During pregnancy, a bond is established between the mother and the child - this is what the development of the placenta contributes to. What it is like and what pathologies of its structure can be, we will analyze together.

• Placenta(from Lat. placenta - flat cake) is a disc-shaped reproductive organ that forms during pregnancy and exists only during this period. It is formed from the chorion and fully matures by 12-16 weeks
• In the structure of the placenta, two surfaces are distinguished. One is located on the side of the fetus with the umbilical cord in the central part, and is called - fruit... The other is facing the wall of the uterus and is divided into 15-20 lobes, and is called - maternal... To prevent the mother's and baby's blood from mixing, these surfaces are separated by a barrier membrane

Placenta function:

1. Provides oxygen supply from mother to fetus
2. Promotes the absorption of nutrients
3. Eliminates carbon dioxide and other metabolic products
4. Prevents the entry of infections and pathogens
5. Transports immunoglobulins
6. Synthesizes hormones

Placental pathology is one of the serious complications of pregnancy. During an ultrasound examination in the first trimester, the doctor may diagnose an abnormal placenta previa, but since it has a migratory ability, subsequent ultrasound may not confirm the diagnosis.
Causes of violation and predisposition to it:

• abortion (s)
• inflammation in the uterus
• multiple pregnancy
• bad habits
• the age of the woman in labor is over 35 years old
• deformation of the uterine cavity (scar or fibroid)

Complete placenta previa

Complete placenta previa

Nature provides for the protection of the uterus from various infections, microbes, damage, etc., everything that contributes to normal development fetus. So, its lower part is blocked by the internal pharynx, from which the birth canal of the child begins. If the placenta completely blocked the pharynx, then in this case they speak of its full presentation. Childbirth is carried out artificially.

IMPORTANT: with the identification of such a pathology, the pregnant woman is sent for inpatient treatment.

Posterior placenta presentation

The laying of the placenta begins from the place of attachment of the ovum. And the breech presentation in this case is not only the norm, but the ideal place for the development of the embryo, laid down by nature. Such localization provides the best blood circulation and enrichment of the fetus with nutrients, prevents any traumatism, allows you to clearly listen to the heartbeat and movements of the child.

IMPORTANT: childbirth with this presentation is quick and without complications

Anterior placenta previa

Along with a favorable posterior placentation, the anterior one is more common. Such placenta previa is not a pathology, but only indicates possible risk placental abruption or displacement towards the pharynx. This is due to the greatest stress on it: due to an increase in the volume of the uterus, stretching of its walls, the growth of the fetus and its active movements, and other factors.

IMPORTANT: despite the possible risk, the pregnancy is going well and the birth is going well naturally.

Regional presentation- one of two types of partial anterior placentation. In this case, the placenta is located at the very edge of the uterine pharynx, partially overlapping it by 1/3.

IMPORTANT: not an obstacle to natural childbirth, but requires careful monitoring by obstetricians.

What does low placenta previa mean?

Low placentation is characterized by the location of the genital organ 6 cm from the internal pharynx. This is revealed during an ultrasound of the second trimester. But since the placenta has a migration ability, there is a great possibility that by the end of pregnancy it will take the correct position.

Causes of low placenta previa

Low presentation can be caused by:

• surgical interventions of a gynecological nature (abortion, cleaning, etc.)
• intrauterine inflammatory processes
• genital infections
• hormonal imbalance
• underdeveloped structure of the uterus
• pathology of the cervix
• multiple pregnancy

IMPORTANT: Low placentation is more common in multiparous.

Low placenta previa during pregnancy: symptoms

Chaotic, painless scarlet bleeding, which is observed from the 12th week of pregnancy, is a signal of low placentation. Exacerbation of hemorrhage is noted in the second trimester, which is associated with partial exfoliation of the placenta. Other signs that determine its violation, such as:

• the location of the fundus of the uterus above normal
• noise of blood flow in the vessels of the placenta
• the pelvic or transverse position of the fetus, the doctor will be able to diagnose during an ultrasound scan.

What is the threat of low placenta previa during pregnancy?

• With a low placentation, a woman has a lack of iron, which disrupts the synthesis of hemoglobin and leads to anemia, low blood pressure, a decrease in circulating blood volume and the possible development of DIC syndrome (violation of intravascular blood coagulation). With this pathology, there is a high risk of termination of pregnancy.
• Low placenta previa affects the physiological state of the child. It restricts adequate oxygen supply, causing hypoxia and developmental delay in the baby.

IMPORTANT: limit physical activity, intimate contact and sauna visits, because this provokes bleeding, thereby causing complications.

Low previa of the placenta on the back wall

The height of the internal os of the placenta is an indicator that the doctor focuses on during ultrasound examination. The location on the back wall, as already mentioned, is a favorable place, but at the same time, a low placenta previa can lead to the following complications:

1. Placental exfoliation and aging.
2. Placental insufficiency.
3. Premature birth.

Low placenta previa during childbirth

Childbirth, with low placentation, up to 80% of cases, is carried out artificially at 38 weeks. Indication for caesarean section along with placenta previa is the pelvic or transverse position of the fetus, a narrow pelvis, polyhydramnios, previous abortions or other surgical interventions, as well as persistent bleeding of more than 250 ml of their volume.
To give birth naturally the fetus should be in a cephalic presentation, contractions should be regular, the cervix should open every hour by 1 cm until full disclosure, and there should be no bleeding (minor ones are allowed). As soon as the cervix reaches the size of three fingers, the obstetrician pierces the fetal bladder to continue labor.

IMPORTANT: if the hemorrhage does not stop after piercing the bladder, an emergency caesarean section is performed.

Low marginal placenta previa

Low marginal presentation indicates that the placenta is located at the level of 6 cm from the pharynx, but does not go beyond its borders. The danger lies in early aging placenta, its detachment, circulatory disorders and the occurrence of hypoxia in a child during natural childbirth.
The methods of treatment are the same as for any pathology of placenta previa.

Sex and low placenta previa

Sex and any other type of sexual manipulation is contraindicated in placenta previa, because excitement and orgasm provokes uterine contraction, and its work leads to bleeding, placental abruption and premature birth.

Low placenta previa during pregnancy: treatment

Special treatment for low placentation is not required, and in principle does not exist, because she can only change her position herself. In this case, the pregnant woman can only contribute to this, observing all the recommendations of the doctors, namely:

1. Healthy sleep for at least 8 hours.
2. A minimum of physical activity.
3. Walks in the open air.
4. Sexual rest.
5. Wearing a bandage.
6. Diet nutrition.

If, after 24 weeks of pregnancy, a woman periodically experiences bleeding, then she is sent to a hospital without fail.
Depending on the strength and abundance of bleeding, the duration of pregnancy and the general health of the mother and fetus, appropriate treatment is carried out.

To do this, use:

1. Drugs with tocolytic and antispasmodic properties, such as No-shpa, Papaverine, Ginipral
2. Iron-containing preparations for the treatment of anemia - Totema, Sorbifer
3. Drugs that improve blood microcirculation - Curantil, folic acid, Vitamin E

Along with treatment, the pregnant woman should eat foods that contain the elements necessary for her.
Low placenta previa diet includes:

• iron-fortified foods (oatmeal, buckwheat, beef, liver, nuts, etc.)
• foods containing protein
• fiber-rich vegetables and fruits (for stool normalization)
• multivitamins

IMPORTANT: taking laxatives is contraindicated!

In most cases, with pathology of the placenta, healthy children are born. Do not worry and fear again. The right decision will - comply with all the recommendations of doctors and not expose your health to any risk. Get more rest and breathe fresh air!

Video. Low placentation during pregnancy

But the diagnosis of "placenta previa" is not a reason for panic - it only means that expectant mother you need to take care of yourself and not neglect the doctor's recommendations.

In the normal course of pregnancy, the placenta (an organ that provides blood, and with it oxygen and nutrients to the fetus) is usually located in the bottom (upper part of the uterus) or on the walls of the uterus, often along the back wall, with a transition to the side walls, those. in areas where the walls of the uterus are best supplied with blood. On the anterior wall, the placenta is located somewhat less often, since the anterior wall of the uterus undergoes significantly greater changes than the posterior one. In addition, the location of the placenta on the back wall protects it from accidental injury.

Placenta previa is a pathology in which the placenta is located in the lower parts of the uterus along any wall, partially or completely overlapping the area of ​​the internal os - the area of ​​exit from the uterus. If the placenta only partially overlaps the area of ​​the internal pharynx, then this is an incomplete presentation, which is noted with a frequency of 70-80% of the total number of presentations. If the placenta completely overlaps the area of ​​the internal os, then this is called complete placenta previa. This option occurs with a frequency of 20-30%.

There is also a low location of the placenta, when its edge is at a lower level than it should be normal, but does not overlap the area of ​​the internal os.

Causes

Most frequent reasons formation low location or placenta previa are pathological changes in the inner layer of the uterus (endometrium) due to inflammation, surgical interventions (curettage, caesarean section, removal of myomatous nodes - nodes of a benign uterine tumor, etc.), multiple complicated labor. In addition, placental attachment disorders can be caused by:

• existing uterine fibroids;
• endometriosis (a disease in which the inner lining of the uterus - the endometrium - grows in uncharacteristic places, for example, in the muscle layer);
• underdevelopment of the uterus;
• isthmic-cervical insufficiency (a condition in which the cervix does not perform its obturator function, it opens slightly and the ovum is not retained);
• inflammation of the cervix;
• multiple pregnancy.

In connection with these factors, the fertilized egg that enters the uterine cavity after fertilization cannot be timely implanted in the upper parts of the uterus, and this process is carried out only when the fertilized egg has already dropped into its lower parts. It should be noted that placenta prevalence is more common in re-pregnant women than in primiparous.

How is placenta previa manifested?

The most common manifestation of placenta previa is recurrent bleeding from the genital tract. Bleeding can occur at different periods of pregnancy, starting from the earliest stages of pregnancy. However, they are most often observed in the second half of pregnancy. IN last weeks pregnancy, when the contractions of the uterus become more intense, bleeding may increase.

The cause of bleeding is repeated placental abruption, which is not able to stretch following the stretching of the uterine wall during the progression of pregnancy or the onset of labor. In a normal position, the placenta is located in areas of the uterus that are subject to the least stretching. In this case, the placenta partially exfoliates, and bleeding occurs from the vessels of the uterus. The fetus does not lose blood. However, he is threatened by oxygen starvation, since the exfoliated part of the placenta does not participate in gas exchange.

The provoking factors for the occurrence of bleeding with placenta previa or its low attachment can be: physical activity, a sharp coughing movement, vaginal examination, sexual intercourse, increased intra-abdominal pressure with constipation, thermal procedures (hot bath, sauna).

With full placenta previa, bleeding often occurs suddenly, i.e. no provoking factors, no pain, and can be very profuse. The bleeding may stop, but after a while it will reappear, or it may continue as scanty secretions... In the last weeks of pregnancy, bleeding resumes and / or increases.

With incomplete placenta previa, bleeding may begin at the very end of pregnancy, but more often this occurs at the beginning of labor. The severity of bleeding depends on the size of the placenta presenting. The more placental tissue is present, the earlier and stronger the bleeding begins.

Recurrent bleeding during pregnancy, complicated by placenta previa, in most cases leads to the development of anemia - a decrease in the amount of hemoglobin in the blood.

Pregnancy with placenta previa is often complicated by the threat of termination; this is due to the same reasons as the occurrence of an abnormal position of the placenta. Premature birth most often occur in patients with complete placenta previa.

For pregnant women with placenta previa, the presence of low blood pressure is characteristic, which occurs in 25-34% of cases,

Management of pregnant women in an obstetric hospital provides, if necessary, the use of drugs that eliminate the contractile activity of the uterus.

Gestosis (a complication of pregnancy, characterized by disruption of all organs and systems of the expectant mother, deterioration of the uteroplacental circulation, often manifested by an increase in blood pressure, the appearance of protein in the urine, edema) is also no exception for pregnant women with placenta previa. This complication, occurring against the background of dysfunction of a number of organs and systems, as well as with the phenomena of blood clotting disorders, significantly worsens the nature of repeated bleeding.

Placenta previa is often accompanied by fetal-placental insufficiency (the fetus does not receive enough oxygen and nutrients) and fetal growth retardation. The detached part of the placenta is turned off from the general system of the uteroplacental circulation and does not participate in gas exchange. With placenta previa, an incorrect position of the fetus (oblique, transverse) or breech presentation, which, in turn, are accompanied by certain complications.

What is "placental migration"

In obstetric practice, the term "placental migration" is widely rooted, which, in fact, does not reflect the real essence of what is happening. The change in the location of the placenta is carried out by changing the structure of the lower segment of the uterus during pregnancy and the direction of growth of the placenta towards better blood supply to the sections of the uterine wall (to the bottom of the uterus) compared to its lower parts. A more favorable prognosis from the point of view of placenta migration is noted when it is located on the anterior wall of the uterus. Typically, the placenta migration process takes place within 6 weeks and is completed by 33 ~ 34 weeks of gestation.

Diagnostics

Identifying placenta previa is not particularly difficult. The presence of placenta previa may be indicated by a pregnant woman's complaints of bleeding. In this case, repeated bleeding from the second half of pregnancy, as a rule, is associated with complete placenta previa. Bleeding at the end of pregnancy or at the beginning of labor is more often associated with incomplete placenta previa.

In the presence of bleeding, the doctor will carefully examine the walls of the vagina and the cervix using mirrors to exclude injury or pathology of the cervix, which may also be accompanied by the presence of bloody discharge.

With a vaginal examination of a pregnant woman, clear diagnostic signs are also easily detected, indicating an incorrect location of the placenta. Currently, the most objective and safe method for diagnosing placenta previa is ultrasound procedure(Ultrasound), which allows you to establish the very fact of placenta previa and the variant of previa (complete, incomplete), determine the size, structure and area of ​​the placenta, assess the degree of detachment, and also get an accurate idea of ​​placenta migration.

If an ultrasound scan reveals a complete placenta previa, then a vaginal examination is not performed at all, since it can provoke bleeding. The criterion for the low location of the placenta in the third trimester of pregnancy (at 28-40 weeks) is the distance from the edge of the placenta to the area of ​​the internal pharynx 5 cm or less. Placenta previa is evidenced by the detection of placental tissue in the area of ​​the internal os.

The nature of the location of the placenta in the II and III trimesters of pregnancy (up to 27 weeks) is judged by the ratio of the distance from the edge of the placenta to the region of the internal pharynx with the size of the fetal head diameter.

If an incorrect location of the placenta is detected, a dynamic study is performed to control its "migration". For these purposes, at least three-fold echographic control (ultrasound) is required during pregnancy at 16, 24-26 and 34-36 weeks.

Ultrasound should be performed with moderate bladder filling. With the help of ultrasound, it is also possible to determine the presence of an accumulation of blood (hematoma) between the placenta and the wall of the uterus during placental abruption (in the event that there was no outflow of blood from the uterine cavity). If the site of placental abruption occupies no more than 1/4 of the placenta area, then the prognosis for the fetus is relatively favorable. If the hematoma occupies more than 1/3 of the area of ​​the placenta, then most often this leads to the death of the fetus.

Features of pregnancy management and childbirth

The nature of pregnancy in women with placenta previa depends on the severity of bleeding and the amount of blood loss.

If there is no spotting in the first half of pregnancy, then the pregnant woman can be at home under outpatient supervision in compliance with a regimen that excludes the action of provoking factors that can cause bleeding (restriction of physical activity, sexual activity, stressful situations, etc.).

Observation and treatment for pregnancy over 24 weeks is carried out only in an obstetric hospital in any case, even in the absence of bleeding and normal health.

Treatment aimed at continuing pregnancy until 37-38 weeks is possible if the bleeding is not profuse, and the general condition of the pregnant woman and the fetus is satisfactory. Even despite the cessation of bleeding from the genital tract, a pregnant woman with placenta previa under no circumstances can be discharged from the hospital before childbirth.

Management of pregnant women in an obstetric hospital includes:

• compliance with strict bed rest;
• if necessary, the use of drugs that eliminate the contractile activity of the uterus;
• treatment of anemia (decreased amount of hemoglobin) and fetal-placental insufficiency.

In the event that the pregnancy was able to deliver up to 37-38 weeks and placenta previa persists, depending on the current situation, the optimal method of delivery is selected on an individual basis.

An absolute indication for a caesarean section in a planned manner is complete placenta previa. Vaginal birth is impossible in this situation, since the placenta overlapping the internal pharynx does not allow the presenting part of the fetus (it can be the fetal head or the pelvic end) to be inserted into the entrance to the pelvis. In addition, in the process of increasing contractions of the uterus, the placenta exfoliates more and more, and the bleeding increases significantly.

In case of incomplete placenta previa and in the presence of concomitant complications (breech presentation, abnormal position of the fetus, scar on the uterus, multiple pregnancy, severe polyhydramnios, narrow pelvis, primiparous age over 30 years, etc.), cesarean section is also performed routinely.

If the above concomitant complications are absent and there is no bloody discharge, then the doctor waits for the moment of the onset of independent labor and opens the fetal bladder. In the event that after opening fetal bladder all the same, bleeding has begun, they are deciding whether to perform a cesarean section.

If, with incomplete placenta previa, bleeding occurs before the onset of labor, then the fetal bladder is also opened. The need and expediency of this procedure is due to the fact that when opening the membranes, the fetal head is inserted into the entrance to the pelvis and presses the exfoliated part of the placenta to the wall of the uterus and pelvis, which helps to stop further placental abruption and stop bleeding. If bleeding continues after opening the fetal bladder and / or the cervix is ​​immature, then a cesarean section is performed. In the case of stopping bleeding in the absence of complications, it is possible to conduct labor through the vaginal birth canal.

Bleeding can begin in the early stages of labor development from the moment of the first contractions. In this case, an opening of the fetal bladder is also performed.

Thus, the management of labor through the vaginal birth canal with incomplete placenta previa is possible if:

• bleeding stopped after opening the fetal bladder;
• the cervix is ​​mature;
• labor is good;
• there is a head presentation of the fetus.

However, cesarean section is one of the most frequently chosen delivery methods by obstetricians with placenta previa and is performed with this pathology with a frequency of 70-80%.

Other typical complications in labor with incomplete placenta previa are weakness in labor and insufficient oxygen supply to the fetus (fetal hypoxia). A prerequisite for conducting labor through the vaginal birth canal is constant monitoring of the state of the fetus and the contractile activity of the uterus; a woman is attached to her stomach with sensors that are connected to an apparatus that records the fetal heartbeat and the presence of contractions, these parameters are recorded on a tape or projected onto a monitor.

After the birth of a child, bleeding may resume due to a violation of the process of separation of the placenta, since the placental site is located in the lower parts of the uterus, the contractility of which is reduced.

Heavy bleeding often occurs in the early postpartum period due to a decrease in the tone of the uterus and damage to the extensive vasculature of the cervix.

Prevention of placenta previa consists in the rational use of contraception, elimination of abortion, in the early detection and treatment of various inflammatory diseases organs of the reproductive system and hormonal disorders.

Marginal presentation of the placenta along the anterior and posterior wall: what does it mean, what is dangerous, predictions

In maintaining pregnancy and the life support of a developing child the main role the placenta plays - a child's place. But for this, it itself must form correctly. The marginal presentation of the placenta is more often detected in the second trimester of gestation, when the organ takes on its final form.

In obstetrics, a presentation is distinguished along the anterior wall and along the posterior wall of the uterus. Which of the options is more dangerous than threatening the child, is there an opportunity to correct the situation, we will consider below.

• The placenta, its functions and the origin of the temporary organ
  • Changes during gestation
  • Location options for a child's seat
• What is marginal placenta previa
• Diagnostics
• Marginal presentation on the back wall
  • What is dangerous for mom and fetus
  • Forecasts
• Marginal presentation on the anterior wall
  • What threatens a child and a pregnant woman
  • Forecasts
• How will the birth take place?
• Indications for cesarean section
• Why intimate life is forbidden
• Is it possible to raise a baby seat with exercise
• Treatment
• conclusions

What is the placenta and what tasks it performs

How is childbirth going with the marginal location of the placenta

The location of the placenta on the posterior wall in itself is not a contraindication to independent childbirth. What they pay attention to:

• no bleeding;
• sufficient tone of the uterus and regularity of contractions;
• soft, correctly opening neck;
• location of the fetus in the womb (optimal - head down).

Natural childbirth with marginal presentation of the placenta along the anterior wall is the most difficult. It is important here whether the symptoms of bleeding were noted during the gestation period. Anterior presentation is dangerous with the risk of placental abruption during childbirth, the development of hypoxia, and fetal death. With slight bleeding, a soft neck and active attempts, an amniotomy is performed - opening the amniotic fluid. Manipulation leads to the lowering of the fetus in the lower section, which allows you to press down the bleeding tissue of the placenta. Oxytocin is introduced, which acts as a hemostatic agent and stimulant of labor. If the bleeding does not stop, an emergency surgery is performed.

When is a caesarean section indicated?

Caesarean section with marginal placenta previa has specific indications:

• blood loss during gestation or during delivery with a volume of more than 300 ml;
• complete blockage of the uterine pharynx;
• a combination of a marginal presentation with an unfavorable history: episodes of miscarriage, multiple abortions, previously performed uterine sections;
• a combination of presentation with multiple pregnancies, pelvic or leg position of the child in the womb.

The afterbirth, located on the back wall, does not suffer during surgery, therefore, childbirth is more successful and with less blood loss, even with placental abruption. Intervention with the location of the placenta on the anterior wall is associated with the occurrence of hypoxia in the fetus. For the mother, this condition is aggravated by significant blood loss and longer recovery.

In the presence of absolute indications, but no bleeding, the operative delivery is performed routinely at 39-40 weeks. With the threat of interruption, Caesarea is 36–. Surgical intervention is always carried out on the basis of the rule: the life of a woman in labor is a priority.

Banned sex?

Talking about what cannot be done with placenta previa, one cannot ignore intimate life. A woman with such a pathology is shown absolute sexual rest. Moreover, not only sex in the knee-elbow position or on the side will fall under the ban, oral, anal penetration should be abandoned. Even masturbation is not recommended, since sexual arousal in any form causes a rhythmic contraction of the uterus, and it can provoke detachment of the placenta and an increase in tone. If a couple wants to give birth healthy child, such sacrifices are necessary.

Are there exercises for raising the placenta with marginal presentation

As a rule, a woman in such a situation is advised to observe a rest regimen: do not be nervous, sleep 8-10 hours, walk more in the fresh air, do not lift weights. In some cases, special gymnastics is advised, but exercises with marginal presentation are not able to affect the placenta so that it rises. They are aimed at improving the blood supply to the low placenta and relieving stress, which is very useful when it is compressed.

What can you advise:

• exercise "cat" is done on all fours with alternating arching and arching of the back;
• for 5-10 minutes several times a day lie in the "birch" position (with legs raised and resting on the wall);
• wearing a bandage is shown, especially in the third trimester.

All exercises should be performed without tension or discomfort. But do not forget that there are also errors of ultrasound diagnostics carried out in the early stages.

Medical treatment for marginal attachment

There is no specific therapy that can help the placenta rise. All measures are aimed at preventing fetal hypoxia, preventing bleeding and the longest possible preservation of pregnancy. The therapeutic tactics are as follows:

• Tocolytics - drugs that help to better stretch the muscle wall, are able to pull the placenta higher from the internal pharynx. These include: No-shpa, Papaverin.
• Means that improve the blood supply to the placental tissue: Curantil, Trental, folic acid.
• With the development of anemia, iron-containing drugs are prescribed: Ferum-Lek, Sorbifer.
• With the threat of detachment, Utrozhestan is shown in candles.

With the development of complications in the form of systematic, but not excessive bleeding, intramuscular administration of magnesium is indicated.

In the event of massive bleeding, injectable drugs will be given by intravenous drip. Therapy should be carried out throughout the gestation period.

conclusions

The marginal location of the placenta is a condition whose etiology is not fully understood. It is characterized by asymptomatic development in the early stages of pregnancy and formidable complications in the prenatal period. But presentation is not a sentence. Timely detection, constant monitoring and preventive treatment help a woman to give birth healthy baby... It might be worth the time to sacrifice for this. intimate life, moving in an airplane and relaxing at sea, and then enjoying the joy of motherhood.

The ideal position of the placenta is closer to the bottom of the uterus, more often on its front wall, and much less often on the back. The placenta can not always attach and begin to fully develop in this place, then this vital organ for the baby is attached from the opposite side closer to the pharynx of the uterus.

Depending on the place of attachment of the placenta, there are:

• full presentation;
• central presentation;
• lateral presentation;
• marginal presentation.

The marginal presentation of the placenta is determined during the second planned ultrasound, until this moment the placenta can move and rise to a normal position from the previously fixed incorrect one. However, the final diagnosis can be made closer to childbirth. This pathology is referred to as partial presentation. With a marginal presentation, the uterine pharynx is overlapped by the edges of the placenta by about a third.

Placenta previa - causes

The reasons for the marginal presentation may lie in the woman's health. Most often, the cause is previously experienced genital tract infections, abortions, as well as complications in the first pregnancy. In addition, presentation is observed in women who have had a diagnosis of uterine fibroids or have a congenital pathology of uterine deformity. Endometriosis can also cause improper attachment placenta. Indeed, in this case, the ovum was attached to the part of the uterus where the most healthy layer of the endometrium was. Incorrect placement of the placenta is more often recorded in multiparous women.

With a marginal presentation, a woman may start bleeding. In this case, bleeding begins completely unexpectedly, without discomfort and pain for a pregnant woman. Most often, the period of risk begins in the third trimester at 28-32 weeks of gestation or during childbirth.

With an incorrect placenta presentation, including the marginal one, the threat of miscarriage is much more often diagnosed. Hypotension - low blood pressure - can also be observed in a pregnant woman; and the development of anemia is not excluded. In addition, with a marginal presentation, the child may take an incorrect position in the uterine cavity, which will require surgical intervention.

Placenta previa - treatment

As a rule, no specific therapy is used to treat marginal presentation. The highlights are the complete or partial rest of the mother herself. At the same time, weight lifting is excluded. It is better to refuse sex with marginal placenta previa, as with the other type.

And yet, with a marginal presentation, constant medical monitoring and timely diagnosis are required. The main indicators to watch out for are a blood test for hemoglobin and coagulation. Indeed, in the event of anemia, a woman will need to prescribe iron-containing drugs. And the blood clotting indicators should be normal in case of bleeding. Blood pressure is also measured regularly. And, of course, ultrasound, which can more accurately determine changes in the position of the placenta.

Childbirth with marginal placenta previa

The decision on how the childbirth will take place will be made by the attending physician, as well as the doctor who takes over the birth. Therefore, it is better to contact the hospital before the onset of contractions.

Labor with marginal placenta previa can take place naturally if there are no other indicators to carry out. With this diagnosis, bleeding is usually not profuse and stops as soon as the baby's head covers the pharynx of the uterus. However, there is always a high probability of completion of labor by surgery, because it is often possible to establish exactly how much the placenta has blocked the pharynx of the uterus only after the opening of the cervix by 5-6 cm occurs.

With the level of modern diagnostics and medicine, a woman who is diagnosed with marginal placenta previa may not worry about her life and the life of her baby.

During pregnancy, a rather dangerous pathology can develop, associated with a violation of the normal location of the placenta. In this case, carrying a baby can be complicated by the development of certain adverse symptoms. It is necessary to consider in more detail what the marginal placenta previa means, as well as how it can be dangerous and what it affects during pregnancy.

What's this?

Doctors consider placenta previa as a pathology in which the place of initial attachment of the placental tissue is in the immediate vicinity of the internal uterine pharynx. Normally, a fertilized egg is attached during implantation in an area of ​​the upper part of the uterus called the fundus.

The location of the future chorion largely determines the initial location of the placental tissue. It is formed from fetal components, therefore it is in close proximity to it. If, for some reason, the fertilized egg is shifted to the internal uterine pharynx, then in this zone, placental tissue begins to form in the future. This leads to the development of pathology - placenta previa.

Doctors identify several clinical variants of this pathological condition. They determine them from how strongly the placental tissue comes into contact with the internal uterine pharynx. One of these clinical options is the marginal presentation. In this case, not the entire surface of the placental tissue, but only its individual sections, come into contact with the uterine pharynx with their edges.

Types of presentation

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Causes of occurrence

A variety of causal factors can lead to the development of this pathology. Quite often this pathological condition are preceded by chronic diseases of the reproductive organs. Women suffering from endometriosis, adnexitis, cervicitis and other diseases of the genital organs even before pregnancy are at increased risk for the development of this pathology.

The risk of developing marginal presentation is also quite high in women who have undergone surgery on the uterus or its appendages. Doctors note that scars on the uterus, which appeared as a result of an earlier cesarean section, can also contribute to the development of marginal presentation.

The consequences of the transferred infectious diseases can also lead to the development of the marginal placenta previa. So, the coccal flora, which affects the internal uterine walls, leads to a change in the mucous membranes, which contributes to the violation of implantation. In this case, usually the fertilized egg descends to the lower parts of the uterus, where the endometrium is more functional.

Coccal flora

Congenital anomalies of the female genital organs can also lead to the development of this pathology. So, with a two-legged uterus, the risk of developing placenta previa slightly increases. The presence of polyps and myomatous nodes, which are located in the area of ​​the uterine fundus, can also become a certain obstacle to the implantation of a fertilized egg in this area.

Not only pathologies on the part of a woman can lead to placenta previa. Some anomalies in the development of the chorion can also cause the development of this pathology. In some genetic pathologies, the trophoblast lacks certain enzymes necessary for implantation into the uterine wall. In this case, attachment to the uterus does not occur, as a result, the pregnancy is independently interrupted almost at the very beginning of its development.

Doctors note that the risk of developing marginal placenta previa is slightly higher in women who give birth to a second and subsequent babies. If, at the same time, the previous pregnancy ended with a cesarean section, then the likelihood of developing a marginal presentation increases.

Features of the course of pregnancy

The marginal presentation of the placenta can significantly complicate the process of carrying a baby. Such a pregnancy is usually characterized by a restless course, as well as the periodic appearance of adverse symptoms. It is worth noting that with an extreme presentation, bearing is still somewhat calmer than with a full one. In this case, the prognosis of the course of pregnancy is more favorable.

Adverse symptoms in this pathology usually appear after 16–20 weeks of pregnancy. By the third trimester, they may increase. In the very first weeks after fertilization, the expectant mother may not have any significant uncomfortable symptoms.

How to determine?

The location of the placental tissue is currently quite simple to determine. For this, doctors resort to prescribing ultrasound examinations. With marginal placenta previa, it is undesirable to carry out transvaginal ultrasound. In this case, the possibility of damage to the low-lying placental tissue is quite high. In this situation, it is better to choose a transabdominal ultrasound.

The localization of the placenta can also be determined through a routine vaginal examination. However, with marginal placenta previa, this technique is often not worth resorting to. If such an examination is carried out carelessly, the delicate tissue of the placenta can be damaged. That is why doctors give their preference to ultrasound techniques.

If, during the diagnosis, the marginal presentation was determined, in this case, the following additional studies are assigned to the expectant mother. They are necessary in order to assess the dynamics of the course of a given pathology.

If the pathology was discovered quite early - at 12-16 weeks of pregnancy, then in such a situation the localization of the placental tissue may still change. The upward displacement of the placenta is called migration by doctors. It proceeds rather slowly and ends only by the 3rd trimester of pregnancy. That is why the localization of the placenta during its presentation is determined several times during the entire period of bearing the baby. Unfortunately, placental migration does not occur in all cases.

Migration of the placenta

Possible complications

The most striking symptom that usually makes a pregnant woman who has a marginal placenta previa seek advice from an obstetrician-gynecologist is the appearance of blood from the genital tract. With this pathology, blood usually appears after lifting heavy objects or after intense physical exercise... The appearance of blood on underwear can only be an isolated symptom. In some cases, it is combined with the appearance of pain in the abdomen.

If a pregnant woman sees bleeding from the genital tract and at the same time her stomach hurts badly, then this means that she should not hesitate to seek medical help.

Bleeding from the genital tract with a very low position of the placenta can develop after sex. The possibility of having sex in the presence of such a pathology must be discussed with an obstetrician-gynecologist. Usually, nevertheless, doctors recommend that their patients with marginal placenta previa limit sex and prescribe sexual rest.

Many pregnant women confuse the pathology of the placenta and the umbilical cord. So, the marginal presentation of the placental tissue has nothing to do with the marginal discharge of the umbilical cord. Placenta previa is a pathology, and the marginal discharge of the umbilical cord is only physiological feature the course of a particular pregnancy.

An equally dangerous complication that can develop during pregnancy, complicated by marginal placenta previa, is the development of detachment of placental tissue from the walls of the uterus. This pathology usually occurs as a consequence of traumatic influences. The more the placental tissue exfoliates from the uterine wall, the less favorable the prognosis for the course of pregnancy. To avoid the development of a possible placental abruption, doctors make up a whole complex various recommendations... So, contraindications include intense sports, as well as running. A pregnant woman in whom pregnancy proceeds with the development of a marginal presentation is forbidden to lift too heavy objects. It is very important that the expectant mother rests more.

In addition to playing sports, a pregnant woman with a marginal placenta previa, the doctor may prohibit and visit the pool. Reviews of many women who had this pathology during pregnancy confirm this. With an extremely severe course of presentation, any physical activity can be limited, and in some cases even bed rest is prescribed.

Severe stress can also make the situation worse. The expectant mother should follow such recommendations strictly.

Preventing infection in the low-lying placenta is another challenge during a complicated pregnancy. In this case, pathogenic organisms most often enter the uterine cavity from the external genital organs. In order to prevent such infection, a pregnant woman should carefully follow the rules of personal hygiene. The extreme position of the placenta relative to the uterine pharynx can also be dangerous for the developing fetus in the womb.

Violation of uteroplacental blood flow can lead to the development of placental insufficiency. In such a situation, the intensity of intrauterine development of the fetus is significantly reduced.

How is labor done?

Pregnancy with marginal placenta previa can have an extremely unpredictable prognosis. At any stage of carrying a baby, dangerous complications can arise that contribute to a change in the tactics initially chosen by doctors. So, in the event of severe bleeding or a threat to the life of the fetus, the doctor will be forced to resort to emergency surgical obstetrics.

Pregnant women with marginal placenta previa, as a rule, undergo a cesarean section. In this case, you can minimize the risk of developing dangerous complications that arise during spontaneous childbirth.

If, before giving birth, a woman was diagnosed with severe anemia, due to frequent previous bleeding from the genital tract, then in such a situation she will be prescribed iron-containing medications. For the fastest compensation of the general condition, such drugs are administered by injection. Even during a cesarean section during pregnancy accompanied by marginal placenta previa, there is a high risk of severe bleeding. During the operation, doctors must monitor the woman's pulse and blood pressure.

With the development of severe bleeding and massive blood loss, these indicators begin to decrease critically. In such a situation, doctors usually resort to parenteral administration of oxytocin or hemostatic agents. The main goal in carrying out such drug therapy is to preserve the life of the mother and her baby.

After the baby is born, doctors must assess his general condition. If necessary, the child undergoes a complex of resuscitation measures. Usually they are required if the baby was born much earlier. due date... Such medical manipulations are performed by a neonatologist who is in the delivery room during childbirth. After giving birth, doctors must also monitor the condition of the woman in labor.