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Transverse placenta. Partial, low and central placenta previa. Marginal placenta previa

A variant of placement of placental tissue, in which it completely covers the internal os of the uterus. It is manifested by painless bleeding of varying intensity, occurring mainly in the second half of the gestational period. In the diagnosis, transvaginal ultrasound is used, less often - MRI and vaginal examination. The only possible way of delivery is to perform a caesarean section. With signs of fetal immaturity and stopped bleeding, infusion and antianemic therapy, tocolytics, hemostatics, antiplatelet agents, and glucocorticosteroids are recommended.

General information

The frequency of complete (central) placenta previa is about 0.08% of all pregnancies. Pathology is three times more common in patients giving birth again, in women aged 35 years and over. According to domestic statistics, complete presentation of placental tissue is observed in 0.03-0.11% of births. Over the past decades, this obstetric pathology has become more common, which is presumably associated with an increased number of intrauterine interventions and abortions. Since with central presentation the risk of fetal death reaches 17-26%, the main task of specialists is the timely detection of anomalies and the choice of optimal tactics for managing a pregnant woman.

Causes of complete placenta previa

Atypical localization of the placenta occurs when it is impossible to implant the fetal egg in the right place. There are two groups of reasons for which the likelihood of complete presentation increases:

  • Uterine factors. Placentation conditions are violated with endometrial dystrophy, cicatricial changes and poor vascularization of the uterine wall. Similar pathological conditions arise due to chronic and postpartum endometritis, due to frequent abortions and other invasive procedures, in the presence of a post-traumatic or postoperative scar (after rupture, conservative exfoliation of the myomatous node, etc.).
  • Fetal Factors. Nidation with overlapping of the pharynx can be provoked by low activity of proteases of the fetal egg. This situation is usually due to erythroblastosis of the fetus and a delay in the development of the embryo due to chromosomal aberrations or hormonal imbalance.

Complete placenta previa is more often diagnosed with multiple pregnancies, in women over 35 years of age, pregnant women with frequent births, uterine hypoplasia, bicornuate or saddle uterus. The likelihood of atypical localization of the placenta increases with a similar problem in the past, smoking, using certain drugs (eg, cocaine).

Pathogenesis

Taking into account the site of primary nidation of the fetal egg, specialists in the field of obstetrics and gynecology consider two mechanisms for the formation of placenta previa. In primary isthmic placenta, due to gross morphological changes in the uterine wall or an insufficient level of proteases, a fertilized egg is initially introduced into the endometrium in the isthmus. With a secondary isthmic placenta, implantation occurs at the bottom of the uterus and only then spreads to the pharynx. At the same time, villi are partially preserved in the decidua capsularis area, and a branched rather than smooth chorion is formed. The further clinical picture is due to the inability of the placental tissue to stretch and the occurrence of bleeding due to the opening of the intervillous spaces during the exfoliation of the placenta from the uterine wall.

Classification

Full presentation corresponds to III and IV degrees of atypical location of the placenta according to the results of an echographic study. Taking into account the peculiarities of the location of the placental tissue in the area of ​​​​the uterine pharynx, two types of complete presentation are distinguished:

  • Asymmetrical. At the III degree of presentation (according to ultrasound data), the placenta enters the opposite side of the lower segment, and most of it is located on one of the walls - either anterior or posterior.
  • symmetrical. At IV degree, the central part of the placenta overlaps the uterine os, its tissues are symmetrically located on the walls of the uterine cavity.

Symptoms of complete placenta previa

A typical sign of overlapping of the uterine os with placental tissue is a painless bright scarlet discharge from the vagina that appears from the second trimester. According to the results of observations, in about a third of pregnant women with full presentation, bleeding begins before 30 weeks, in a third - at 33-34 and in the remaining third - from 36. Discharges have different intensities, appear spontaneously at rest or against the background of physical exertion or uterine hypertonicity. In most patients, before the onset of labor, such bleeding occurs repeatedly and stops on its own. In every fifth woman, the appearance of bleeding is accompanied by a clinic of premature termination of pregnancy - acute cramping pain in the lower abdomen and increased uterine tone.

Complications

The most formidable complication of complete placenta previa is its detachment with profuse obstetric bleeding, which is often accompanied by the loss of a child and is a threat to the life of a pregnant woman. Significant blood loss is sometimes complicated by hypovolemic shock, DIC, renal tubular and pituitary necrosis. Constant blood loss during spontaneous bleeding leads to anemia, placental insufficiency and intrauterine fetal hypoxia. In addition, in such patients, the likelihood of placental accreta, pathological transverse and oblique position of the child, premature rupture of the amniotic sac and the onset of labor, and weakness of labor force increases.

Diagnostics

Treatment of complete placenta previa

There are no conservative or operative methods for changing the location of the placenta. Natural childbirth with full presentation is impossible, delivery is carried out by caesarean section. Obstetric tactics are aimed at reducing the risk of preterm birth and the rapid removal of the fetus in case of a threat of massive bleeding. A patient with suspected complete placenta previa is subject to urgent hospitalization. If the fetus is premature, there is no labor activity, and spotting has stopped, expectant conservative management is possible. The pregnant woman is transferred to full bed rest with the exclusion of any physical activity. After the transferred blood loss are shown:

  • Infusion therapy. The appointment of physiological and colloidal solutions allows you to restore the volume of circulating blood and improve its rheological characteristics.
  • Antianemic agents. The choice of drug is determined by the severity of anemia. To maintain the recommended level of hemoglobin (from 100 g / l), in mild cases, iron-containing agents are used, with significant blood loss - a transfusion of blood or its components.
  • Drugs that improve hemostasis and microcirculation. If bleeding is combined with a violation of the blood coagulation function, the pregnant woman is injected with fresh frozen plasma, platelet mass, antiplatelet agents.
  • Tocolytics. Means to reduce hypertonicity of the myometrium are prescribed with caution. With a stable condition and preserved kidney function, magnesium sulfate is most often used.
  • Glucocorticosteroids. Shown in high doses at risk of respiratory distress syndrome in the newborn. In premature pregnancy, the maturation of the lungs is accelerated.

With persistent bleeding, which poses a threat to the pregnant woman, an urgent caesarean section is performed. A planned intervention is carried out at a gestational age of 36-37 weeks, if the fetal weight exceeds 2500 g and there are signs of the maturity of its lung tissue. The access and volume of the operation is determined by the location and depth of the placenta. The incision is made corporally or in the lower uterine segment. With heavy incessant bleeding, after the removal of the child, uterotonic agents are administered, mattress or tightening sutures are applied to the tissues of the uterus. If there is no effect, ligate the uterine, ovarian and internal iliac arteries. In extreme cases and with a true increment of the placenta, the uterus is extirpated. In the postoperative period, antibacterial agents are mandatory.

Forecast and prevention

The prognosis depends on the timeliness of detection of pathology and the validity of medical tactics. Maternal mortality rates in pregnant women with a complete placenta previa are close to zero, but these women usually experience increased blood loss during surgery. The level of perinatal mortality reaches 10-25%, the main cause of death of children is their prematurity. Taking into account the established risk factors, for the purpose of primary prevention, timely treatment of infectious and inflammatory diseases of the female genital area, pregnancy planning with the rejection of abortions, unreasonable invasive procedures (diagnostic curettage, conservative myomectomy, etc.) are recommended. For the prevention of complications, early registration with an obstetrician-gynecologist and ultrasound at the recommended time are important.

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

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

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

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

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

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

Types of placenta previa and their characteristics

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

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

Complete placenta previa

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

Incomplete (partial) placenta previa

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

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

Low (inferior) placenta previa

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

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

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

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

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

Central placenta previa

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

Lateral placenta previa

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

Marginal placenta previa

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

Posterior placenta previa (placenta previa on the posterior wall)

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

Anterior placenta previa (placenta previa on the anterior wall)

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

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

Placenta previa - causes

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

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

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

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

  • Any surgical interventions on the uterus in the past (abortions, caesarean sections, removal of fibroids, etc.);
  • Childbirth that proceeded with complications;
  • Anomalies in the structure of the uterus;
  • Underdevelopment of the uterus;
  • Isthmic-cervical insufficiency;
  • Multiple pregnancy (twins, triplets, etc.);
  • Endocervicitis.
Due to the fact that most of the causes of placenta previa appear in women who have undergone any gynecological diseases, surgical interventions or childbirth, this complication in 2/3 of cases is observed in re-pregnant women. That is, women who are pregnant for the first time account for only 1/3 of all cases of placenta previa.

For fruitful reasons placenta previa include the following factors:

  • Inflammatory diseases of the genital organs (adnexitis, salpingitis, hydrosalpinx, etc.);
Considering the listed possible causes of placenta previa, the following women are included in the risk group for the development of this pathology:
  • Burdened obstetric history (abortions, diagnostic curettage, difficult births in the past);
  • Transferred in the past any surgical interventions on the uterus;
  • Neuro-endocrine disorders of the regulation of menstrual function;
  • Underdevelopment of the genital organs;
  • Inflammatory diseases of the genital organs;
  • uterine fibroids;
  • endometriosis;
  • Pathology of the cervix.

Diagnosis of placenta previa

Diagnosis of placenta previa may be based on characteristic clinical manifestations or on the results of objective studies (ultrasound and bimanual vaginal examination). Signs of placenta previa are as follows:
  • Bloody discharge from the genital tract of a bright scarlet color with a completely painless and relaxed uterus;
  • High standing of the bottom of the uterus (the indicator is greater than that which is typical for a given period of pregnancy);
  • Incorrect position of the fetus in the uterus (breech presentation of the fetus or transverse position);
  • The noise of blood flow through the vessels of the placenta, clearly distinguishable by the doctor during auscultation (listening) of the lower segment of the uterus.
If a woman has any of the listed symptoms, then the doctor suspects placenta previa. In such a situation, a vaginal examination is not performed, since it can provoke bleeding and premature birth. To confirm the preliminary diagnosis of placenta previa, the gynecologist sends the pregnant woman to an ultrasound scan. Transvaginal ultrasound allows you to accurately determine whether a given woman has placenta previa, as well as to assess the degree of overlap of the uterine os, which is important for determining the tactics of further pregnancy management and choosing a method of delivery. Currently, it is ultrasound that is the main method for diagnosing placenta previa, due to its high information content and safety.

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

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

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

ultrasound diagnostics

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

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

Placenta previa - symptoms

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

Bleeding with placenta previa

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

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

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

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

  • Sudden, profuse and painless bleeding, often occurring at night, when a woman wakes up literally "in a pool of blood" is characteristic of complete placenta previa. Such bleeding may stop as suddenly as it began, or it may continue in the form of a scanty discharge.
  • The onset of bleeding in the last days of pregnancy or in childbirth is characteristic of incomplete placenta previa.
The intensity of bleeding and the amount of blood loss does not depend on the degree of placenta previa. In addition, bleeding with placenta previa can be not only a symptom of pathology, but also become its complication if it does not stop for a long time.

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

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

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

What threatens placenta previa - possible complications

Placenta previa can threaten the development of the following complications:
  • The threat of termination of pregnancy;
  • Iron-deficiency anemia;
  • Incorrect location of the fetus in the uterus (oblique or transverse);
  • Breech or foot presentation of the fetus;
  • Chronic fetal hypoxia;
  • Delayed fetal development;
  • Fetoplacental insufficiency.
The threat of abortion is due to recurrent episodes of placental abruption, which provokes fetal hypoxia and bleeding. Complete placenta previa most often ends in premature birth.

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

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

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

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

Placenta previa - principles of treatment

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

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

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

  • Tocolytic and antispasmodic drugs that improve the stretching of the lower segment of the uterus (for example, Ginipral, No-shpa, Papaverine, etc.);
  • Iron preparations for the treatment of anemia (for example, Sorbifer Durules, Ferrum Lek, Tardiferon, Totem, etc.);
  • Drugs to improve the blood supply to the fetus (Ascorutin, Curantil, Vitamin E, folic acid, Trental, etc.).
The most common conservative treatment for placenta previa due to light bleeding consists of a combination of the following drugs:
  • Intramuscular injection of 20 - 25% magnesia, 10 ml;
  • Magne B6 2 tablets twice a day;
  • No-shpa 1 tablet three times a day;
  • Partusisten 5 mg four times a day;
  • Sorbifer or Tardiferon 1 tablet twice a day;
  • Vitamin E and folic acid 1 tablet three times a day.
A woman will have to take these drugs throughout her pregnancy. When bleeding occurs, it is necessary to call an ambulance or get to the maternity hospital on your own and be hospitalized in the department of pathology of pregnant women. In the hospital, No-shpu and Partusisten (or Ginipral) will be administered intravenously in large doses in order to achieve the effect of strong relaxation of the muscles of the uterus and good stretching of its lower segment. In the future, the woman will again be transferred to tablet forms, which are taken in smaller, supportive dosages.

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

  • Trental is given intravenously or taken as a tablet;
  • Curantyl take 25 mg 2-3 times a day one hour before meals;
  • Vitamin E take 1 tablet per day;
  • Vitamin C take 0.1 - 0.3 g three times a day;
  • Cocarboxylase is administered intravenously at a dose of 0.1 g in a glucose solution;
  • Folic acid is taken orally at 400 mcg per day;
  • Actovegin take 1 - 2 tablets per day;
  • Glucose is administered intravenously.
Therapy for placental insufficiency is carried out in courses throughout pregnancy. If the use of these funds can prolong the pregnancy up to 36 weeks, then the woman is hospitalized in the antenatal ward and the method of delivery is chosen (caesarean section or natural childbirth).

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

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

Childbirth with placenta previa

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

Caesarean section with placenta previa

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

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

Childbirth through natural ways

Childbirth through natural routes with placenta previa can be carried out in the following cases:
  • Absence of bleeding or its stop after opening the fetal bladder;
  • Ready for childbirth cervix;
  • Regular contractions of sufficient strength;
  • Head presentation of the fetus.
At the same time, they wait for the independent onset of labor without the use of stimulant drugs. In childbirth, the fetal bladder is opened when the cervix is ​​dilated by 1–2 cm. If, after opening the fetal bladder, bleeding develops or does not stop, then an emergency caesarean section is performed. If there is no bleeding, then childbirth continues naturally. But with the development of bleeding, an emergency caesarean section is always performed.

Sex and placenta previa

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

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

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

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

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

Placenta previa during pregnancy: types of pathology and their characteristics

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

Types of presentation according to the results of ultrasound

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

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

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

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

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

Reasons for the development of placenta previa

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

Uterine factors in the development of placenta previa

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

Uterine factors include:

  1. Surgical intervention in the uterine cavity.
  2. Difficult childbirth.
  3. Benign tumor in the uterus.
  4. Endometriosis.
  5. Underdeveloped uterus.
  6. Congenital anomalies in the structure of the uterus.
  7. Pregnancy with twins or triplets.
  8. Isthmic-cervical insufficiency.
  9. Inflammation of the cervical canal.

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

Fetal factors of placenta previa

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

Among the fetal factors, we note:

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

Indicators of placenta previa during pregnancy

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

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

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

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

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

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

What is dangerous placenta previa during pregnancy

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

  1. Miscarriage.
  2. Severe toxicity.
  3. Anemia.
  4. Pathological location of the fetus in the uterus (pelvic or foot).
  5. Chronic oxygen starvation of the fetus.
  6. Slowed rates of intrauterine development of the child.
  7. Fetoplacental insufficiency.

Treatment of placenta previa during pregnancy

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Placenta previa during pregnancy and sexual life

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

Placenta previa during pregnancy: reviews

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

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

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

The placenta is the connection between the child and the mother, it is through it that the fetus receives nutrition and oxygen from the mother's body, giving, in turn, metabolic products.

The condition of the placenta directly determines how correctly the pregnancy will develop, and in some cases, the life of the fetus. Therefore, when placenta previa is diagnosed in a pregnant woman, doctors closely monitor her.

1. Presentation on the anterior wall. This is more likely not a diagnosis, but simply a statement of fact and it is not at all necessary that some complications will follow, although the risk of their development cannot be completely ruled out. Ideally, the placenta should be located on the back wall of the uterus, since it is in this place that the uterus is the least susceptible to changes during pregnancy.

The anterior wall is intensively stretched, thinned, which can lead to placental abruption or its further displacement to the uterine os.

2. Lower placenta previa. Normally, the placenta is located at the bottom of the uterus. We know that the uterine fundus is on top, therefore, the pharynx is on the bottom. With a low location of the placenta (low placentation) - it is attached closer to the pharynx, not reaching it by less than 6 cm.

In this case, 2 scenarios are possible: either the placenta will drop even more, and it will be possible to talk about full or partial presentation, or it will rise up to the bottom along with the walls of the uterus increasing in size. With low placentation, as a rule, natural childbirth takes place without problems.

3. Incomplete (partial) placenta previa. There are two types of this presentation: lateral and marginal. With lateral presentation, the placenta covers the internal os (exit from the body of the uterus into the cervix) by 2/3. At the edge - by 1/3. Don't panic if you've been diagnosed with a partial presentation.

Very often, the placenta moves into its correct position before delivery. It is highly likely that childbirth is successful naturally, but everything is decided individually in each case.

4. Full (central) presentation. The most severe case of abnormal location of the placenta. The placental tissue completely covers the uterine os, that is, the child simply cannot enter the birth canal. In addition, the pathology is also dangerous for the life of the mother, since the pharynx is the most extensible part of the uterus, which cannot be said about the placenta.

The uterus increases in size and there is a detachment of the placental tissue, which cannot be stretched as effectively and quickly. The integrity of the vessels is violated, which leads to severe bleeding, which, with complete placenta previa, can begin as early as the second trimester and disturb the woman until the very birth. Childbirth is possible only by caesarean section.

Causes of placenta previa

The main reason is a violation of the integrity of the endometrium - the mucous layer of the uterus. A fertilized egg cannot attach in the most suitable place for this - at the bottom. It is there that the uterus stretches the least and can provide a high-quality metabolism between the mother and the fetus due to good blood supply.

However, due to diseases of the cardiovascular or other systems of the mother's body, fundus blood supply can be broken, and the ovum goes to look for a more suitable place for implantation.

Also, it will not be able to attach if there are scars and other endometrial damage. Usually, such deformities appear as a result of gynecological curettage, for example, during an abortion.

But the problem may not only be in the reproductive system of the mother. When underdevelopment fertilized egg, it may not reach the bottom of the uterus, attaching immediately after entering it - in the area of ​​\u200b\u200bthe internal pharynx.

Symptoms and complications

The main symptom and complication at the same time is bleeding. It is caused by placental abruption: some area of ​​the placenta "breaks away" from the uterus, damaging the vessels. It is noteworthy that with low placentation, bleeding is internal, expressed as a hematoma. In all other cases, it is vaginal bleeding.

With partial placenta previa, bleeding begins in late pregnancy, with full - from the second trimester. In addition to the growth of the uterus itself, active physical activity, sex, gynecological examination and uterine tone can provoke bleeding.

As a result of regular, heavy bleeding, a woman may develop hypotension- stable low blood pressure, and anemia- low hemoglobin level. Therefore, pregnant women with presentation should be under the supervision of doctors and constantly undergo examinations. With bleeding and complete placenta previa, after 24 weeks, the woman is placed in a hospital, where she receives supportive treatment.

In some, fortunately rare, cases, placenta previa leads to fetal death.

Treatment of placenta previa

There is no medical treatment for the placenta. Doctors can not roll on this pathology. The only way out of the situation is to observe the pregnant woman, try to eliminate concomitant diseases, since any negative factor can worsen the condition, neutralize bleeding, relieve uterine tone.

Often, with placenta previa, especially central, complicated by bleeding, strict bed rest is prescribed in a hospital setting.

Childbirth with placenta previa

The main danger in childbirth is placenta previa because during contractions the placenta can completely exfoliate, and this will lead to acute fetal hypoxia, bleeding that threatens the life of the mother and the need for emergency operative delivery.

As mentioned above, natural childbirth with a low presentation is practically not a concern. With incomplete presentation - each case is considered individually. Central placenta previa is always a caesarean section at 38 weeks.

In addition, there is a possibility postpartum complications ie the onset of bleeding. If the bleeding cannot be stopped, the uterus is removed, but these are isolated very severe cases when the life of the mother is at stake.

How to behave pregnant with placenta previa

An expectant mother diagnosed with placenta previa should protect herself from physical and emotional stress. It is necessary to exclude sudden movements, stress, overwork. Of course, this is not easy, given our rhythm of life, but the life of her child depends on it.

A woman needs good sleep, daytime rest, fresh air and emotional peace. It would be useful to revise your diet by adding iron-rich foods to it. For those who are concerned about frequent bleeding, this is a must. In addition, constipation should not be allowed.

Placenta previa is a rather serious pathology that cannot but cause anxiety in the expectant mother. But she simply must pull herself together and carefully take care of herself and her baby. Moreover, today the vast majority of pregnancies complicated by presentation are easily tolerated thanks to medical care, and end in successful delivery.

I like!

Low placentation during pregnancy is a serious complication that requires constant monitoring of the woman and emergency care if necessary.

The placenta is a temporary organ that forms by the second week of pregnancy, woven from the vessels of the mother and fetus. It attaches to the wall of the uterus, grows, develops and reaches maturity. Organ functions:

  • saturation of the child's blood with oxygen and the removal of carbon dioxide;
  • delivery of nutrients to the fetus and removal of waste products;
  • the synthesis of hormones necessary for the normal development of pregnancy and preparing the female breast for milk production;
  • immune defense of the baby in the womb.

The attachment of the placenta to the back or side wall of the uterus is considered the norm. But if it is too low, problems can begin.

Low placenta previa is an anomaly of the course of pregnancy. It is characterized by fastening in the lower part of the uterus, which completely or slightly covers the internal pharynx. This means that complications are possible during childbearing and childbirth.

Schematic representation of the problem

The condition often resolves spontaneously when the upper sections of the uterus are displaced. This phenomenon is called placental migration. But in general, the risk of fetal death is quite high: from 7 to 25%.

The cause of death of the baby can be acute hypoxia due to insufficient placental blood supply or premature birth.

This pathology is also dangerous for a pregnant woman. Bleeding that occurs with placenta previa causes death in 1-3% of women.

The exact place of attachment allows you to find out the ultrasound in the 3rd trimester. Normally, the location of the organ is located at a distance of 5 or more centimeters from the internal os of the uterus.

Causes

Most of the causes of low placentation are due to diseases and conditions that occurred before pregnancy.

What causes the deviation:

  • inflammatory and infectious processes in the genitals;
  • damage to the mucous membrane of the uterus;
  • miscarriages or abortions in the past;
  • gynecological interventions;
  • multiple pregnancy. Women with twins or triplets are automatically at risk;
  • childbirth by caesarean section;
  • fibroids, endometritis and other diseases of the uterus;
  • smoking, excessive alcohol consumption;
  • many births;
  • anomalies in the structure and development, the work of the uterus;
  • the woman's age is over 35 years.

The most common cause of low presentation is past curettage of the uterus. The procedure damages the mucous membrane, which prevents the fetal egg from attaching to the upper part of the organ.

See a doctor

The insidiousness of deviation is that it practically does not manifest itself. Symptoms appear already at an advanced stage, when irreversible processes take place in the body, for example, exfoliation. These signs:

  • heaviness in the lower abdomen, pulling pains;
  • bloody issues. When they appear, you need to call an ambulance;
  • death of the fetus in the womb or its excessive activity due to hypoxia - lack of oxygen;
  • severe toxicosis - 30% of women with this diagnosis suffer from it;
  • in about half of the cases of pathology on ultrasound, a breech presentation of the fetus is detected.

The pregnant woman herself cannot suspect an anomaly in herself until vivid symptoms appear. The condition is monitored on planned ultrasounds. The study allows not only to identify the problem, but to determine its degree and severity.

Types of low presentation depending on the localization of the placenta:

  • back. This arrangement of the body is the most prosperous option. In most cases, in the later stages, the child's place moves up, freeing the birth canal. Pregnancy proceeds relatively comfortably;
  • front. In this case, you need to prepare for difficulties. If the baby is large and active, it will put pressure on the placenta. This will cause problems with the umbilical cord, the risk of entanglement and clamping. Such a presentation rarely changes for childbirth, which means that the birth canal will not be free;
  • complete or partial, when the organ obscures the cervix of the uterus. Deviation requires great care. It is important to discuss all the details with the doctor before giving birth and prepare that you will have to give birth by caesarean section.

What to do

Diagnosis with low placentation allows you to determine how dangerous this condition is for the pregnant woman and the child. Held:

  • analysis of symptoms: discharge, abdominal pain;
  • ultrasound is the main type of diagnostics, safe and informative. It is carried out at 12, 19-20 and 30 weeks;
  • bimanual examination of the vagina (provided there is no bleeding).

After confirming the diagnosis of "low placenta previa", the doctor prescribes treatment and makes recommendations to correct the situation. If desired and competent actions, the location of the organ can be changed.

If the pregnancy proceeds normally, and the period has not reached 35 weeks, the treatment is conservative. Strict bed rest, observation of the fetus and the intensity of bleeding are shown. Any loads, sexual contacts are forbidden.

There are no medications that raise the placenta. Prescribe medications that help improve the condition of the pregnant woman and contribute to the migration of the child's place. This:

  • tocolytics, antispasmodics - stimulate the stretching of the lower parts of the uterus;
  • agents that reduce the tone of the myometrium;
  • iron-containing preparations - are prescribed to women with bleeding to prevent iron deficiency anemia;
  • medicines that activate placental circulation - to avoid the development of hypoxia in the fetus;
  • magnesia, intravenous glucose, vitamins.

To prevent premature birth with low placentation, the drug Utrozhestan helps. To prevent respiratory disorders in the fetus during childbirth, glucocorticosteroids are prescribed.

If the presentation is partial, accompanied by mild bleeding, conservative treatment helps to save the child. But a woman should remember that with the slightest discharge and deterioration of health, an ambulance should be called immediately.

With severe bleeding, poor condition of the woman, pregnancy is interrupted for health reasons.

  • severe blood loss (more than 200 ml);
  • pressure drop, anemia;
  • full presentation together with the opened bleeding.

Snapshot of ultrasound analysis

The choice of method of delivery under the condition of term pregnancy depends on the indications. With full presentation, the cervix is ​​​​closed, so a caesarean section is performed. It is also carried out with:

  • placental abruption;
  • polyhydramnios;
  • wrong position of the baby;
  • scars on the uterus;
  • multiple pregnancy;
  • age after 30 years.

If the presentation is partial, natural childbirth is not excluded. But only under the condition that the child is head down, active labor and the maturity of the cervix. With sudden bleeding, a puncture of the fetal bladder is made. This helps to stop the bleeding and lead to a normal birth.

If the cervix is ​​not ready, the baby's head is small, a caesarean section is performed.

What is dangerous

Consequences can be dire

Low placenta previa during pregnancy is a condition that is dangerous for both the woman and the fetus. Among the unpleasant consequences:

  • the child can damage the placenta with active movements. This is especially true for later periods, when a large baby presses on the organ and is able to hook the placental membrane;
  • with low placentation, the cervix is ​​not intensively supplied with blood, which is fraught with the development of fetal hypoxia;
  • the anomaly threatens with complications in childbirth, since the child's place prevents the baby from leaving the womb;
  • insufficient placental circulation can cause increased fetal activity, which is fraught with entanglements and clamping of the umbilical cord;
  • placental abruption is a dangerous condition that leads to the death of the fetus, and sometimes the woman. With a complication, the stomach begins to hurt, bleeding appears;
  • in pregnant women with such a diagnosis, low blood pressure is often observed, late preeclampsia develops.

The organ is densely intertwined with blood vessels connected to the uterus. This ensures the placental blood exchange. And the blood carries vitamins, proteins, oxygen, hormones and other substances necessary for life to the fetus.

With a low presentation, the blood supply to the lower part of the uterus worsens. Consequently, the nutrition of the fetus with useful components is defective. This increases the risk of intrauterine growth retardation and hypoxia.

If placental insufficiency and deterioration of blood flow are diagnosed, maintenance therapy is prescribed to compensate for the lack of useful substances in the fetus.

That's what threatens low placentation. A child due to an anomaly can suffer at any stage of pregnancy. Caution and strict adherence to the doctor's recommendations will help protect him and yourself from complications.

When will rise

Low placental presentation is found at different times. At the same time, it is difficult to predict the consequences, and it is not known how long it will take to rise. Depending on the trimester of pregnancy, therapeutic actions to correct the pathology depend.

  • 1 trimester. The first planned ultrasound is performed at 12-13 weeks, at the same time an anomaly is detected. You should not worry in this period, since in 70% of cases the placenta rises by 20-21 weeks;
  • 2 trimester. By the time of twenty weeks, the placental circulation is improving, but with a low presentation, it is disturbed, especially if the fetus is large and presses on the organ from above. In this case, the gynecologist puts the pregnant woman in a hospital with strict adherence to bed rest and drug therapy. Usually, by 22-23 weeks, the baby's place rises up. If the situation does not change, the doctor gives the woman advice on lifestyle and continues to try to correct the situation;
  • 3rd trimester. Mostly by 32-34.5 weeks, the placenta shifts upward under the pressure of the growing uterus. Then the problem disappears. If during pregnancy she did not fall into place, at 36 weeks the issue of caesarean section is decided. This is especially important with full presentation.

The cause could be uterine scraping.

Depending on the trimester and the nature of the location of the placenta, different actions are taken to correct the anomaly. It is important for a woman to be patient and not panic.

In most cases, the placenta rises towards the end of pregnancy. If this did not happen, but the woman and the baby feel well, a caesarean section is performed.

What Not to Do

Pregnant women with low placentation should be constantly monitored by a doctor. If you strictly follow his recommendations, everything will be fine. And what not to do:

  • worry. Modern medicine successfully manages pregnant women with low placental attachment. In 90% of cases, a woman gives birth to a healthy baby. Moreover, 60% of births are carried out naturally, and only 40 - by caesarean section;
  • have sex. Sex at any time can damage the organ and lead to detachment. This only applies to women with low placenta previa;
  • play sports, do exercises on the press, lift weights, walk a lot. Decide what is more important, an active lifestyle or the health of the child;
  • do douching and any other vaginal manipulations so as not to harm the pregnancy;
  • worry, worry, be annoyed. This will lead to an unhealthy emotional atmosphere and aggravate the condition. Develop stress resistance;
  • ride public transport, visit places with a large crowd of people. There they can push, which will cause an even greater omission of the organ;
  • ignore the doctor's advice, do not lie down to save when necessary.

You must be patient


If the presentation is low, the woman is advised to place a pillow under her feet so that they are above body level. This will help the placenta to take the right place faster.

Low placentation is not a disease, but a special condition. The situation requires, first of all, not treatment, but correction. Much depends on the mood of the pregnant woman, her actions, how accurately they correspond to the advice of doctors.

Preventive measures will help to avoid anomalies. These include:

  • prevention of infectious and inflammatory diseases, their timely treatment;
  • maintaining a healthy lifestyle: proper nutrition, adherence to the regime of work and rest, not abuse of alcohol and tobacco;
  • protection against unwanted pregnancy so that there is no history of abortion;
  • carrying out a caesarean section only in cases where there are vital indications;
  • implementation of gynecological manipulations and operations in proven clinics by experienced doctors.