fixed on the opposite part of the lower segment of the uterus, the internal pharynx is blocked by a part of the placenta;
  4. the center of the placenta falls on the internal pharynx, and both parts of it are symmetrically located on opposite lobes of the uterus.

Grade 3 and 4 previa is uncommon, less than 1% of the total number of births.

If the internal pharynx is completely blocked, natural childbirth is impossible. But timely diagnosis allows you to prepare the mother and baby in advance for a cesarean section and the birth of a healthy baby.

Low presentation symptoms

As a rule, until the 20th week of pregnancy, the low location of the placenta does not manifest itself in anything.

In case, it is necessary to consult a doctor. But this is not yet a reason for panic!

Light red mucous or bloody discharge that is not accompanied by pain or may be the result of pressure on the vaginal wall and does not pose a threat to the unborn baby.

As a rule, physical activity, coughing and sneezing, constipation, and sexual intercourse can provoke the appearance of secretions.

In addition to bleeding, only 20% of pregnant women have:

  • headache;
  • nausea;
  • dizziness;

If a woman feels pain, hospitalization is necessary to assess the condition of the mother and fetus, strict bed rest. In most cases, doctors manage to quickly cope with the situation. Perhaps the expectant mother will be able to return home before giving birth. Sometimes a woman is hospitalized with similar symptoms several times during pregnancy.

In the arsenal of modern doctors there are medicines that are safe for pregnant women to stop bleeding.

If necessary, additional therapy with iron and vitamin C preparations, or blood transfusion is carried out.

Why is it dangerous?

If at the beginning of pregnancy a previa of 1-2 degrees was diagnosed, but until 24-26 weeks of pregnancy the placenta did not change its position, a low previa may threaten with new complications.

The dangers that arise at the end of the second and the beginning of the third trimester are associated with the pressure of the placenta itself and the growing fetus on the cervix. They can threaten the mother, baby, or complicate the course of labor:

  • recurrent bleeding may result in;
  • anemia causes hemorrhagic shock (a threat to the life of the fetus);
  • possible deterioration of blood flow due to compression of blood vessels, and this leads to fetal hypoxia;
  • (can also cause fetal hypoxia);
  • low placentation can prevent the head of the fetus from descending into the small pelvis. As a result, an incorrect (lateral) position of the fetus is diagnosed, possibly also. This makes it difficult for natural childbirth;
  • even when the birth canal is free, the placenta can shift during vaginal labor and make it impossible. In this case, an emergency COP is performed;
  • the location of the placenta on the anterior wall of the uterus can threaten with large blood loss during the delivery operation. In this case, the CS is carried out according to a special algorithm, which allows the child to be born faster, and then to give the mother the necessary therapy.

In case of heavy or recurrent bleeding, or intrauterine fetal hypoxia, the woman remains in the hospital until the very birth.

By 36 weeks, after assessing the maturity of the fetus, a caesarean section is prescribed. If necessary, delivery is carried out earlier.

What if you have been diagnosed with low placenta previa?

There are no medications that would change the position of the placenta to a safer one. But if the threat of fetal hypoxia is diagnosed, the doctor may prescribe drugs to improve blood circulation, additional vitamin complexes and antispasmodics to reduce the tone of the uterus.

If the pregnant woman feels well and is at home, one should not forget about the prevention of complications.

  • The expectant mother must protect herself from stress and anxiety.
  • It is advisable that someone close to you or a visiting assistant take over the housework.
  • Constipation should be avoided
  • Sexual contact is prohibited, as well as any vaginal procedures (douching, suppositories, etc.)
  • You cannot lift weights. If you have an older child, let someone help you in caring for him.
  • If possible, you should limit travel in transport, especially during rush hours
  • If the woman's condition allows, you can do swimming or gymnastics for pregnant women (after consulting a doctor!) Special sets of exercises will make the ligaments more elastic, help strengthen the pelvic muscles, and relieve tension.

Low placenta previa during pregnancy can threaten the life of the mother and the health of the baby.

If you have been diagnosed with such a diagnosis, it is necessary to follow the doctor's recommendations with special care.

The expectant mother should avoid stressful situations, physical exertion, refuse long trips, and limit sex life. Perhaps the baby will be born a little earlier than planned, but doctors will do everything possible so that by this time the baby is healthy and viable.

Placenta previa during pregnancy is one of the most serious pathological complications that occurs during the period of gestation. In this case, the placenta completely or completely blocks the uterine pharynx.

Such a complication cannot be cured with a drug method and is difficult to prevent, the prognosis is unpredictable. There remains a chance that the fetus itself will move into place and the problem will disappear.

In obstetrics, placenta previa is a pathological process in the body of the expectant mother, in which the fetus exfoliates from the walls and attaches very low to the uterus. Pathology is rare.

If the problem was detected in the 1st trimester of pregnancy, then it is not dangerous. By the end of gestation, she will snap into place again and make way for the baby. In the case when the condition was detected in late pregnancy, internal bleeding appears. If the disease is not detected in time, there may be serious problems during gestation and during childbirth.

During labor during labor, the baby exits through the cervix into the birth canal. If a deviation is detected, then during contractions, the vessels attached to the walls of the uterus can burst and cause severe bleeding in the womb. This is fatal to the child and the mother herself. Therefore, with some types of presentation, the birth of a baby is impossible.

Provoking factors

The pathological condition occurs in women for the following reasons:

  1. Sexual infectious diseases. Pregnancy is difficult and with possible consequences due to the presence of infectious bacteria in the body that affect the endometrium (the inner part of the uterus). Due to infection during fertilization, the placenta cannot firmly anchor to the walls and falls to the uterine pharynx. In this case, there is a risk of not only the appearance of an incorrect location of the embryo, but also a miscarriage at 10-13 weeks of gestation.
  2. Genetic factor. When a fetus has genetic abnormalities, its enzymes cannot reach the endometrium. As a result, the embryo is not fixed in the womb.
  3. Deformation of the structure of the uterus. If a girl has had unsuccessful operations or has congenital deformities, fibroids and polyps with depletion of the vaginal walls can be observed. This problem does not allow the embryo to gain a foothold and fully begin to develop.
  4. Insufficiency of the endometrium. During abortion and curettage, the top layer of the endometrium is injured and removed. If the procedure was done poorly, then there is a low development of the endometrium. The placenta fails to gain a foothold anywhere, and it sinks to the bottom of the vagina.

And also significant factors provoking breech presentation of the fetus include:

  • at the previous birth there was a cesarean;
  • the woman's age is over 30;
  • endometriosis;
  • drug and alcohol abuse;
  • multiple pregnancy;
  • adenomyosis;
  • trauma to the vagina;
  • chronic diseases of the lower genital organs;
  • pathologies that disrupt the full development of the baby.

Types of placenta previa

Depending on the nature of the disease and the characteristics of the location of the fetus in the region of the short neck, several types of disease are distinguished. There are two main classifications. The first is formed on the basis of the location of the child's seat, the second is based on the results of an ultrasound scan. It is worth noting that the size and location of the baby changes as the fetus develops and the uterus grows.

The following types of pathological conditions are distinguished:

Complete

With a full placental presentation of the fetus, the internal pharynx closes completely. When the uterus is opened, the baby will not be able to go outside. The natural appearance of a baby in such a situation is impossible. If the pregnancy reaches 30–34 weeks without the progression of the disease, then only cesarean will be done. This type of disease is most dangerous for the mother and baby. With complications, a lethal outcome is observed.

Incomplete (partial)

With a partial pathological condition, the clinical picture is as follows: the cervix does not completely overlap, due to incomplete closure of the tube, the liquid cannot circulate normally inside. Complications arise from the exfoliation of the embryo from the walls of the vagina. The placenta collapses and blocks the tube. If this happened before 20 weeks of gestation, there is a chance that she will rise back. With a weak course of the pathological state, problems are not observed.

In this case, childbirth does not take place naturally, since the baby's head is not able to go out into the narrow opening. Therefore, a cesarean is done. Partial presentation occurs in 40% of pregnant women with pathology. It is a safer type of pathological condition, despite the surgical intervention, the procedure performed does not harm the development of the baby and the health of the woman.

Low (bottom)

In this type, the embryo is located 48mm from the fallopian tube. That is, the internal pharynx remains completely open. Against the background of a low presentation, there may be a natural appearance of the baby. According to experts, this is the most favorable and safe type of pathology during gestation and childbirth.

Central

The cervical entrance is blocked by the placenta. When examining and palpating the vagina, it is impossible to determine the fruiting membrane. In such a situation, the appearance of the baby in a natural way is impossible, since the passage is completely closed. Central presentation according to the results of ultrasound can be 3 and 4 degrees, which is dangerous for the child.

Lateral

Part of the fetus overlaps the fallopian tube, the rest is located on one of the sides. The type of disease refers to partial presentation. According to the results of ultrasound, a 2-3 degree of disease progression is revealed. With this type, there are both natural childbirth and with the help of surgical intervention.

Regional

Or extreme. On examination, only the rough shell of the embryo is revealed, which indicates that there is a small lumen in the uterine passage and the child is placed from its edge. Natural childbirth is possible with this type, but sometimes the intervention of doctors is required.

Posterior (placenta previa on the posterior wall)

The most popular type of rejection. Most of the fruit is located on the back of the wall. You can give birth naturally, but there is a possibility that the baby will go badly.

Anterior (placenta previa on the anterior wall)

In this type, the placenta is adjacent to the front. It is not considered a dangerous and pathological case, therefore natural childbirth is permissible. It is considered as a variant of the norm and does not interfere with the full development of the fetus.

The disease is divided into developmental stages.

There are 4 degrees of cervical overlap:

  • I degree - the embryo develops in the area of ​​the tube, there is a small hole 2 cm in diameter.
  • II degree - part of the fetus lies on the edge of the entrance to the cervical canal without affecting it completely.
  • III degree - the embryo completely closes the canal, leaving no space. In this case, the fetus will be located on one of the walls of the uterus, and its lower part is located on the aisle.
  • IV degree - the placenta is located in the lower part of the womb and obstructs the entire cervical passage. In this case, the embryo is located along the anterior and posterior walls of the vagina.

The degree of the disease is determined only by the results of an ultrasound scan. Only after diagnosis can you find out the severity of the disease and find out possible complications.

What is the danger of such an ailment - possible complications

What is it fraught with? If the marginal position of the child's place is diagnosed in the early stages of gestation, there is a risk that when the child begins to grow, the placenta, along with the uterine walls, will move sideways. In addition, the fruit may flake off and move downward. In this case, the channel will be completely closed. In this case, fetal damage may occur.

If the child's seat is fixed on the front or back wall, then the risk of complications is minimal. With this diagnosis, the pregnancy is proceeding normally, and a cesarean is not required.

But, if by the 22nd week of gestation, the child has not changed its position, treatment and doctor's supervision will be required. There is a risk to the life of the mother and baby.

Due to the development of the disease, the following complications are possible:

  1. The baby's body in the mother's womb will press on the placenta, this will impair the supply of oxygen and blood. There are foci of ischemia, the baby will die due to the rapid aging of the child's place.
  2. The lower part of the uterus has less elastic and stronger tissues. With the development of the disease, the risk of detachment and the opening of internal bleeding increases. This will harm the girl's body and destroy the child.
  3. Even if the pregnancy proceeded well, and there are no complications, the wrong position of the baby can provoke the appearance of hypoxia and the newborn will die during childbirth.
  4. When leaving, the baby can touch the placenta and sharply pull it out. This will provoke damage to the walls, severe internal bleeding.

If a girl gives birth naturally, and complications arise, then the doctors are forced to do a cesarean section, otherwise there is a risk of the baby's death when going outside. In this case, emergency measures are taken and the baby is removed surgically.

Treatment methods

The course of treatment is prescribed after a complete medical examination and examination of the woman in labor. The duration and characteristics of treatment depend on the duration, location of the child and the type of internal bleeding. Therapy should be supervised by specialists.

The course includes the following treatment methods:

  1. Hospitalization of the expectant mother to preserve and identify the nature of the disease.
  2. Taking drugs that increase blood clotting and relieve spasms.
  3. Bed rest and rest.
  4. Restriction on active physical exercise and stress.
  5. Daily examination of the patient to determine the course of the disease.
  6. Premature birth and caesarean section are possible.

If a woman in labor has severe bleeding and a detachment of the child's place from the walls is detected, then a certain clinical protocol comes into play. The patient is urgently hospitalized and undergo emergency medical care. This condition is very dangerous for a woman and a baby. If internal bleeding is not stopped in time, the child will die in the womb and the woman will have serious complications that will lead to disastrous consequences. The loss of a large amount of blood can lead to a critical condition of a woman. The loss of 350-400 ml of blood at a time is considered especially dangerous.

If the disease is characterized by a small volume of blood secretion, and the woman's condition does not threaten her life, then she is not put in the clinic, the treatment is allowed to be carried out at home, but under the supervision of a gynecologist. When symptoms of anemia, low blood pressure and heavy bleeding appear, the woman is prescribed an emergency delivery by cesarean section.

Childbirth with this diagnosis

With such a diagnosis, natural childbirth and cesarean section are observed. What exactly will be prescribed depends on the condition of the woman in labor and the nature of the pathology. The main danger of natural childbirth is that during contractions, detachment of the child's place can occur. This condition will provoke a severe form of hypoxia in the baby, and internal bleeding will open. This will threaten the life of the newborn and the mother. Therefore, immediate surgical intervention is needed.

The natural exit of the child, for example, with a low position of the baby in the womb. In case of partial or incomplete form of the disease, each case is considered separately. The central location requires surgery and a caesarean section. What kind of procedure will be prescribed is decided only by the obstetrician. Sometimes two methods can be used at once.

Caesarean section is done regardless of the trimester. If necessary, it can be prescribed in the early stages of gestation if a premature pregnancy is diagnosed.

And also the procedure is carried out in the following emergency cases:

  • if the woman has lost more than 300 ml during bleeding;
  • there was an acute form of hypotension and anemia;
  • strong instantaneous blood loss in the amount of 350 ml or more;
  • bleeding opened in full presentation.

The operation is performed regardless of the development and condition of the unborn child. The main indicator is the condition of the mother. What kind of childbirth will be determined before 37–38 weeks of pregnancy. If the pregnancy has given complications, then premature birth is possible. In the early stages of gestation, the baby may not survive.

Preventive measures

How to behave in order to prevent pathology? This question is of interest to all girls who are concerned about their health and the health of the future baby. As a preventive measure, first of all, you need to know about the prevention of abortion. They can become the main reason for the appearance of problems during the period of bearing a baby.

In addition, the girl must undergo routine examinations with a gynecologist every six months. When detecting genital diseases and hormonal disruptions, you need to undergo comprehensive treatment.

Recommendations: if symptoms of presentation appear in the early stages, you need to undergo a full laboratory examination in order to establish an accurate diagnosis and the nature of the disease. During pregnancy, a girl is forbidden to overexert herself, carry weights, overcool and overheat the body, as the likelihood of internal bleeding increases.

Conclusion

Placenta previa is a serious complication that occurs at different stages of pregnancy. There are different types of the disease, which differ in their nature. If a pathology is detected, you need to undergo a complete medical examination and begin the prescribed course of therapy.

An abnormal condition can lead to serious consequences, therefore, it is impossible to delay with therapy. Sometimes the diagnosis is not dangerous for the mother and child, in other cases it is a risk and threat to the life of both the woman and the baby.

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

What is the placenta?

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

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

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

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

The attachment of the placenta to the posterior wall is the most physiological, because in this position, the placenta is most protected from injury. Sometimes, but much less often, the placenta can be located on the anterior wall or on the lateral walls of the uterus.

The anterior wall during pregnancy changes to a much greater extent than the posterior one, therefore such an arrangement of the placenta is less advantageous, although it is considered normal.

What is placenta previa?

Presentation is the most important indicator of the relationship between mother and fetus. The word "presentation" is used to describe the part of the fetus or placenta that is located in the lowest part of the uterus, just before exiting the pelvis. For example, cephalic presentation means that at the exit from the small pelvis (and, accordingly, from the uterus) there is the fetal head, breech presentation - the child's pelvis, foot presentation - his legs. The presenting part of the fetus is born first, the outcome and course of labor largely depend on it.

A very dangerous phenomenon observed during pregnancy is placenta previa - a pathology in which not the fetus, but the placenta is located at the bottom of the uterus.

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

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

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

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

Why is placenta previa dangerous?

  • The main danger of placenta previa is bleeding.

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

With full placental presentation, the fetus cannot be born naturally, because it completely "clogs" the exit from the uterus. Delivery is possible only by performing a cesarean section.

  • Underdevelopment of the fetus and the development of respiratory disorders.

Since the placenta is attached in an unfavorable place during presentation, its vessels do not penetrate well enough into the uterus. As a result, the fetus receives less oxygen and important nutrients from the mother's blood. This phenomenon is called in medicine feto-placental failure. The consequence of such a deficiency is fetal underdevelopment and the development of respiratory disorders, tk. the lungs of such children are also underdeveloped.

  • Gestosis.

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

  • Wrong position and presentation of the fetus.

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

Causes of placenta previa

The most common cause of atypical placental fixation is changes in the inner wall of the uterus, which is called the endometrium, that exist even before pregnancy.

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

Symptoms and signs of placenta previa

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

They can be observed at different times, but are most typical for the second half of pregnancy. With an increase in the duration of pregnancy, bleeding becomes more and more intense. The reason is simple: the growing or contracting uterus changes its size and shape, and it does this at the expense of its lower part - where the placenta is attached. Unlike the wall of the uterus, the placenta cannot stretch. Its detachment and bleeding occurs. This loses the blood of the mother, but not the fetus.

The amount of bleeding and the type of presentation does not always correspond to each other, although the most dangerous are usually bleeding in full presentation. Bleeding has the following features:

  • Suddenness;
  • External discharge of scarlet blood;
  • No apparent external cause;
  • Painless;
  • Recurring (required!);
  • Suddenly stopping;
  • Often occurs at rest, especially at night

In connection with blood loss, another characteristic sign of placental presentation is anemia of varying severity.

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

All other signs of placenta previa are formed by emerging complications and are not permanent. For example, with the development of gestosis against the background of presentation, there will be increased blood pressure, proteinuria, edema... It is possible to detect a breech presentation, a transverse oblique position of the fetus. If it takes place feto-placental failure, then you can find the corresponding changes on the part of the fetus.

Diagnosis of placenta previa

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

At the same time, a very interesting phenomenon is observed, which is called "Migration of the placenta". The fact is that in the second trimester of pregnancy, placenta presenting can be seen about 10 times more often than before childbirth. It seems that during pregnancy, the placenta migrates upward. In fact, the place of primary attachment of the placenta does not change in any way, just the growth of the uterus in late pregnancy is observed due to a change in the size of its lower segment, and the growth of the placenta occurs upward, towards the parts of the uterus, richer in blood vessels.

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

Pregnancy with placenta previa

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

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

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

The course of labor with placenta previa

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

  • Emergency delivery performed only through a cesarean section. It is indicated if the pregnant woman has profuse bleeding, or the bleeding is repeated too often and leads to severe anemia. In this case, it makes no sense to prolong the pregnancy, as it can be dangerous for both the mother and the fetus.
  • In a planned manner delivery is most often also done by caesarean section. The indications for him are:
  1. Complete placenta previa;
  2. Incomplete placental presentation, if concomitant complications still occur in parallel:
  • A scar on the uterus;
  • Transverse or oblique position of the fetus;
  • Breech presentation;
  • Multiple pregnancy;
  • Narrow pelvis;
  • The age of primipara is over 30 years old.

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

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

For a successful delivery through the vaginal birth canal, a very favorable combination of many circumstances is necessary: ​​head presentation, good labor, mature cervix, stopping bleeding after opening the fetal bladder. This is why caesarean section is the most popular method for placenta previa.

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

Prevention of the occurrence of this complication- this is

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

The placenta is an organ that appears only during pregnancy, which connects the organisms of the mother and the embryo. Through the placenta, vitamins, nutrients and oxygen are supplied to the child from the mother's body. Through the placenta, toxins and decay products are released from the fetus. The organ completes its formation at 16 weeks of gestation, but continues to increase until 36 weeks, since the need for an actively developing embryo for oxygen and nutrition is constantly increasing. The placenta, like any organ, can develop with pathologies. A common deviation is the low location of the placenta.

How the placenta is formed

Before conception, in the middle days of the menstrual cycle, a corpus luteum forms in a woman's ovary - a gland that regulates the synthesis of progesterone, helps the endometrium prepare for the introduction of an egg, and supports pregnancy. A temporary gland is formed from a follicle from which a mature egg has emerged into the fallopian tube.

Further, the existence of the corpus luteum is determined by whether fertilization has occurred or not. An unfertilized egg leaves the body with menstrual blood, and the corpus luteum slowly shrinks until it disappears completely. If conception occurs, then the corpus luteum continues to exist for about four months until the placenta is fully formed.

But how and why is the placenta formed? The organ begins to develop when the ovum attaches to the endometrium. The implanted egg breaks into two structures: the embryo itself is formed from one cluster of cells, the placenta is formed from the second. Interestingly, the placenta develops from the male part of the egg's genetic material.

The formation of the placenta is completed by the 16th week of pregnancy. The fully formed organ begins to synthesize progesterone, replacing the corpus luteum. Also, the placenta is a reliable gateway between the mother's body and the embryo. It prevents toxins, medication particles and other harmful compounds from entering the child's body. Metabolism between mother and fetus is also carried out by the placenta. Therefore, the placenta is one of the most important organs for the normal course of pregnancy.

What is low placenta during pregnancy

For those who have not encountered such a problem, it is difficult to understand what a "low placenta previa" is. Despite this, most women give birth on their own, without endangering the child and themselves.

The embryo that enters the uterine cavity through the fallopian tube is attached as close as possible to the uterine fundus, pressing against the walls of the organ. Over time, a placenta appears around the embryo.

Low location of the placenta - the distance from the placenta to the uterine outlet is less than 6 cm.

In medical practice, there is one more concept that you should know. We are talking about placenta previa, which is a placenta strongly lowered to the bottom of the uterus, blocking the exit.

Types of placenta location

The placenta should normally be located on the back of the uterus, near the bottom. But it must be borne in mind that the uterus is an inverse structure, therefore its bottom is on top. But the placenta is not ideally located in all cases. Sometimes the placenta is placed on the anterior wall of the uterus, which is harmless.

But low placenta previa is dangerous. The low-lying placenta is strongly compressed by the embryo, therefore, it can be injured or exfoliated due to the slightest external influence. And in the later months of pregnancy, a wiggling and pushing baby often touches the placenta and squeezes the umbilical cord.

The low location of the placenta is also bad due to the fact that the lower part of the uterus is not saturated with blood as actively as its bottom. As a result, the embryo develops hypoxia - oxygen starvation.

If the low placenta during pregnancy is located in the back of the uterus, then the problem can correct itself: the placenta will move to a higher place. The anterior wall is intensively stretched, the placenta attached to it is also able to move, but not up, but to the lower section, blocking the cervix. But the most dangerous pathology in pregnant women is complete or incomplete placenta previa.

Causes of the low location of the placenta

A variety of factors provoke a low location of the placenta. Often the causes of pathology are injuries to the mucous membranes of the uterus, which appeared after inflammatory reactions, infectious diseases, miscarriages and surgical abortions. Sometimes the fertilized egg cannot attach to the upper part of the uterus if the woman has previously undergone surgery on the uterus or a cesarean section.

The placenta can be located low if the uterus is improperly developed or underdeveloped, has a pathological form. Sometimes a low placenta previa is noted when carrying several fetuses.

Rarely are primiparas with low diligence, often it occurs after the second or each subsequent birth. It's all to blame for the changes that have occurred with the genitals. The more of these changes, the more problematic the pregnancy is. Also, a low placenta during pregnancy is formed due to the following factors:

  1. the age of the woman in labor is over 30 years old;
  2. separation of the placenta in previous births was performed by doctors;
  3. multiple pregnancy;
  4. moxibustion erosion, abortion, cesarean;
  5. benign neoplasms;
  6. genital infantilism;
  7. inflammation of the pelvic organs;
  8. problems with the work of the kidneys and liver, intoxication.

Symptoms of the low location of the placenta

Usually, low placenta previa does not show any symptoms. In rare cases, there is a pulling pain in the lower abdomen, bleeding opens. But these are signs of not just low placement, but already detachment of the placenta.

To find out if there is a low location of the placenta, it is possible only through ultrasound monitoring. Therefore, an ultrasound scan is an important and mandatory procedure for pregnant women.

The formed placenta, which does not overlap the internal uterine pharynx, does not cause discomfort to the expectant mother. About such as low placenta previa, the pregnant woman learns only at the last examination.

In 1 out of 10 women in labor, this condition can adversely affect pregnancy, there is a sharp deterioration in well-being, there are:

  • bloody issues;
  • lower abdominal pain;
  • low pressure.

Low placentation treatment

Low placenta during pregnancy is not treated with medications. Usually, one can only hope that the placenta will independently move to the optimal place. This is an expected and likely outcome.

At 19 - 20 weeks, pregnant women undergo a planned ultrasound scan, which confirms or refutes the low location of the placenta. With the growth of the uterus, the placenta rises higher, therefore, in many cases, the placenta takes the correct position closer to childbirth.

Low placenta previa at week 20 is not a verdict yet. The pregnant woman learns about this fact only on an ultrasound scan, without feeling the symbolic symptoms.

In many expectant mothers, the placenta gradually rises to the upper part of the uterus over time. But not everyone is so lucky. In some women in labor, the diagnosis of a low location of the placenta persists until the very birth.

What to do when diagnosed with low placenta during pregnancy? The first step is to give up intimate relationships and minimize physical activity. A woman should not carry weights, play sports, strain her stomach.

If bleeding occurs, you should immediately consult a doctor. While the pregnancy lasts, the doctor closely monitors the condition of the patient's placenta. The expectant mother should visit all ultrasound examinations prescribed by the doctor in a timely manner. In most cases, in the third trimester of pregnancy, low placenta previa disappears on its own.

Childbirth with a low placenta

The low location of the placenta is a dangerous condition for a pregnant woman. But how can pathology affect childbirth? The degree of danger depends on where the placenta is located. Many women diagnosed with low placenta previa give birth naturally.

If the placenta is placed near the opening of the uterus, the amniotic sac will likely need to be punctured. In this situation, the child presses the placenta against the uterus with his head. If the fetus is in the wrong position in the uterus or when the placenta previa, the expectant mother must be assigned a cesarean section.

The location of the placenta less than 5 cm from the internal os is considered a signal for a caesarean section.

If at 20 weeks ultrasound shows a low location of the placenta, then doctors recommend wearing a bandage.

Doctors say that up to 38 weeks, this fact is not considered a pathological condition, however, with a low location of the placenta, it is possible, even necessary, to fulfill a number of requirements:

  1. observe hygiene;
  2. visit a doctor in a timely manner, take tests, do an ultrasound;
  3. rest more, do not take long walks;
  4. do not bend over.

Even if you have mild lower abdominal pain and bloody discharge, it is important to go to the hospital as soon as possible.

What is the danger and how is childbirth going

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

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

Important differences

It is worth clearly distinguishing between the low location of the placenta during pregnancy (low placentation) and placenta previa.

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

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

With a low location of the placenta, in contrast to presentation, the tissue of the placenta never comes into contact with the cervix and, even under the most unfavorable circumstances, does not interfere with the normal course of the act of natural childbirth.

Causes of occurrence

Gynecologists note that the probability of establishing a diagnosis of low placentation is the greater, the shorter the gestational age. It has been proven that the placenta has a unique ability to migrate.

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

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

The reasons for placenta previa are:

  • various inflammatory processes affecting the mucous membrane of the body of the uterus - much more often this condition is observed with repeated pregnancies (and those that ended with an interruption at an early stage, and complicated by purulent inflammation of the uterus in the postpartum period);
  • surgical procedures affecting the uterine mucosa - diagnostic curettage (even performed if indicated), abortion, medical hysteroscopy, during which polypectomy was performed;
  • neoplasms of the uterus - polyps, fibroids, fibroids, especially when they reach significant sizes;
  • multiple pregnancy;
  • malformations of the uterus - saddle deformity, two-horned uterus.

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

How is the low location of the placenta manifested and what threatens

Until the moment when the placenta, as it develops, reaches the internal uterine pharynx, there may be no clinical manifestations of this condition - the pregnant woman has no complaints at all, and low placentation is diagnosed only during an ultrasound examination.

It is for the timely detection of pregnancy complications, including for detecting the peculiarities of the location of the placenta, that each pregnant woman should during the waiting time for the child visit three compulsory ultrasounds(at 11-12 weeks, at 20-21 or 22-24 weeks, at 32-33 weeks of normal pregnancy).

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

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

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

If a low attachment of the placenta is found, it is necessary limiting physical activity on a pregnant woman- any work related to weight lifting is prohibited (if necessary, a corresponding conclusion of the VKK is issued for transfer to light labor), it is recommended to reduce physical activity and limit sexual activity until the threat of termination of pregnancy disappears.

How is childbirth going?

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

If the low placentation disappears, and the woman does not have any other indications for operative delivery through a cesarean section, then there is no need to refuse giving birth through the vaginal birth canal.