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

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

• full presentation;
• central presentation;
• lateral presentation;
• edge presentation.

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

Marginal placenta previa - causes

The reasons for the marginal presentation may lie in the health of the woman. 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 been diagnosed with uterine fibroids or have a congenital pathology of uterine deformity. Endometriosis can also cause improper attachment of the placenta. Indeed, in this case, the fetal egg was attached to that part of the uterus, where there was the most healthy layer of the endometrium. The incorrect location of the placenta is more often fixed in multiparous women.

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

With improper placenta previa, including the marginal one, the threat of miscarriage is much more often diagnosed. A pregnant woman may also experience hypotension - low blood pressure; and the development of anemia is not ruled out. In addition, with marginal presentation, the child may take the wrong position in the uterine cavity, which will require surgical intervention.

Marginal placenta previa - treatment

As a rule, no specific therapy is used to treat marginal presentation. The main points are the complete or partial rest of the mother herself. This excludes heavy lifting. From sex with marginal placenta previa, as with another type, it is better to refuse.

And yet, with marginal presentation, constant medical monitoring and timely diagnosis are required. The main indicators that you should monitor are a blood test for hemoglobin and clotting. Indeed, in the case of anemia, a woman will need to prescribe iron-containing drugs. And the blood clotting parameters 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 birth will take place will be made by the attending physician, as well as the doctor who delivers. Therefore, it is better to contact the maternity hospital before the onset of contractions.

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

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.

The placenta is laid at the very beginning of pregnancy and is fully formed by 16 weeks. It provides nutrition to the fetus, excretion of metabolic products, and also performs the function of the lungs for it, because. it is through the placenta that the fetus receives the oxygen necessary for its life. In addition, the placenta is a real "hormonal factory": hormones are formed here that ensure the preservation, normal development of pregnancy, growth and development of the fetus.

The placenta consists of villi - structures, inside which the vessels pass. As pregnancy progresses, the number of villi, and, accordingly, the number of blood vessels is constantly growing.

Location of the placenta: norm and pathology

From the side of the uterus at the site of attachment of the placenta there is a thickening of the inner membrane. Deepenings are formed in it, which form the intervillous space. Some villi of the placenta fuse with the maternal tissues (they are called anchors), while the rest are immersed in the maternal blood that fills the intervillous space. Anchor villi of the placenta are attached to the partitions of the intervillous spaces, vessels pass through the thickness of the partitions, which carry maternal arterial blood saturated with oxygen and nutrients.

The villi of the placenta secrete special substances - enzymes that "melt" small arterial vessels that carry maternal blood, as a result of which blood flows out of them into the intervillous space. It is here that the exchange between the blood of the fetus and the mother takes place: with the help of complex mechanisms, oxygen and nutrients enter the fetal blood, and the fetal metabolic products enter the mother's blood. The fetus is connected to the placenta by the umbilical cord. One end is attached to the umbilical region of the fetus, the other - to the placenta. Inside the umbilical cord are two arteries and a vein that carry blood, respectively, from the fetus to the placenta and vice versa. Blood rich in oxygen and nutrients flows through the vein of the umbilical cord to the fetus, and venous blood from the fetus, containing carbon dioxide and metabolic products, flows through the arteries.

Normally, the placenta is located closer to the bottom of the uterus along the anterior or, less often, its posterior wall. This is due to more favorable conditions for the development of the fetal egg in this area. The mechanism for choosing the place of attachment of the fetal egg is not completely clear: there is an opinion that the force of gravity plays a role in choosing a place - for example, if a woman sleeps on her right side, then the egg is attached to the right wall of the uterus. But this is just one of the theories. We can only say unequivocally that the fetal egg does not attach to places that are unfavorable for this, for example, to the locations of myomatous nodes or to places of damage to the inner lining of the uterus as a result of previous curettage. Therefore, there are other options for the location of the placenta, in which the placenta is formed closer to the lower part of the uterus. Allocate a low location of the placenta and placenta previa.

They say about the low location of the placenta when its lower edge is at a distance of no more than 6 cm from the internal pharynx of the cervix. This diagnosis is established, as a rule, during ultrasound. Moreover, in the second trimester of pregnancy, the frequency of this pathology is about 10 times higher than in the third trimester. It's pretty easy to explain. Conventionally, this phenomenon is called the "migration" of the placenta. In fact, the following happens: the tissues of the lower part of the uterus, very elastic, with an increase in the duration of pregnancy, undergo significant stretching and stretch upwards. As a result of this, the lower edge of the placenta seems to move upward, and as a result, the location of the placenta becomes normal.

Placenta previa is a more serious diagnosis. In Latin, this condition is called placenta praevia. "Pre via" literally means before life. In other words, the term "placenta previa" means that the placenta is on the way to the emergence of a new life.

Placenta previa is complete or central, when the entire placenta is located in the lower part of the uterus and completely covers internal os cervix. In addition, there is a partial placenta previa. It includes marginal and lateral presentation. They say about lateral presentation of the placenta when up to 2/3 of the outlet of the uterus is covered with placental tissue. With marginal placenta previa, no more than 1/3 of the opening is closed.

Causes of anomalies

The main cause of anomalies of placental attachment are changes in the inner wall of the uterus, as a result of which the process of attaching a fertilized egg is disrupted.

These changes are most often caused by an inflammatory process of the uterus that occurs against the background of curettage of the uterine cavity, abortion, or associated with sexually transmitted infections. In addition, deformity of the uterine cavity predisposes to the development of such a pathology of the placenta, due either to congenital anomalies in the development of this organ, or to acquired causes - uterine fibroids (benign tumor of the uterus).

Placenta previa can also occur in women suffering from serious diseases of the heart, liver and kidneys, as a result of congestion in the pelvic organs, including in the uterus. That is, as a result of these diseases, areas with worse blood supply conditions than other areas appear in the wall of the uterus.

Placenta previa in multiparous women occurs almost three times more often than in women carrying their first child. This can be explained by the "baggage of diseases", including gynecological ones, which a woman acquires by the age of the second birth.

There is an opinion that this pathology of the location of the placenta may be associated with a violation of some functions of the fetal egg itself, as a result of which it cannot attach itself to the most favorable part of the uterus for development and begins to develop in its lower segment.

Quite often, placenta previa can be combined with its tight attachment, as a result of which the independent separation of the placenta after childbirth is difficult.

It should be noted that the diagnosis of placenta previa, with the exception of its central variant, will be quite correct only closer to childbirth, because. the position of the placenta may change. This is all due to the same phenomenon of “migration” of the placenta, due to which, when the lower segment of the uterus is stretched at the end of pregnancy and during childbirth, the placenta can move away from the area of ​​\u200b\u200bthe internal os and not interfere with normal childbirth.

Beware of bleeding!

Bleeding with placenta previa has its own characteristics. It is always external, i.e. blood flows out through the cervical canal, and does not accumulate between the wall of the uterus and the placenta in the form of a hematoma.

Such bleeding always begins suddenly, as a rule, without visible external cause and are not accompanied by any pain. This distinguishes them from bleeding associated with premature termination of pregnancy, when, along with spotting, there are always cramping pains.

Often bleeding begins at rest, at night (woke up "in a pool of blood"). Once having arisen, bleeding always repeats, with greater or lesser frequency. Moreover, it is never possible to foresee in advance what the next bleeding will be in terms of strength and duration.

After 26-28 weeks of pregnancy, such bleeding can be triggered by physical activity, sexual intercourse, any increase in intra-abdominal pressure (even coughing, straining, and sometimes a gynecologist's examination). In this regard, examination on the chair of a woman with placenta previa should be carried out with all precautions in a hospital, where emergency assistance can be provided in case of bleeding. The bleeding itself is dangerous for the life of mother and baby.

Symptoms and possible complications

The main complications and the only manifestations of placenta previa are spotting. Depending on the type of presentation, bleeding may occur for the first time during various periods of pregnancy or in childbirth. So, with central (complete) placenta previa, bleeding often begins early - in the second trimester of pregnancy; with lateral and marginal options - in the third trimester or directly in childbirth. The amount of bleeding also depends on the type of presentation. With a complete presentation, bleeding is usually more abundant than with an incomplete version.

Most often, bleeding occurs at a gestational age of 28-32 weeks, when the preparatory activity of the lower uterine segment is most pronounced. But every fifth pregnant woman with a diagnosis of placenta previa notes the appearance of bleeding in early dates(16-28 weeks of pregnancy).

What causes bleeding in placenta previa? During pregnancy, the size of the uterus constantly increases. Before pregnancy, they are comparable to the size of a matchbox, and by the end of pregnancy, the weight of the uterus reaches 1000 g, and its dimensions correspond to the size of the fetus along with the placenta, amniotic fluid and membranes. Such an increase is achieved, mainly due to an increase in the volume of each fiber that forms the wall of the uterus. But the maximum change in size occurs in the lower segment of the uterus, which stretches the more, the closer the term of delivery. Therefore, if the placenta is located in this area, then the process of "migration" is very fast, the low-elastic tissue of the placenta does not have time to adapt to the rapidly changing size of the underlying uterine wall, and placental abruption occurs over a greater or lesser extent. In the place of detachment, damage to the vessels occurs and, accordingly, bleeding.

With placenta previa, the threat of abortion is often noted: increased uterine tone, pain in the lower abdomen and in the lumbar region. Often, with this location of the placenta, pregnant women suffer from hypotension - stably reduced pressure. A decrease in pressure, in turn, reduces performance, causes weakness, feelings of weakness, increases the likelihood of fainting, the appearance of a headache.

In the presence of bleeding, anemia is often detected - a decrease in the level of hemoglobin in the blood. Anemia can exacerbate the symptoms of hypotension, in addition, oxygen deficiency caused by a decrease in hemoglobin levels adversely affects the development of the fetus. There may be growth retardation, fetal growth retardation syndrome (FGR). In addition, it has been proven that children born to mothers who suffered from anemia during pregnancy always have a reduced hemoglobin level in the first year of life. And this, in turn, reduces the defenses of the baby's body and leads to frequent infectious diseases.

Due to the fact that the placenta is located in the lower segment of the uterus, the fetus often takes the wrong position - transverse or oblique. Often also found breech presentation fetus when its buttocks or legs are facing the exit from the uterus, and not the head, as usual. All this makes it difficult or even impossible to have a child naturally, without surgery.

Diagnostics

Diagnosis of this pathology is most often not difficult. It is usually established in the second trimester of pregnancy based on complaints of intermittent bleeding without pain.

The doctor on examination or during an ultrasound scan may reveal an incorrect position of the fetus in the uterus. In addition, due to the low location of the placenta, the underlying part of the child cannot descend into the lower part of the uterus, therefore, a high standing of the presenting part of the child above the entrance to the small pelvis is also a characteristic feature. Of course, modern doctors are in a much more advantageous position compared to their counterparts 20-30 years ago. At that time, obstetrician-gynecologists had to navigate only by these signs. After being widely adopted ultrasound diagnostics the task has been greatly simplified. This method is objective and safe; Ultrasound allows you to get an idea of ​​the location and movement of the placenta with a high degree of accuracy. For these purposes, it is advisable to triple ultrasound control at 16, 24-26 and 34-36 weeks. If according to the data ultrasound no pathology of the location of the placenta is detected, the doctor, upon examination, can identify other causes of bloody discharge. They can be various pathological processes in the vagina and cervix.

Observation and treatment

An expectant mother who has been diagnosed with placenta previa needs careful medical supervision. Of particular importance is the timely clinical research. If even a slightly reduced level of hemoglobin or disorders in the blood coagulation system are detected, the woman is prescribed iron supplements, because. in this case, there is always a risk of rapid development of anemia and bleeding. If any, even minor, deviations in the state of health are detected, consultations of the relevant specialists are necessary.

Placenta previa is a formidable pathology, one of the main causes of serious obstetric bleeding. Therefore, in the event of bleeding, all a woman’s health problems, even small ones, can aggravate her condition and lead to adverse consequences.

In the presence of bloody discharge, observation and treatment of pregnant women with placenta previa at gestational ages over 24 weeks is carried out only in obstetric hospitals that have conditions for providing emergency care in an intensive care unit. Even if the bleeding has stopped, the pregnant woman remains under the supervision of the hospital doctors until the due date.

In this case, treatment is carried out depending on the strength and duration of bleeding, the duration of pregnancy, the general condition of the woman and the fetus. If the bleeding is insignificant, the pregnancy is premature and the woman feels well, conservative treatment is performed. Strict bed rest, drugs to reduce the tone of the uterus, improve blood circulation are prescribed. In the presence of anemia, a woman takes drugs that increase the level of hemoglobin, general strengthening drugs. Calming agents are used to reduce emotional stress.

regime plus diet

If there is no bleeding, especially with a partial variant of placenta previa, a woman can be observed on an outpatient basis.

In the diet, there must be foods rich in iron: buckwheat, beef, apples, etc. Be sure to have a sufficient protein content, because. without it, even with a large intake of iron, hemoglobin will remain low: in the absence of protein, iron is poorly absorbed. It is useful to regularly eat vegetables and fruits rich in fiber, because. stool retention can provoke the appearance of spotting. Laxatives for placenta previa are contraindicated. Like all pregnant women, patients with placenta previa are prescribed special multivitamin preparations. If all these conditions are met, the manifestations of all the symptoms described above, which in most cases accompany placenta previa, are reduced, which means that conditions are provided for the normal growth and development of the child. In addition, in the event of bleeding, the adaptive capabilities of the woman's body increase, and blood loss is more easily tolerated.

childbirth

With complete placenta previa, even in the absence of bleeding, a caesarean section is performed at 38 weeks of gestation, because. spontaneous childbirth in this case is impossible. The placenta is located on the way the baby leaves the uterus, and if you try to give birth on your own, it will completely detach with the development of very severe bleeding, which threatens the death of both the fetus and the mother.

The operation is also resorted to at any stage of pregnancy in the presence of the following conditions:

Placenta previa, accompanied by significant bleeding, life-threatening;

Recurrent bleeding with anemia and severe hypotension, which are not eliminated by the appointment of special drugs and are combined with a violation of the fetus.

In a planned manner, a cesarean section is performed at a period of 38 weeks with a combination of partial placenta previa with another pathology, even in the absence of bleeding.

If a pregnant woman with partial placenta previa carried the pregnancy to term, in the absence of significant bleeding, it is possible that childbirth will occur naturally. With the opening of the cervix by 5-6 cm, the doctor will finally determine the variant of placenta previa. With a small partial presentation and minor spotting, an autopsy is performed amniotic sac. After this manipulation, the fetal head descends and compresses the bleeding vessels. The bleeding stops. In this case, the completion of childbirth in a natural way is possible. With the ineffectiveness of the measures taken, childbirth is completed promptly.

Unfortunately, after the birth of a child, the risk of bleeding remains. This is due to a decrease in the contractility of the tissues of the lower segment of the uterus, where the placenta was located, as well as the presence of hypotension and anemia, which have already been mentioned above. In addition, it has already been said about the frequent combination of presentation and dense attachment of the placenta. In this case, the placenta after childbirth cannot completely separate from the walls of the uterus on its own, and it is necessary to conduct a manual examination of the uterus and separation of the placenta (the manipulation is performed under general anesthesia). Therefore, after childbirth, women who had placenta previa remain under the close supervision of hospital doctors and must carefully follow all their recommendations.

Infrequently, but still there are cases when, despite all the efforts of doctors and a caesarean section, the bleeding does not stop. In this case, it is necessary to resort to the removal of the uterus. Sometimes this is the only way to save a woman's life.

Precautionary measures

It should also be noted that with placenta previa, one should always keep in mind the possibility of developing severe bleeding. Therefore, it is necessary to discuss with the doctor in advance what to do in this case, which hospital to go to. Staying at home, even if the bleeding is light, is dangerous. If there is no prior agreement, you need to go to the nearest maternity hospital. In addition, with placenta previa, you often have to resort to blood transfusions, so if you have been diagnosed with such a diagnosis, find out in advance which of your relatives has the same blood type as you and get their consent to donate blood for you if necessary (the relative must pre-test for HIV, syphilis, hepatitis).

You can arrange in a hospital where you will be observed so that your relatives donate blood for you in advance. At the same time, it is necessary to enlist a guarantee that the blood is used specifically for you - and only if you do not need it, it will be transferred to a general blood bank. It would be ideal for you to donate blood for yourself, but this is only possible if your condition does not cause concern, all indicators are normal and there is no spotting. You can donate blood for storage multiple times during your pregnancy, but you also need to ensure that your blood is not used without your knowledge.

Although placenta previa is a serious diagnosis, modern medicine allows you to endure and give birth healthy child, but only under the condition of timely diagnosis of this complication and with strict observance of all doctor's prescriptions.

When everything is over and you and your baby are at home, try to organize your life properly. Try to rest more, eat right, be sure to walk with the baby. Do not forget about multivitamins and drugs for the treatment of anemia. If possible, avoid breastfeeding. This will not only lay the foundation for the health of the baby, but also speed up the recovery of your body, because. stimulation of the nipple by sucking causes the uterus to contract, reducing the risk of postpartum hemorrhage and uterine inflammation. It is desirable that at first someone helps you in caring for the child and household chores, because your body has suffered a difficult pregnancy, and it needs to recover.

Marginal placentation during pregnancy is a partial overlap of the cervix of the uterus. This situation can become dangerous if the placenta does not rise on its own by 26 weeks.

The placenta, after conception, is formed by the 16th week of pregnancy. But, throughout the entire period of gestation, this embryonic organ develops intensively. Marginal placentation during pregnancy occurs if the membrane is too low to the pharynx. In the last trimester, pathology threatens the life of the mother and child during labor.

Causes of marginal placentation during pregnancy

A unique temporary internal organ - the placenta, provides nutrition and respiration of the fetus. Visually, the "children's place" looks like a disk, which is normally attached to the back wall in the uterus and at some distance from the pharynx. With the marginal location of the placenta, an incomplete presentation is detected when the membrane partially blocks the exit for the child.

The main factor affecting the location is the specific structure of the fetal egg. With such an anomaly, implantation is impossible in the upper section, the embryo is attached closer to the lower edge.

There are also reasons that directly depend on the health of the expectant mother:

1. endometriosis;
2. uterine fibroids;
3. the formation of more than one fetus;
4. repeated pregnancy;
5. interruption of gestation (abortion).

After the first ultrasound examination at 12-13 weeks, marginal placenta previa requires only observation and control. While maintaining the existing situation by the 28th week, such a pathology becomes dangerous during delivery.

Varieties and symptoms of marginal placentation during pregnancy

Incorrect presentation of the baby, most often, does not manifest itself in any way. Symptoms may be limited to only bleeding in the third trimester or during childbirth. Bleeding is caused by the absence of pain. Expansion and subsequent rupture of the marginal sinus characterize prolonged and profuse blood loss.

Due to a significant loss of blood, the hemoglobin index decreases, anemia develops, which requires the immediate appointment of iron-containing drugs.
The formation of an embryonic organ on the anterior wall is considered the most dangerous. Anterior attachment threatens greater mobility, heavy loads, and excess uterine distention. With such a pathology, there is a risk of mechanical damage to the baby, and the elasticity of the uterus leads to the descent of the placenta and the overlap of the pharynx.

Marginal placentation during pregnancy - is it dangerous or not?

Early diagnosis pathological manifestation is considered the norm. As the fetus develops, the embryonic membrane independently, for natural reasons, rises higher, occupying the required location.

If such a presentation is preserved until the third trimester, there is a risk of complications. In addition to bleeding, gradual peeling begins internal organ. The baby, during labor, can clamp the placenta, blocking his own oxygen supply, which can result in a stillbirth.

Before the onset of 20-24 weeks of pregnancy, the shell should rise to a higher place. If during control ultrasound studies, the pathology does not change for the better, then this is fraught with the appearance of ischemia, early aging placenta and circulatory disorders.

How to treat marginal placentation during pregnancy

To exclude marginal placentation by the time of delivery, drug therapy and treatment in the form of physiotherapy are used.

Medical methods include:

• tocolytic drugs, administered intramuscularly or drip (ginipral, partusisten), in order to reduce uterine contractions;
• drugs that activate blood circulation (chimes, actovegin, trental);
• medicines to reduce anemia and normalize hemoglobin;
• antispasmodics;
• vitamin complexes.

With an existing threat premature birth when the placenta begins to slough off, corticosteroids are given to reduce the risk of hypoxia in the baby during pregnancy.

An additional method to improve the functionality of the child's place is wearing a bandage and electrophoresis. At home, an exercise will be useful in which a woman needs to stand in a knee-elbow position for a short period of time, at least 4 times a day. The method is effective in the second trimester, thus, the pressure is reduced and the anterior wall is stretched, which provokes a small rise above the pharynx.

After therapy, the likelihood of placental elevation increases significantly. According to statistics, more than 95% of women go through labor without complications. Doctors recommend, with such a diagnosis, to minimize physical activity, limit sexual contacts or completely abandon them, and also avoid stressful situations.

Marginal placenta previa is an anomaly in the location of the fetus in the mother's body. This feature can adversely affect the health of the mother and baby. There are several types of such an arrangement of the fetus, for any of them it is necessary to constantly examine the woman and prescribe drugs or exercise therapy. Such patients are usually hospitalized in the clinic to monitor the dynamics of the pregnant woman's condition.

The prognosis is favorable. But when the first symptoms of this pathology appear, you need to consult a doctor for advice.

• Show all

  Marginal placenta previa: what is it?

  Marginal placenta previa - attachmentembryoat the 28th week of pregnancy or more, in which there is a partial (incomplete)overlap of the internal os of the uterus, i.e., overlap of the segment. This condition may have a variety of etiologies, such as improper attachment trophoblast during implantation or anatomical features of the muscular layer of the uterus. Violation of the structure of the muscles also appears due to inflammation against the background of infections that are sexually transmitted.

  Normal location and marginal presentation of the chorion

  Pathogenesis is also associated with the fact that marginal placenta previa is possible with thinning of the myometrium, which is often due to frequent scrapings and abortions. The deformation of the uterus due to benign tumors and congenital pathologies also affects. In diseases of the cardiovascular system, the violation in question is also possible.

  The formation of anomalous presentation is influenced by age factors (age over 36 years and under 18). The bearing of twins or a violation of the menstrual cycle against the background of hormonal failure can also affect the appearance of this pathology. Anomalies in the development of the embryo also contribute to the incorrect location of the chorion. Due to insufficient blood circulation, the placenta cannot attach properly.

  A high number of births in history can also affect placental malposition, and the location of the placenta in a previous pregnancy affects the future location of the chorion.

  

  Features of the location of the chorion

  After 16 weeks of pregnancy, a placenta (baby place) is formed in the uterus, which connects the body of the mother and child. Through it, breathing and nutrition of the fetus is carried out, and metabolic products are excreted. The placenta resembles a disk with a diameter of 15-20 cm and a thickness of 2-4 cm.

  Normally, the chorion is located in the uterus and is not adjacent to the pharynx. The fetal part of the organ is covered with villi, which are supplied by small vessels from the navel. The umbilical cord is attached to it.

  From the side of the uterus at the site of attachment of the placenta, a thickening of the inner membrane is observed. The umbilical cord connects the fetus to the placenta. One end is attached to the umbilical region of the fetus, the other - to the placenta.

  Inside the umbilical cord are two arteries and a vein that carry blood from the fetus to the placenta and back. Oxygenated blood flows through the vein of the umbilical cord. Through the arteries - venous, which is saturated with carbon dioxide.

  

  The umbilical cord and the normal position of the fetus

  In a normal pregnancy, the chorion is close to the bottom of the uterus. This creates favorable conditions for the development of the fetus.

  The low location of the placenta is abnormal. V this case its lower part is no more than 6 cm away from the internal os of the uterus. There is a complete and central location of the placenta, which is manifested by the overlap of the internal pharynx completely. Partial presentation, which includes the marginal and lateral form, is characterized by the fact that the placenta covers most of the outlet of the cervix.

  
  

  

  Main features and types

  According to the classification, the marginal presentation of the chorion is of two types: along the front wall and along the back. In the first form, mechanical damage to the placenta and its detachment due to physical activity woman and baby movements. Localization on the back wall does not have such severe consequences.

  With marginal placenta previa, patients complain of spotting at night or at rest. The amount of blood loss depends on the severity of the pathology and vascular damage. The release of blood may be associated with physical activity, sexual intercourse and fetal activity, examination by a gynecologist.

  A woman has signs such as a feeling of discomfort in the lower abdomen and an increased tone of the muscles of the uterus. If regular bleeding occurs, then anemia develops. Against this background, a woman has an increase in fatigue, a decrease in efficiency and weakness. Hypoxia is noted due to a deficiency in the intake of nutrients.

  Regional placental presentation often threatens miscarriage.

  

  Examination and treatment

  Diagnosis is carried out by a gynecologist on the basis of complaints and ultrasound. Thanks to this method, it is possible to assess the location of the placenta and the degree of overlap of the uterine os. Treatment depends on the symptoms, length of pregnancy, and the health of the mother and fetus. Therapy is carried out in a hospital setting.

  Doctors recommend being completely at rest with this type of pathology, excluding sexual intercourse and avoiding stressful situations. It is recommended to wear a bandage. In the second trimester of pregnancy, you can change the localization of the placenta with the help of therapeutic physical culture.

  Women with Rh negative blood immunoglobulins are administered.

  Due to the fact that the patient develops anemia, she needs to eat more foods that contain a large amount of iron (buckwheat, liver, beef, apples, red fish).

  In the absence of bleeding, women are regularly examined by a gynecologist, but are treated at home, that is, on an outpatient basis. They need to stay in bed proper nutrition and spend a lot of time in the fresh and warm air. It is recommended to constantly eat vegetables and fruits.

  Medicines

  In this pathology, it is actively used medicines. To relieve uterine hypertonicity, you can use tocolytics (fenoterol, indomethacin, Ginipral) and antispasmodic drugs (No-Shpa, Spanil).

  

  For the treatment of anemia, it is recommended to use ferroceron, Kaferide, Hemofer, i.e. those medicines that contain iron in their composition. In order to maintain the immune system of the body, women are prescribed vitamin complexes. Sometimes antiplatelet agents are prescribed to stop bleeding (tirofiban, Zilt).

  
  

  To prevent placental abruption, pregnant women are prescribed progestogen drugs (Dufaston, Utrozhestan). Some patients have mental disorders such as depression. In order to stop their manifestations, it is necessary to use sedatives based on valerian, motherwort.

  It is strictly forbidden to stop bleeding on your own with various medications, because the wrong dosage can lead to the death of the child.

  If certain drugs are not suitable for the patient, then the doctor should replace them with similar ones in action, but different in composition.

  Childbirth and consequences

  With heavy bleeding resort to caesarean section. After the birth of a child, a woman has a high risk of complications in the form of bleeding and anemia due to a decrease in uterine contractions. In this case, the patient should be in the hospital until complete recovery.

  Bleeding is associated with placental abruption. Sometimes after a caesarean section, it does not stop. In such a situation, specialists may decide to carry out a blood transfusion, which the girl's close relatives donate in advance. Doctors often resort to removing the uterus to save a woman's life.

  Sometimes intrauterine death of the fetus occurs due to a delay in its development and growth, and the death of a woman and a child is also possible.

  If bleeding is not observed with marginal placenta previa and the condition of the woman's body is normal, then natural childbirth is possible, but with the use of amniotomy (opening the membranes of the fetus). natural childbirth are only possible in the following cases:

  • regular strong contractions;
  • uterus ready for childbirth.

  If this method did not bring positive results, then the woman is delivered through an incision in the abdomen.

  If the patient has pathologies according to the results of ultrasound and bleeding, then obstetricians consider early birth (up to 36 weeks). To prevent bleeding after childbirth, women are given oxytocin. After childbirth, women experience weakness and fatigue against the background of reduced pressure, and due to blood loss, a decrease in hemoglobin levels is possible.

  Prevention and prognosis

  The prognosis of this diagnosis is favorable. With proper treatment, constant examination and timely diagnosis, the fetus can be carried up to 38 weeks and give birth healthy baby. Prevention of the pathology in question consists in the timely treatment of all gynecological diseases before the conception of a child or pregnancy. It is necessary to avoid hypothermia of the body.

  Gynecologists do not recommend resorting to abortions or operations on the uterus. During pregnancy, you need to stop lifting weights, playing sports. A woman should be provided with a favorable psychological atmosphere so as not to provoke a miscarriage. Smoking and drinking alcohol is a dangerous factor, because other diseases may develop that complicate the course of pregnancy.

The normal development of the fetus during pregnancy is possible only with the proper functioning and location of the placenta. In some cases (less than 1% of the total number of births), placenta previa is possible, which can greatly complicate childbirth.

The placenta is an organ that is part of the structure of the uterus and contributes to normal development fetus during pregnancy. However, the course of pregnancy is affected not only by the proper functioning of the placenta, but also by its location. Pathologies of the location of the placenta in the uterus are called placenta previa and are an infrequent complication of pregnancy.

Causes

In accordance with the causes of education, placenta previa can be classified into two groups:

• associated with the state of the body of a woman,
• associated with the development of the fetal egg.

In most cases, the cause of placenta previa is the development of pathological changes in the uterine mucosa, leading to disturbances in the normal decidual reaction of the endometrium. These include:

• chronic inflammation of the endometrium,
• operations on the uterus, including perforation of the uterus, conservative myomectomy, C-section and etc.,
• anomalies in the development or underdevelopment of the uterus,
• uterine fibroids,
• postpartum complications,
• multiple births (repeated pregnancy increases the likelihood of placenta previa by 3 times, since a woman accumulates a significant number of gynecological ailments by the second birth).

If the nidative function of the trophoblast is impaired (the late appearance of enzymatic processes in it), then the timely inoculation of a fertilized egg in the region of the uterine fundus is impossible, and it is inoculated only in the lower sections of the uterus. Serious diseases of the liver, kidneys and heart can also lead to placenta previa, as they cause congestion in the pelvic organs. The result of these phenomena is the deterioration of blood supply conditions in some areas of the uterine wall.

Migration of the placenta is also possible, which can be traced using ultrasound. The initial stage of pregnancy is characterized by the central presentation of the branched chorion, and by childbirth the placenta can be located normally or low. In some cases, placenta previa is combined with its dense attachment, causing difficulties with independent separation after childbirth.
In general, the diagnosis of placenta previa is more correctly made in the second half of pregnancy, since a change in the position of the placenta is possible (except in the case of central placenta previa).

Symptoms

The main symptom of placenta previa is spotting, which is also the main complication of this disease. The type of presentation determines in which period of pregnancy bleeding occurs and their intensity. For example, central placenta previa often results in early (2nd trimester) heavy bleeding, while marginal or lateral placenta previa often results in minor bleeding in the 3rd trimester or at delivery.

In most cases, the appearance of bleeding is observed at the 28th - 32nd week of pregnancy due to the greater severity during this period of the preparatory activity of the lower uterine segment. For the period of the 16th - 28th week of pregnancy, only 20% of cases of bleeding occur.

The main cause of bleeding in placenta previa is the constant increase in the size of the uterus throughout pregnancy: at the beginning, its size is equivalent to a matchbox, and by the end of pregnancy, the weight of the uterus can reach 1 kg (its volume is equivalent to the volume of the fetus, placenta, amniotic fluid and shells). Such a significant increase in the size of the uterus is possible due to an increase in the volume of each fiber from its structure. The maximum change in the size of the uterus is observed in its lower region and closer to childbirth. The location of the placenta in this place leads to the fact that the placental tissue, which is not distinguished by elasticity, does not have time to adapt to the more rapidly changing dimensions of the uterine wall. The result of this is the detachment of the placenta, on which the vessels are damaged, and bleeding occurs.

Placenta previa always causes external bleeding, in which blood passes through the cervical canal to the outside, and does not accumulate between its wall and the placenta, forming a hematoma. The onset of such bleeding is usually unexpected and does not cause pain. Thus, they can be distinguished from bleeding that occurs during premature termination of pregnancy (accompanied by cramping pains). The first bleeding inevitably entails subsequent bleeding, occurring with varying frequency, duration and intensity.

The appearance of bleeding after the 26th - 28th week of pregnancy can be caused by physical exertion, sexual intercourse and an increase in intra-abdominal pressure, including a gynecological examination. Therefore, a gynecological examination of women with placenta previa must be carried out with all precautions and in a hospital setting that provides emergency assistance if necessary. Prolonged bleeding is a danger to the life of the child and mother.

What is dangerous

Why is placenta previa dangerous? Anomalies in the location of the placenta are dangerous for both the baby and the mother.
And all because the walls of the uterus, as the gestational age and the size of the fetus increase, are constantly stretched. At the same time, the risk of premature placental abruption increases significantly, as a result of which the baby loses contact with the mother's body and, in the absence of timely medical care can die from an acute lack of oxygen and malnutrition.
Mom is also in danger: in the process of placental abruption, massive bleeding may develop.

Therefore, if by the time of delivery the placenta still covers the internal os of the cervix, childbirth in a natural way is impossible. After all, the process of childbirth begins with the opening of the cervix, accompanied by stretching of the internal pharynx, the outcome of which can be placental abruption, which will lead to bleeding, and life future mother and the baby will be at risk.

Diagnostics

In most cases, the diagnosis of placenta previa occurs in the 2nd trimester of pregnancy and is based on complaints of periodic bleeding. Pain does not occur. During the examination (or ultrasound), an incorrect position of the fetus may be revealed, as well as a high standing of the presenting parts of the child above the passage into the small pelvis (due to preventing them from lowering into the underlying part low location placenta).

The most objective, accurate and safe method of obtaining information about the movement and location of the placenta is ultrasound. In practice, a triple ultrasound is used - at the 16th, 24th - 26th and 34th - 36th week. If, as a result of these examinations, no pathologies were found in the location of the placenta, then other factors are most likely the cause of bleeding (for example, the presence of pathological lesions of the cervix and vaginal area).

The dangers of pathology

Placenta previa often increases the likelihood of a threatened miscarriage and the development of hypotension (a stable decrease in pressure). Hypotension also leads to weakness, decreased performance, fainting and headaches. In addition, bleeding can often provoke anemia, in which the level of hemoglobin in the blood decreases. As a result, symptoms of hypotension may increase and fetal development may be slowed down (growth retardation). In addition, in children of mothers who suffered from anemia during pregnancy, in the first year of life, a reduced level of hemoglobin is observed, which causes a decrease in the body's immunity.

The location of the placenta in the lower part of the uterus often leads to the fetus occupying the wrong position (oblique, transverse). The fetus may not be located with the head, as usual, but with legs or buttocks towards the exit from the uterus. This will require surgical intervention during childbirth, since they are impossible in a natural way.

Kinds

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. Inferior 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.

How is pregnancy and childbirth going?

A caesarean section for placenta previa is required at 38 weeks of gestation. Natural childbirth in this case is dangerous with severe bleeding that threatens the life of the child and mother and occurs as a result of detachment of the placenta when the child tries to exit. Also, a caesarean section is prescribed in the case of:

• placenta previa, accompanied by intense bleeding, life-threatening,
• recurring bleeding with severe hypotension and anemia, not eliminated by taking special drugs and combined with fetal pathologies,
• the presence of another pathology of the uterus with partial placenta previa.

Natural childbirth is possible in pregnant women with partial placenta previa, who carried the fetus to the term of delivery. The final location of the placenta is determined by opening the cervix by 5 cm. As a result, the bleeding stops, and childbirth takes place naturally. If bleeding continues, then surgery is required.