Complete placenta previa. What are the complications of placenta previa? Low placentation: features

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The quality of pregnancy, as well as the quality of labor, largely depends on the location of the placenta. Normally, it is attached to the front or back wall, closer to the fundus of the uterus.

But in approximately 1% of all pregnancies, it is discovered that the baby's place was implanted in an atypical place - too close to the internal os of the cervix. In such a situation, doctors talk about his presentation and raise the question of the advisability of natural delivery.

What is it? Placenta previa is a pregnancy pathology that involves the attachment of the placenta in such a way that it partially or completely blocks the exit to the cervical canal. Such localization of the child's place not only is an obstacle to normal labor, but also poses a threat to the life and health of the child and mother.

The main reason why the fertilized egg is implanted incorrectly is pathological changes in the structure of the endometrium of the uterus, which are caused by the following factors:

• Inflammatory diseases of the uterus, especially their chronic forms.
• Disorders of the structure of the endometrium and myometrium, in particular endometriosis, fibroids.
• Congenital anomalies of the uterine body (for example, bicornus)
• Mechanical trauma to the uterine cavity (curettage, history of cesarean section)
• Presence of multiple pregnancy.
• A history of more than 4 births.

Whatever the reason that leads to the pathology of the endometrial structure, the fertilized egg does not have the opportunity to implant into the wall of the uterus in time, and therefore attaches to the lower segment of the reproductive organ.

What are the dangers of placenta previa?

Currently, doctors are aware of the presentation by the end of the pregnancy, so most women undergo a caesarean section to avoid unnecessary risks associated with natural childbirth.

But if the expectant mother is not seen by a gynecologist and does not monitor the state of her pregnancy in any way, then with full presentation she has a high risk of dying if she allows birth naturally.

Placenta previa is also dangerous for the fetus. Starting from the second trimester, a woman may be bothered by periodic bleeding from the vagina, which is provoked by detachment of part of the baby's place.

• In addition, improper attachment of the placenta can cause hypoxia in the fetus and provoke premature birth.

Placenta previa during pregnancy does not go unnoticed either by the mother or by the attending physician. The first trimester can be relatively calm, but as the baby’s place matures and the size of the uterus increases, a woman may notice the following symptoms:

1. Bloody discharge. They are recurrent in nature and can appear suddenly, even if the patient is on bed rest.
2. Anemia. It is a consequence of frequent bleeding.
3. Exacerbation of STDs. Associated with a general weakening of the body’s defenses, which regularly experiences blood loss.

The studies complement the clinical picture characteristic of placenta previa. Tests, palpation and ultrasound examination will reveal the following signs of pathology:

• Fetal hypoxia
• Partial placental abruption
• Cervical smoothing
• Incorrect position of the fetus in the third trimester
• Presence of ascending genital tract infections

Already in the second trimester of pregnancy, it becomes clear whether the placenta will be previa, so if a woman is registered with a gynecologist, then by the time of birth doctors will try to minimize the risks for her and the baby.

Partial, low and central placenta previa

If the location of the baby's place is atypical, a cesarean section is not always indicated. If there are such types of localization of amniotic tissue, in which it is possible for a pregnant woman to have a natural birth.

Central placenta previa

Central placenta previa - sometimes called complete placenta previa. It involves absolute closure of the internal os of the cervix. This position of the child’s seat is observed in approximately 22–25% of cases of all presentations.

If the birth takes place naturally, then both mother and child will die, so in this case the only safe obstetrics service is a cesarean section, carried out before the end of the pregnancy (most often at 36 weeks).

Partial placenta previa

Partial placenta previa means that the internal cervical os is not completely blocked. Doctors distinguish two types of this pathology: lateral and marginal placenta previa (usually along the posterior wall).

• In the first case, the baby's place blocks approximately half of the cervical canal, and doctors do not always risk allowing such a pregnant woman to have a natural birth.
• In the second case, the baby's place blocks the cervical canal by a third - this makes it possible for normal delivery through the natural birth canal.

Low location of the placenta

Low location of the placenta - suggests that the baby's place is located at a distance of 5 - 6 cm to the internal os of the cervix. In some pregnant women, as the term increases, the membranes may stretch and end up close to the fundus of the uterus (this is the clinical picture that is observed normally).

This is one of the mildest forms of pathology, but medical supervision is still necessary, because low placenta previa during pregnancy threatens frequent bleeding and increased uterine tone.

Pregnancy management tactics

Atypical placement of a child's seat is quite rare, but requires special approach to the management of such a pregnancy. From the moment the pathology is discovered, the expectant mother should visit the gynecologist not once every 14 days, but once a week.

In addition, she will have to take more tests and undergo more examinations. In order for the pregnancy to end successfully, the gynecologist needs to adhere to a certain technique.

• Palpation of the uterus outside a hospital setting is extremely undesirable. It can cause severe bleeding and subsequent anemia in the patient.
• Regular fetal cardiotocography (CTG) to exclude hypoxia, or to carry out timely medical measures if it is detected.
• Regular ultrasound examination to monitor the condition of the placenta.
• Providing a pregnant woman with complete rest in a hospital setting at gestational ages from 30 weeks with severe bleeding.

The decision on how the birth will take place is made only by the doctor, without taking into account the opinion of the woman herself, since the situation obliges doctors to follow the path of reducing the risks of maternal and infant mortality.

Delivery with placenta previa

An atypical location of the baby's place may allow a natural birth, but only if the doctor did not see the potential risk of death for the mother and fetus. In all other cases, a caesarean section is performed.

Natural childbirth– possible with incomplete placenta previa and partial occlusion of the internal os of the cervix in the absence of severe bleeding.

Also, delivery through the genital tract can be carried out using special forceps if available. dead fetus. But at the same time, the child must have either a pelvic or cephalic presentation.

C-section– indicated for complete occlusion of the cervical canal, partial occlusion, as well as in the presence of severe bleeding.

The dead fetus is also removed abdominally if its release through natural channels is dangerous for the life of the mother. In this case, the child's seat must be quickly separated manually.

Placenta previa - consequences for the child

Timely medical intervention can largely correct the severity of bleeding during placenta previa, but in approximately 20% of cases the child suffers in one way or another from the atypical location of the baby's place. This is indicated by the following factors:

• Congenital anemia
• Prolonged hypoxia
• Fetal anomalies
• Hypotrophy

Often, severe bleeding can lead to the death of the fetus, as well as the death of the mother herself, if emergency assistance is not provided on time.

To prevent placenta previa, treatment for STDs and chronic inflammatory diseases of the uterus can be recommended. At the planning stage, it is necessary to monitor the state of the endometrium and its physiological changes depending on the change in the first and second phases using ultrasound for at least two cycles.

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During pregnancy, the baby is in the placenta. With the help of this shell, the child receives oxygen and nutrients from the mother's body. If the organ is in order and is attached to the back wall of the uterus, then the life of the fetus is not in danger. A serious pathology during pregnancy is placenta previa syndrome (low or marginal). What danger it poses to the fetus, the symptoms of the disease are described below.

What is placenta previa

Incorrect location or presentation of a child's place is a pathology that is found on early stages pregnancy. With this problem, the organ blocks the internal os partially or completely. It is located in the cervix and can block the birth canal. In the first trimester of pregnancy, pathology is common, but more later“placenta migration” may occur - during the development of the child, the uterus stretches, the placenta moves further from the cervix.

Symptoms

The main clinical symptom of placenta previa is bleeding. Its cause is organ detachment: the presence of bloody discharge indicates that a part is moving away from the side walls of the uterus and damaging the blood vessels. Highlight:

• vaginal bleeding;
• internal bleeding (with low presentation).

With heavy and frequent bleeding, a woman may suffer from hypotension (low stable blood pressure) and anemia (hemoglobin levels decrease). The pregnant woman is sent to the clinic for inpatient care for constant monitoring and examination. In difficult cases, pathology may result in fetal death. Bleeding occurs suddenly and always during sleep.

Reasons

Placental presentation occurs for many reasons. This can happen after active physical activity, examination of the cervix by a gynecologist. Pathology may develop in the first weeks. Until the 24th week, doctors do nothing: there is a chance of normal movement of the organ and attachment to the walls of the uterus. Other factors that cause pathology include:

• features characteristic of a fertile egg;
• endometrial pathology;
• C-section;
• perforation of the uterus;
• scraping;
• multiple births with complications;
• myomectomy;
• abnormalities in the location of the uterus;
• contraction of the uterus;
• diseases of the reproductive system.

Species

There are several types of presentation in the cervical region and two main classifications. The first is determined using transvaginal ultrasound diagnostics. The second is determined during childbirth, when the cervix has opened by 5 cm. The degree and type of pathology changes as the opening of the pharynx, cervix and uterine growth increases. In total, there are three options for presentation:

• complete;
• low;
• incomplete;
• central;
• lateral.

Complete

With complete placentation, the placenta covers the internal os. That is, if the cervix opens completely, the child will not be able to be born, because his path is blocked by an organ that completely closes the exit from the uterus. In case of complete pathology, natural childbirth is not carried out. One option for delivery is the use of caesarean section. This location is the most dangerous pathology of the cervix. In 25% of cases, serious complications occur during childbirth, which can lead to maternal or child mortality.

Incomplete

In the case of partial presentation (incomplete closure), the organ partially blocks the internal canal of the cervix: a small area remains in the opening. Incomplete pathology is compared to a plug, because the organ covers part of the pipe, which does not allow amniotic fluid move at the required speed. The lowest edge is level with the opening of the cervix. The baby's head will not be able to pass through the narrow part of the birth canal.

Low

Classic low presentation of the chorion during pregnancy is determined by its incorrect location, that is, the organ is located 7 cm or more from the perimeter of the cervical canal and does not reach the entrance. The entrance to the area of ​​the internal os of the cervix is ​​not captured. They may allow natural childbirth if gestation is progressing well. Low pathology is the most favorable of all dangerous complications. In obstetric practice, ultrasound is used to determine the degree of pathology during pregnancy.

Central

With such a presentation, the entrance to the cervical canal from the side of the uterus is completely closed by the new organ. During a vaginal examination, the gynecologist will not be able to identify the membranes. In this case, there is no natural labor, so a caesarean section is used. Central pathology is determined during childbirth or during a vaginal examination.

Lateral

During a vaginal examination with lateral presentation, the doctor determines the part of the organ that covers the entrance to the cervical canal, next to which there is a rough membrane. With lateral placentation, an incorrect location is formed, which is determined after examination and corresponds to the results of ultrasound about the presence of incomplete pathology or grade 2-3 in the first weeks of pregnancy.

Regional placenta previa

In case of marginal pathology, during a vaginal examination with the help of fingers, the gynecologist is able to identify the rough membranes of the fetus that protrude into the lumen of the cervical canal. Marginal placentation during pregnancy is determined by the fact that the organ is located near the edge of the internal os. It is determined during a vaginal examination and corresponds to the results of ultrasound for incomplete presentation or grade 1-2.

Placenta previa on the posterior wall

This type of pathology is characterized by the attachment of the organ to the villi of the posterior wall of the uterus. This deviation is common with incomplete or low presentation. The main part of the organ is attached to the back wall of the uterus, the exit is blocked by the placenta, which prevents natural labor. In this case, a caesarean section is performed - natural childbirth poses a danger to the child’s life.

Placenta previa on the anterior wall

Anterior pathology is marked by the attachment of the organ to the anterior wall of the uterus. This case is common with low or incomplete presentation. That is, the main part of the organ is attached to the anterior wall of the uterus, and this condition is considered not a pathology, but the norm. This condition is determined during an ultrasound scan before the 26th week of pregnancy. In this case, there is the option of placenta migration, which increases the likelihood that the woman will be sent for a normal natural birth.

What are the dangers of breech presentation?

Placental presentation recurs periodically, placental abruption can provoke fetal hypoxia and bleeding, therefore, there is a threat of termination of pregnancy. For example, with complete pathology, it comes to the point that pregnancy ends in premature birth. The consequences of the pathology may be the following:

• gestosis;
• termination of pregnancy;
• fetoplacental insufficiency;
• incorrect positioning of the fetus inside the uterus;
• chronic fetal hypoxia;
• foot or breech presentation fetus;
• iron deficiency anemia.

Fetoplacental insufficiency is due to the fact that the lower segment of the uterus has low blood supply compared to the body or fundus, that is, little blood reaches it. If there is poor blood flow in the localization of the placenta, this means that there is not enough oxygen and nutrients that should flow to the fetus, which does not satisfy its needs. Incorrect positioning of the baby or breech presentation is caused by insufficient free space in the lower part of the uterus for the head.

Diagnostics

In order to determine the type or degree of pathology of the placenta, they look at risk factors in the anamnesis, external uterine bleeding and objective examination data. An external examination reveals a high position of the uterine fundus (transverse or oblique position of the fetus). Sometimes auscultation of the noise of placental vessels in the uterine segment at the location of the placenta is performed. During an ultrasound, diagnostics are carried out:

• size of placentation;
• stages;
• type;
• structures;
• degree of detachment;
• presence of hematomas;
• threats of abortion;
• placental migration.

During a gynecological examination, the cervix is ​​examined to exclude vascular injuries or pathologies. When the external pharynx is closed, the part of the fetus cannot be determined. In case of complete presentation, a massive soft formation (fetal sac) is identified, which occupies the vaginal opening. During a palpation examination of a pregnant woman, with complete pathology, the occurrence of bleeding is diagnosed. If during examination there are membranes of the uterus and placental tissue in the lumen of the uterine pharynx, this means that you have an incomplete presentation.

Treatment

Among the methods of treating this pathology, there are two types - medicinal and non-medicinal. It is necessary to ensure the woman’s complete rest (exclude physical activity, sex, stressful situations, etc.). She is prescribed bed rest and medications such as Drotaverine, Fenoterol, Dipyridamole, Dexamethasone, which contribute to a better progress of labor. Caesarean section is prescribed for a narrow pelvis, polyhydramnios, multiple pregnancies, and the presence of scars in the uterus.

Childbirth with placenta previa

With this diagnosis, doctors select individual approach to delivery. If the mother does not have obstetric complications and other pathologies with low placental implantation, this means that a natural birth can occur. During childbirth, the woman’s condition is continuously monitored, especially the amount of bloody discharge that accompanies the process, labor indicators and the intrauterine condition of the child.

Sometimes urgent tests are performed in the laboratory or ultrasound. If complications, heavy bleeding and complete placentation are observed during labor, a cesarean section is performed. Regardless of various complications during pregnancy, it is necessary to act in accordance with the advice of a specialist, so it is recommended to listen to your doctor. A caesarean section for low placentation may also be prescribed.

Prevention

Preventive measures for previa include preventing abortions, detecting and treating hormonal dysfunction or genital pathology. Pathology develops during pregnancy and at this time it is necessary to diagnose abnormalities. It is recommended to manage the pregnancy rationally, taking into account all the threats and risks of complications, and to correct violations in a timely manner in order to obtain an optimal delivery.

Video

Placenta previa during pregnancy is considered one of the serious complications during pregnancy and subsequent childbirth. The fact is that the situation when the placenta completely or partially covers the uterine os, and this is placenta previa, is irreparable - there is no way to correct this state of affairs with medication, although there is always a chance that it will displace on its own from the lower parts of the uterus.

The only symptoms that may indicate placenta previa during pregnancy are painless bleeding. They usually appear closer to the second half of pregnancy against the background of complete well-being.

Causes of placenta previa

Placenta previa is diagnosed using ultrasound, and the final diagnosis can be made after 24 weeks - before that there is a chance that the placenta will change position on its own. In addition to the fact that ultrasound determines the final diagnosis of placenta previa, this method also makes it possible to determine the variants of presentation, the size and area of ​​the placenta, and the degree of abruption.

The reasons for the occurrence of placenta previa during pregnancy can be changes in the mucous membrane of the inner wall of the uterus as a result of repeated abortions, inflammation or sexually transmitted infections, or previous complicated childbirth.

A predisposition to such pathology is more common in women with deformations of the uterine cavity, caused by congenital anomalies or acquired (for example, as a result of uterine fibroids).

The cause of placenta previa can even be diseases of the heart, liver or kidneys, accompanied by congestion in the pelvic organs (including the uterus).

In addition, placenta previa is three times more common in women who are giving birth more than once.

Depending on the location of the placenta, there is a low presentation (attachment) of the placenta, complete (central) or partial presentation (can be lateral or marginal).

Low placenta previa

During a normal pregnancy, the placenta is located along the bottom or body of the uterus, along the anterior (less often posterior) wall with a transition to the lateral walls. Low placenta previa is characterized by a situation where the placenta is located in close proximity to the internal os of the cervix - at a distance of 6 cm or even less.

This pathology is most often determined in the second trimester of pregnancy during the next ultrasound. But at the same time, if low placenta previa was diagnosed during this period, there is a possibility that over time, as pregnancy progresses, the placenta will take a “normal position.”

Conventionally, this state of affairs is called “migration,” and the movement of the placenta is caused by stretching and stretching of the uterine tissue. So, as the fetus develops, the elastic tissues of the lower part of the uterus gradually rise upward. At the same time, some upward movement of the placenta occurs, due to which its location becomes normal. Therefore, if a low location of the placenta was discovered in the second trimester of pregnancy, there is a fairly high probability that it will move towards the end of pregnancy and the situation will normalize.

Regional placenta previa

Partial or incomplete placenta previa refers to its location in which the internal os of the uterus is blocked by the placenta, but not completely. One type of partial placenta previa is marginal placenta previa.

With the marginal location of the placenta, its lower edge is at the level of the edge of the internal os, while the outlet of the uterus is covered by approximately a third by placental tissue.

Usually, marginal placenta previa is diagnosed in the second trimester of pregnancy using ultrasound, against the background of complaints from the pregnant woman of constant bleeding. If marginal placenta previa has been determined, the woman needs careful medical supervision and carrying out all necessary research. Iron-containing drugs may be prescribed as necessary to avoid bleeding and the development of anemia due to a decrease in hemoglobin levels.

Complete placenta previa (central placenta previa)

Complete placenta previa is probably the most serious pathology associated with improper placement of the placenta. We speak of complete presentation when the placenta completely closes the internal os; during a vaginal examination, placental tissue is detected everywhere; the fetal membranes are not palpable. If, in addition, it is possible to establish that the center of the placenta is located at the level of the pharynx, a diagnosis of “central placenta previa” is made.

Partial placenta previa is diagnosed with a frequency of 70-80% of the total number of presentations. At the same time, complete presentation occurs in 20-30% of cases, and this, unfortunately, is not a small indicator.

With complete placenta previa, the woman, even in the absence of bleeding, must be sent to the hospital. Diagnosed central presentation is a serious pathology in which the pregnant woman should be provided with constant qualified medical supervision.

Treatment of placenta previa

If previa is detected, the doctor will decide on the treatment regimen and subsequent actions based on the specifics of placenta previa. But, be that as it may, in the case when a pregnant woman was diagnosed with placenta previa, she will need constant supervision by specialists.

If no bleeding is observed, the expectant mother may be allowed to be observed on an outpatient basis. At the same time, she needs to avoid stress - both physical and emotional, exclude sexual contact, sleep at least 8 hours a day and walk as much as possible. You will also need a special diet that involves consuming foods rich in iron, protein and vitamins. A diet is necessary to maximize the intake of useful substances into the pregnant woman’s body: with placenta previa, part of it does not participate in gas exchange, which can provoke. Meanwhile, the mother may experience anemia or anemia, which also becomes a consequence of placenta previa during pregnancy.

If, after 24 weeks, a pregnant woman experiences periodic bleeding, she will be asked to go to a hospital, where she can always receive emergency care in case of possible complications. In this case, doctors recommend inpatient observation until the end of pregnancy. If the bleeding is minor and the woman’s well-being has not deteriorated, they resort to conservative treatment methods: the pregnant woman is prescribed bed rest, complete rest, and medications that reduce the tone of the uterus and improve blood circulation. If the expectant mother is detected, she is prescribed drugs to increase hemoglobin levels, as well as drugs for general strengthening body.

Childbirth with placenta previa

Placenta previa during pregnancy is an indication for delivery by cesarean section; in the case of complete presentation, it is mandatory, since other methods of delivery are impossible. If the pregnancy has been preserved, a cesarean section is performed at 38-39 weeks.

With incomplete placenta previa, childbirth is possible, but it is associated with a certain risk. In addition, for natural childbirth with incomplete placenta previa, mandatory cessation of bleeding after opening of the membranes, a mature cervix, good labor and cephalic presentation of the fetus are mandatory conditions. In other cases, if childbirth proceeds naturally, there is a high risk of complete detachment of the placenta, which will result in very heavy bleeding. And this is fraught with serious complications - even death for both mother and baby.

Especially for- Tatyana Argamakova

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

The chorionic villi penetrate the loose mucous membrane of the uterus, densely permeated with blood vessels, and receive the necessary nutrients from there.

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

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

There are also some factors on the maternal side that, according to statistics, significantly increase the likelihood of the placenta being located in the lower segment of the uterus:

• frequent (or chronic) inflammatory processes of the endometrium and infections of the genital organs;
• congestion in the pelvis (due to chronic diseases of the mother);
• previous abortions;
• placenta previa in previous pregnancies;
• scar on the uterus;
• smoking;
• complicated previous births;
• abnormalities in the structure of the uterus.

All these reasons influence the formation of the uterine mucosa. If it is underdeveloped and the blood flow is weakened, then nature itself chooses a “convenient” place for feeding the fetus - the lower part of the uterine cavity. According to the laws of physics, the blood supply to this area will always be better than in the upper lobes.

Preventative measures such as avoiding bad habits, timely visits to the doctor and treatment of inflammatory diseases, full physical activity, hygiene of the genital organs - significantly reduce the risk of such complications during pregnancy.

Diagnostics

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

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

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

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

The woman is closely monitored by a doctor for the entire period, undergoes tests and ultrasounds more often, and regularly receives medication that supports the placenta and prolongs the pregnancy.

The position of the placenta is monitored by ultrasound at 16, 25 and 34 weeks of pregnancy.

Depending on whether the placenta covers the cervix and where the central part of the baby’s place is located, doctors distinguish 4 degrees of presentation:

1. the placenta is 3 cm from the internal os;
2. the edge of the placenta has reached the cervix, but the internal os is not blocked;
3. one of the edges of the placenta is attached to the opposite part of the lower segment of the uterus, the internal os is covered by part of the placenta;
4. the center of the placenta is located on the internal os, and both of its parts are symmetrically located on opposite lobes of the uterus.

Presentation of the 3rd and 4th degrees is uncommon, less than 1% of the total number of births.

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

Symptoms of low presentation

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

In case, you need to consult a doctor. But this is not yet a reason to panic!

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

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

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

• headaches;
• nausea;
• dizziness;

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

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

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

Why is it dangerous?

If at the beginning of pregnancy a presentation of 1-2 degrees was diagnosed, but until the 24-26th week of pregnancy the placenta has not changed its position, low presentation may lead to new complications.

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

• recurrent bleeding can lead to;
• anemia causes hemorrhagic shock (threat to the life of the fetus);
• Possible deterioration of blood flow due to compression of blood vessels, and this leads to fetal hypoxia;
• (can also cause fetal hypoxia);
• low placentation may prevent the fetal head from descending into the pelvis. As a result, an incorrect (lateral) position of the fetus is diagnosed, and it is also possible. This makes natural childbirth difficult;
• Even when the birth canal is clear, the placenta can shift during contractions during natural childbirth and make it impossible. In this case, an emergency CS is performed;
• the location of the placenta on the anterior wall of the uterus can lead to large blood losses during the delivery operation. In this case, the CS is performed according to a special algorithm, which allows the baby to be born faster, and then provide the mother with the necessary therapy.

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

By 36 weeks, after assessing fetal maturity, a cesarean section is prescribed. If necessary, delivery is carried out earlier.

What to do if you have been diagnosed with low placenta previa?

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

If the pregnant woman feels well and is at home, we must not forget about preventing complications.

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

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

If you have been diagnosed with this, you must follow your doctor's recommendations with special care.

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

Placenta previa during pregnancy is one of the terms in obstetric practice. This refers to the various types of attachment of this vascular disc inside the uterine cavity. The designation "present" indicates that the placenta is located in close proximity to the birth canal and, therefore, blocks it. About the options and specifics of localization of the placenta in expectant mother Let's talk further.

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

To understand the essence of presentation as a pathology, let us remember how the uterus is built. The large muscular organ is divided into a body, bottom and neck. The cervix is ​​at the bottom of the uterus, the fundus is at the top, and between them is the body of the uterus. The outer part of the cervix extends into the vagina.

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

Placenta previa during pregnancy: types of pathology and their characteristics

Based on the results of an analysis of the specific localization of the placenta in the cervix, several types of presentation were identified. Today, doctors use two main classifications of pathology.

Types of presentation according to ultrasound results

1. Full presentation. The round and flat baby's place completely blocks the cervix. When the time is right, the cervix will open, but the baby's head will not be able to move forward. Complete placenta previa during pregnancy excludes natural childbirth - the baby will be removed by caesarean section. This type of pathology accounts for about 25–30% of cases of the total number of presentations. Complete presentation is completely unpredictable, as it causes high mortality rates for women in labor and newborns.
2. Partial presentation. In this case, the placenta does not completely block the exit from the cervix, while a small area remains open. The baby’s head cannot squeeze through this gap, so most often doctors are inclined to operative delivery. Pathology occurs in 40–55% of pregnancies.
3. Low presentation. The baby's place is located approximately 3 - 5 cm from the cervix, but is not adjacent to it. it is obvious that the area of ​​entry into the cervical canal remains free. Low placenta previa during pregnancy gives a woman a chance to give birth to a child on her own. Despite the fact that this type of pathology is considered the safest from the point of view of bearing a child and childbirth, complications are possible here too. If we delve deeper into the question of what threatens low placenta previa during pregnancy, we should list the most common complications:

• threat of spontaneous abortion;
• anemia and low blood pressure in women;
• malposition;
• oxygen starvation and a high probability of developmental delay in the child.

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

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

1. Central. The opening of the cervical canal is closed by the placenta. The obstetrician diagnoses this when he inserts a finger into the vagina: the placenta can be felt, but the membranes cannot be checked. Natural delivery with this type of pathology is impossible, and the baby is born through cesarean section. We also note that central placenta previa during pregnancy corresponds to complete placenta previa, which is determined by ultrasound.
2. Lateral. In this case, the obstetrician is able to palpate not only the part of the placenta that covers the opening of the cervical canal, but also the rough surface of the fetal membranes. Lateral presentation corresponds to partial placenta previa according to ultrasound results.
3. Regional. The obstetrician feels the rough membranes that protrude slightly into the external opening of the cervix, as well as the placenta, which is located near the internal os. Regional presentation is correlated with the initial stages of partial presentation according to ultrasound data.
4. Rear. This pathology is a variant of partial or low presentation, when almost the entire placenta is located in the posterior wall of the uterus.
5. Front. This condition is also considered a particular type of partial or low presentation - in this case the placenta is attached to the anterior wall of the uterus. This case is not regarded as a pathology, but is considered a variant of the norm.

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

Causes of placenta previa

It can provoke the development of pathology when the fertilized egg is implanted in the area of ​​the lower segment of the uterus and placenta previa subsequently forms at this site. large number factors. Depending on the origin of these factors, they are divided into uterine and fetal.

Uterine factors in the development of placenta previa

They depend solely on the expectant mother. They are expressed by all sorts of abnormalities of the uterine mucosa that appear due to inflammation (for example, endometritis) or surgical manipulations inside the uterus (for example, abortion or cesarean section).

Uterine factors include:

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

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

Fetal factors of placenta previa

Depends on the specifics of the development of the fertilized egg. Fetal factors are paid attention to when there is reduced enzymatic activity in the tissues of the fertilized egg, due to which it attaches to the uterine mucosa. When there are not enough enzymes, the egg with the embryo is not able to implant into the lining of the fundus or walls of the uterus, so it is attached to its lower part.

Among the fetal factors we note:

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

Indicators of placenta previa during pregnancy

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

3 - 4 weeks before the baby is born, the uterus prepares for the upcoming heavy load and from time to time contracts significantly. Against the background of training contractions, bleeding becomes more profuse than before. Blood appears due to partial placental abruption, which is caused by stretching of the uterus. When any part of the placenta detaches, blood vessels open, which are the source of blood.

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

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

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

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

Why is placenta previa dangerous during pregnancy?

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

1. Miscarriage.
2. Severe toxicosis.
3. Anemia.
4. Pathological location of the fetus in the uterus (pelvic or leg).
5. Chronic oxygen starvation of the fetus.
6. Slow pace intrauterine development child.
7. Fetoplacental insufficiency.

Treatment of placenta previa during pregnancy

There is no specific treatment that could be used to influence the location of the placenta in the “right” place. Stopping frequent uterine bleeding and prolonging pregnancy (ideally until the due date of birth) is all that doctors can offer to a patient with such a problem.

The reasonable behavior of the expectant mother is of great importance for the successful bearing of a baby against the background of presentation. Here's what she should do to avoid causing bleeding with her careless behavior:

• avoid intense physical activity;
• do not jump or bounce;
• avoid bumpy driving on uneven roads;
• refuse to fly on an airplane;
• don't be nervous;
• do not lift or carry heavy things.

During the day, a pregnant woman with placenta previa should take short rests. To relax, you need to lie on your back and raise your straight legs up, resting them on a wall, closet or back of the sofa. This position should be taken as often as possible.

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

Firstly, pregnant women are required to be prescribed medications from the following drug groups:

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

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

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

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

Thirdly, when treating a pregnant woman with placenta previa, the intrauterine condition of the baby must be monitored. To eliminate placental insufficiency and prevent the development of oxygen starvation, pregnant women are prescribed the following medications:

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

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

If there is a sudden development of heavy and persistent bleeding that cannot be stopped for a long time, the pregnant woman is advised to undergo an emergency cesarean section, otherwise the life of the expectant mother is in great danger. Unfortunately, in such a force majeure situation, they no longer think about the well-being of the fetus, since all efforts to preserve pregnancy in the event of massive bleeding due to placenta previa usually lead to death for both mother and child. According to statistics, today more than 70–80% of cases of placenta previa during pregnancy end in surgical delivery.

Placenta previa during pregnancy and sexual activity

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

Placenta previa during pregnancy: reviews

Women who, while carrying a child, are faced with any type of presentation, talk about pathology in different ways. The problem, identified at 20–27 weeks of pregnancy, in the vast majority of cases “resolved” on its own over time: by the time the baby was born, migration had occurred, and the placenta had risen higher from the lower segment of the uterus. The birth went well.

In rare cases, the low-attached placenta retained its pathological position until delivery. The women in this case gave birth to the child by Caesarean section. Pregnancy under such circumstances was relatively difficult and expectant mothers were forced to behave extremely carefully so as not to cause massive bleeding from the genital tract and not lose the baby.

All women confirmed that placenta previa during pregnancy is a real challenge. However, in most cases, carrying a child with a presentation resulted in the successful birth of a healthy baby, so the main thing for the mother is to worry less and believe in the best.