Placenta previa - classification, symptoms, diagnosis, principles of treatment. Childbirth with placenta previa

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During pregnancy, the baby is in the placenta. With the help of this shell, the child receives oxygen, nutrients from the mother's body. If the organ is in order and fixed on the back wall of the uterus, then nothing threatens the life of the fetus. A serious pathology during pregnancy is placenta previa syndrome (low or marginal). What danger to the fetus it carries, the symptoms of the disease are described below.

What is placenta previa

The incorrect location or presentation of the child's place is a pathology that is detected in the early stages of pregnancy. With this problem, the organ overlaps the internal pharynx partially or completely. It is located in the cervical area and can block the birth canal. In the first trimester of pregnancy, pathology is common, but at later stages, “placental 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 the detachment of the organ: the presence of bloody discharge indicates that the part moves away from the side walls of the uterus and damages the vessels. Allocate:

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

With heavy and frequent bleeding, a woman may suffer from hypotension (low stable pressure) and anemia (hemoglobin levels decrease). The pregnant woman is sent to the hospital for preservation for constant monitoring and examination. In difficult cases, with pathology, fetal death is possible. The bleeding is sudden and always during sleep.

The reasons

Placental presentation occurs for many reasons. This can happen after active physical exertion, examination of the cervix by a gynecologist. Pathology can 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. The causes of the appearance of pathology include other factors:

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

Kinds

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

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

Complete

With complete placentation, the placenta covers the internal os. That is, if the cervix is ​​fully opened, the child will not be able to be born, because an organ blocks the way, which completely closes the exit from the uterus. With complete pathology, natural childbirth is not carried out. One option for delivery is only 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 infant mortality.

incomplete

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

Low

The classic low presentation of the chorion during pregnancy is determined by the wrong location, that is, the organ is 7 cm or more from the perimeter of the cervical canal, does not reach the entrance. The entrance to the region of the internal cervical os is not captured. Can allow natural childbirth if the gestation is going well. Low pathology is the most favorable of all dangerous complications. In obstetric practice, with the help of ultrasound, the degree of pathology during pregnancy is determined.

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 activity, so a caesarean section is used. Central pathology is determined during childbirth or during a vaginal examination.

Lateral

During a vaginal examination with a lateral presentation, the doctor determines the part of the organ that closes the entrance to the cervical canal, next to which there is a rough fetal 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 2-3 degrees in the first weeks of pregnancy.

Marginal placenta previa

With marginal pathology during a vaginal examination with the help of fingers, the gynecologist is able to determine 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 pharynx. It is determined during a vaginal examination, corresponds to the results of ultrasound for incomplete presentation or 1-2 degrees.

Posterior placenta previa

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 is a danger to the life of the child.

Anterior placenta previa

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

What threatens previa

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

• preeclampsia;
• abortion;
• fetoplacental insufficiency;
• incorrect location of the fetus inside the uterus;
• chronic fetal hypoxia;
• foot or pelvic presentation of the fetus;
• Iron-deficiency anemia.

Fetoplacental insufficiency is due to the fact that the lower segment of the uterus has a low blood supply, compared to the body or bottom, that is, little blood enters 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 be supplied to the fetus, which does not satisfy its needs. Incorrect positioning of the child or breech presentation is due to 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, look at the risk factors in history, external uterine bleeding and objective examination data. An external examination reveals a high standing of the fundus of the uterus (transverse or oblique location of the fetus). Sometimes auscultation of the noise of the placental vessels in the uterine segment at the location of the placenta is performed. During the ultrasound diagnostics is carried out:

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

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

Treatment

Among the methods of treatment of this pathology, there are two types - drug and non-drug. It is necessary to ensure the complete rest of the woman (exclude physical activity, sex, stressful situations or other). She is prescribed bed rest and drugs, such as Drotaverine, Fenoterol, Dipyridamole, Dexamethasone, which contribute to a better course of childbirth. Caesarean section is prescribed for a narrow pelvis, polyhydramnios, multiple pregnancies, the presence of scars in the uterus.

Childbirth with placenta previa

With such a diagnosis, doctors select an individual approach to delivery. If the mother does not have obstetric complications and other pathologies with low placental malposition, this means that there may be a natural birth. During childbirth, the condition of the woman is continuously monitored, especially the amount of bloody discharge that accompanies the process, the performance of childbirth and the prenatal state of the child.

Sometimes urgent tests are carried out in the laboratory or ultrasound. If complications are observed during labor, heavy bleeding and complete placentation, a caesarean section is performed. Regardless of the 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. Cesarean section with low placentation can also be prescribed.

Prevention

Preventive measures for presentation are the prevention of abortion, the detection and treatment of hormonal dysfunction or genital pathology. Pathology develops during pregnancy and at this time it is necessary to diagnose anomalies. It is recommended to rationally manage pregnancy, taking into account all the threats and risks of complications, to correct violations in a timely manner in order to obtain optimal delivery.

Video

The site is a medical portal for online consultations of pediatric and adult doctors of all specialties. You can ask a question about "placenta previa posterior" and get a free online consultation with a doctor.

Questions and answers for: posterior placenta previa

2015-08-26 00:41:31

Eli asks:

Hello, the gestational age is 34 weeks (from the day of the last menstruation), height 164, weight at 13 weeks 60 kg, today 70 kg. at 33 she was at the appointment with her doctor, she did not like that in 3 weeks I gained 3 kg, as well as my slight swelling of the feet, although I did not complain, there was no varicose veins. Before that, all the tests (cardiogram, smears, blood, urine) and ultrasound are normal, the pressure is 110/80, the child, according to her, will be 3,600. the doctor could not listen to the heartbeat because of the dead battery in the device !!! - everything is normal ... But, they prescribed Tivortin to drink 10 ml 3 times a day for 2 weeks, they just explained that this is to avoid oxygen starvation of the baby. I read the instructions, to be honest, there is no desire to take it, because. for the whole pregnancy there were only vitamins, and I felt good. In addition, it is not clear how my normal pressure will behave after taking it.
Today I decided to go for an ultrasound, the result is as follows:
fetal position is longitudinal, cephalic presentation, rhythmic heartbeat 135 beats / min, 4-chamber section of the heart +, fetal movements +
BPR 86 mm, LZR - 104 mm, Cranial index: N, SJ N, DB-66 mm, SDGK N, The amount of amniotic fluid is normal, The vertical size of the amniotic fluid is AF 50 mm, placenta along the back wall, uterine fundus. The degree of maturity of the placenta is 3, the thickness of the placenta is 38 mm, there are no pathological inclusions. The umbilical cord in the projection of the fetal neck is not visualized, the number of vessels is 3, visualized. CMs were not detected at the time of the examination. Myometrium tone - normotonus.
Dopplerogram: From / To - 2.97 IR - 0.66

Biophysical profile of the fetus - 8 points
The activity of fetal movements - 2b.
Muscle tone of the fetus - 2b.
The amount of amniotic fluid - 2b.
Respiratory movements - 2b.

Conclusion: B 34 weeks, cephalic presentation Premature maturation of the placenta.

I called my doctor, she prescribed Normoven in addition to Tivortin ... she said for the placenta ... Control of CTG once a week (I agree with CTG).

I am completely at a loss from such a diagnosis, I shoveled a bunch of conflicting information about these drugs, there is no desire to take them and it’s scary for my daughter ... I would be grateful for an independent opinion of a specialist on my situation.

Responsible Palyga Igor Evgenievich:

Hello Elya! Tivortin can be prescribed during pregnancy, it does not have any negative effect on the fetus and is prescribed for hypoxia. To be honest, I see no indications for prescribing drugs, but I have no right to virtually cancel or prescribe drugs. One thing I can say for sure - CTG is necessary to pass weekly. With an increase in hypoxia, you will be sent to a hospital.

2012-12-13 11:36:51

Christina asks:

Hello, I am turning to you for advice. The fact is that I cannot be given the final term of pregnancy. I am 21 years old, the first pregnancy, at the time of conception was 20 years old. There were no abortions.
The first day of the last menstruation is July 5, 2012, but I am sure that conception could not occur, since I had sex only after the 10th.
At the first ultrasound (October 17, 2012), the period was set for monthly - 14 weeks 6 days, and according to the results of ultrasound - 13 weeks 3 days.
On the second ultrasound (December 9, 2012), the monthly period is 22 weeks 3 days, but the results of the ultrasound:
BPR 48mm;
LZR 61mm;
OG 176mm;
coolant 148mm;
DB / coolant * 100% \u003d 21.6%
Thigh length right and left 32mm;
Leg length right and left 28mm;
The length of the humerus sp. sl. 30mm;
Forearm length sp. sl. 26mm;
The length of the nasal bone is 7.8 mm;
Thickness of the neck fold (up to 21 weeks) 4.5mm;
Heart rate 134 beats per minute;
The distance from the lower edge of the placenta to the inside. pharynx 70mm;
Placenta thickness 24mm;
0 degree of maturity;
amniotic index. liquid 148mm;
Umbilical cord 3 vessels;
Cervical length 36mm;
Localization of the placenta along the back wall;
The position is longitudinal, pelvic presentation.
The spine is located at 8 o'clock.
Gender girl.
Conclusion 19-20 weeks of pregnancy, and according to the first ultrasound should be 21-22 weeks.
Could this be a delay in the internal development of the fetus?

Responsible Gritsko Marta Igorevna:

That's right, the term is 22 weeks, according to ultrasound 20 weeks. Were the results of the combined and triple tests normal? If yes, then you should not worry, you need to assess the situation in dynamics. I don't think it's intrauterine growth retardation. Get a follow-up ultrasound in a month.

2012-07-04 05:08:12

Venus asks. :

Hello, Doctor. Help me please! I had an ultrasound today at 32 weeks. Please decipher. Is everything okay with me? And she didn’t exactly say the gender of the child, the girl said more percent, so who will be?
Presentation: head. Position: longitudinal.
SOG 149; SRU h/w 3s. BPR/OG: 81/291.
SJ 270. dB 61. PMP: 1773g (32cm)
Amniotic fluid: 55mm.
Localization of the placenta: on the back wall.
Degree of maturity: 1degree of maturity
Placenta thickness: 35mm.
Recommendations for ultrasound observation: entanglement around the neck.

Conclusion: Pregnancy 32 weeks. The rate of development of the fetus rear view.

Responsible Wild Nadezhda Ivanovna:

Who will be? There will be a child! I can’t say the rest, because I need an inspection. A very persuasive request: if you can’t make out the doctor’s handwriting, then don’t invent diagnoses for yourself, it’s better to ask. They will answer you, give explanations, but do not write nonsense. What is written is within the normal range for such a period. I think that the most important thing is that the baby is healthy, and the gender - let it be a surprise on the day of birth.

2012-05-15 03:22:08

Elena asks:

Now the 17th week on the ultrasound, they said marginal presentation, the lower edge reaches the area of ​​\u200b\u200bthe internal pharynx, at 27-28 weeks I have to fly by plane for 3.30 minutes, no more deviations, no tone, no neck, 50 mm long, closed all over, no pain, no blood, no placenta on the back wall, can I fly? Having taken all the sedatives, just in case, vikasol noshpu magne, can something happen in a three-hour flight? You need to fly very much. What do you think?

Responsible Wild Nadezhda Ivanovna:

It is impossible to predict in advance. Marginal placenta previa is dangerous - bleeding, and this can lead to the death of the child. In addition, bleeding during pregnancy is dangerous for the life of the woman herself. It is very massive and in a very short period of time, they may not have time to provide assistance. But, one feature is characteristic of the placenta: migration, i.e. it can rise, but not always. You need an ultrasound. The placenta, which is difficult to diagnose along the back wall, can be missed a lot (not everything is visible, technically) ... During pregnancy, trips and flights are undesirable, especially in the hot season, this is a big burden on the immune system of a woman and a child. Please tell me where the sea will go from you, etc., is it really vital? Is it really possible to neglect the child and your health like that? ... After all, besides everything, there is a pressure drop during takeoff and landing. And much more... You don't even need placenta previa.... Believe me! Everything that does not happen all for the better, so it is necessary from above. Think very much.

2016-04-07 10:46:44

Olga asks:

Good afternoon. Tell me, please, I have pregnancy 2, (1 frozen at 8 weeks). Deadline 21 weeks. For a period of 18 weeks, the ultrasound doctor determined that my placenta is located on the back wall very low, 5 mm, not reaching the pharynx. I was put on bed rest. After 2 weeks, i.e. for a period of 20 weeks, I was given a complete placenta previa with a transition to the anterior wall by 9 mm. They said to continue strict bed rest, which will most likely continue until delivery, because. Raising the placenta is unlikely. I have such a question for you: do I really need to lie down all the time or are walks for 20 minutes on the street allowed? The fact is that I have been on bed rest since the 10th week (there was a hematoma). In total, I have been lying in a horizontal position for 2.5 months without going outside. And if I still have to lie down for 4 months without going out into the fresh air, I don’t know how I can withstand it. Thanks

Responsible Wild Nadezhda Ivanovna:

If there is placenta previa, then there is a high probability of massive bleeding, in such situations the mother is saved, the child dies. Therefore, the choice is yours: walks or a child. The placenta is able to migrate, so everything is possible, you need patience and a positive attitude.

2015-05-20 18:41:04

Elena asks:

Tell me, please, at 20 weeks, they put in place full placenta previa completely covers the level of the internal os with a transition to the back wall, the width of the internal os is 2 mm at 21 weeks, the placenta is located along the anterior wall of the uterus, the lower edge overlaps the os by 53 mm, if there is any hope that the placenta migrates? and necessarily whether to go to the hospital?

Responsible Bosyak Yulia Vasilievna:

Hello, Elena! You have two ultrasound reports with different descriptions during one (!) week. My opinion is that one of the doctors described the situation incorrectly. I advise you to go through a control ultrasound with another specialist in a week. With complete placenta previa, complete rest and observation in the hospital is really shown. As your pregnancy progresses, the placenta may move up, so don't worry.

2015-04-07 14:08:57

Mary asks:

Hello, please tell me ultrasound + ultrasound of the fetus at 21 weeks showed placenta previa of the 3rd degree: "localization of the placenta along the anterior wall of the uterus reaches the internal pharynx with the transition to the back wall" the placenta is bilobed. dangerous and what threatens?? is there a chance of placenta elevation?

2015-02-22 12:26:36

Irina asks:

Good afternoon! The first day of the last menstruation on October 3, 2014, was bacterial vaginosis, they prescribed a treatment that I did not complete, because I found out on November 5 that I was pregnant, I took such drugs gynecitis for 4 days (29.10; 31.10; 02.11; 04.11), darsil from 29.10 to 4.11, milagin (3 candles) from 29.10 to 31.10, terzhinan from 1.10 to 4.10. Now I am 20 weeks pregnant, I did an ultrasound on 10/21/14, the period was set for 6-7 weeks (central presentation, hypertonicity in the lower segment, everything else is normal), then ultrasound on 12/19/14 for a period of 11-12 weeks (marginal presentation on the back wall, hypertonicity in the lower segment, gate space-1.4 mm, nasal bones-2.6), the next day she donated blood for screening, the results are normal (free beta hcg-53.6, free beta hcg mom-1.16, PAPP -2.11, PAPP MOM-1.26). Ultrasound on 01/19/15 (for the second screening) everything is normal (the placenta has risen), January 24. The blood for screening is also normal, the results of AFP-alfafetoprotein AF -1.09 MOM, hCG MOM-0.74, free estriol UE3-0.93 MOM. Ultrasound of the second scheduled 02/18/15 is also normal, everything is visualized, the only slight tone is periodically (I am flying it)! For all the time, all tests, routine and special screenings and ultrasound, everything is normal, BUT I still worry about the risk of teratogenic effects on the fetus, very much so. Suspicious! Tell me please, is it possible in such a case as mine, with all normal research, the possibility of having a baby with deviations?! Thank you very much in advance!

The placenta is an organ of paramount importance in the process of bearing a child. Therefore, doctors pay special attention to her during the examination of pregnant women. Normally, this organ is attached closer to the bottom of the uterus and begins to actively grow with the baby. On average, the placenta reaches a mass of 500-600 g and resembles a cake with many blood vessels. But there are many factors that cause pathological attachment of the placenta in the wrong place and create certain difficulties for the development of the fetus and future births. What is actually a marginal placenta previa and why is such a condition dangerous for a pregnant woman?

A physiologically normal place of attachment of the placenta is the fundus of the uterus or areas close to it, mainly on the anterior and sometimes on the posterior wall. With various deviations in the health of the mother, the placenta can be located on the opposite side near the cervix of the uterus. Depending on its location, the following types of placenta previa are diagnosed:

1. Complete(the placenta completely covers the cervix).
2. Low(the placenta is located close to the pharynx at a distance of no more than 4-5 cm).
3. Lateral(the cervix is ​​partially blocked by the placenta).
4. Regional(the placenta reaches the pharynx only by the edge).

If the process of implantation of the fetal egg in the upper segment of the uterus has been disturbed, there is such a concomitant pathology as the marginal placenta. This means that the "baby place" is located lower than 2 cm from the birth canal. Sometimes the edge of the placenta reaches the internal os of the uterus. If this situation persists until the 28th week of pregnancy, then we are talking about the marginal attachment of the placenta.

According to statistics, the marginal location of the placenta after 32 weeks of pregnancy remains only in 5% of pregnant women. But they fall into the risk zone of pathological childbirth. The perinatal mortality rate increases by 25%.

Pathological placentation: risk factors

Doctors name many reasons for such a common pathology, but no one can give the final correct answer. It remains only to take into account all the possible causes of such a pathology.

The marginal location of the placenta is most often localized along the posterior wall of the uterus. This is a threatening pregnancy condition, the appearance of which occurs for several reasons:

1. Sexual Infectious Diseases (STIs). The chronic course of diseases caused by pathogenic coccal flora damages the inner layer of the uterus - the endometrium. At the time of conception, the fertilized egg cannot attach in the right place and enters the lower part of the uterus, where the endometrium is more functional. In this case, in addition to improper placentation, women often have a threat of abortion.
2. Genetic pathologies of the embryo. If the fetus is genetically defective, its trophoblast enzymes are not able to penetrate the endometrial layer to attach there. In most cases, these enzymes are delayed and appear a little later. If this does not happen, then fertilization ends with an arbitrary abortion.
3. Abnormal structure of the uterus and traumapostoperative manipulations. Fibroids, polyps or a bicornuate structure of the uterus with depleted endometrium, do not allow the embryo to fully attach in the area of ​​the uterine fundus. It begins to fall and settles in the lower segments of the uterus.
4. Insufficiency of the endometrium. Due to curettage or abortion, a certain layer of the endometrium is removed. If the procedure was carried out by an inexperienced doctor, then in women there is insufficient growth of the endometrium and the fetal egg simply has nowhere to attach.

The main risk factors for marginal placenta previa on the posterior wall:

• delivery by caesarean section in the past;
• endometriosis;
• drinking and smoking;
• age over 35 years;
• multiple pregnancy;
• adenomyosis;
• the presence of a scar on the uterus;
• chronic inflammatory processes;
• pathologies that interfere with full implantation.

On a note! We are talking about the consequences of posterior marginal placenta previa only in the third trimester of pregnancy. Prior to this, the placenta is able to “migrate” along the walls of the uterus and does not pose a particular threat.

Symptoms and diagnosis of marginal placenta previa

The main symptom of the marginal location of the placenta is manifested by spontaneous bleeding of varying intensity. It can be minor bleeding before 30 weeks of pregnancy or severe recurrent bleeding from the slightest contraction of the uterus during childbirth. They can be provoked by both the act of defecation and harmless physical activity.

Bleeding is due to the fact that the lower sector of the uterus during childbirth begins to expand, involving in the birth process the area of ​​\u200b\u200bthe uterus where the placenta is attached. Uteroplacental cells begin to rupture, which provokes bleeding. This condition threatens the mother with severe blood loss, and the fetus with hypoxia.

Advice! Pregnant women with placenta previa are prohibited from conducting an ultrasound examination using a vaginal probe and sexual intercourse.

Diagnosis of the marginal low placenta is carried out using an ultrasound diagnostic apparatus during a routine examination or resort to the use of MRI in controversial situations. Every third woman with such a pathology is determined by the incorrect position of the fetus.

Interesting! Sometimes women on examination by a doctor find out that they have a marginal attachment of the umbilical cord to the placenta. This concept has nothing to do with marginal placenta previa. And it just means that the umbilical cord does not come from the center of the placenta, but from the edge. This is not a deviation from the norm, but a physiological feature.

Possible treatment options

There is no classical medical treatment for this pathology. In 95% of cases, there is a “crawling” of the placenta to its proper place in a natural way. In addition to vitamin complexes and iron preparations (if anemia occurs from bleeding), the doctor does not prescribe anything. If the woman's condition is unsatisfactory, she is sent to a hospital to maintain pregnancy.

• wearing a special bandage;
• exercises in the knee-elbow position so that the fetus takes the correct position;
• physiotherapy (for individual purposes);
• sexual rest;
• regular chair;
• easy daily routine without physical exertion;
• bed rest in the last weeks of pregnancy (in extreme cases);
• regular visits to the doctor.

Some statistics! Incorrect placement of the placenta or low placental is diagnosed in only one woman out of two hundred. The share of marginal placenta previa is 15-20%.

Management of pregnancy and childbirth

With primary, severe bleeding, a woman is admitted to the hospital and can be there until the 36th week of pregnancy under close supervision. Continuous monitoring of the fetal heart is carried out. If his condition worsens, corticosteroids are prescribed for premature maturation of the lungs. At 34 weeks, an analysis of the amniotic waters is done to determine the readiness of the fetal lungs to breathe on their own. If the analysis is positive, and the condition of the pregnant woman worsens, then a decision is made on premature delivery by caesarean section.

Important! Marginal placenta previa is not a contraindication to natural childbirth. Caesarean section is performed only in the presence of severe complications.

Complications with marginal placenta previa

As already mentioned above, the placenta moves to its proper place in most women closer to the third trimester. Only in 5% of women this does not happen, therefore, such deterioration in the course of pregnancy and childbirth is possible:

1. The threat of abortion or premature labor with subsequent bleeding.
2. Severe forms of iron deficiency anemia.
3. Prolonged hypoxia fetuses and malformations.
4. Central or marginal abruption of the placenta.
5. Rupture of the uterus due to fusion of the placenta and the wall of the uterus.
6. Perinatal death of a child.
7. Embolism of the mother's blood vessels.
8. Severe postpartum bleeding.

Summing up

Now that you are aware of what the marginal location of the placenta is and what the consequences of this are, you can take a responsible approach to solving such a problem. Always listen to the doctor's advice, and if in doubt, do not be afraid to seek the advice of another specialist. And remember that under the competent supervision of a gynecologist, neither you nor the baby will have any consequences.

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

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

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

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

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

Types of placenta previa and their characteristics

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

Complete placenta previa

Incomplete (partial) placenta previa

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

Low (inferior) placenta previa

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

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

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

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

Central placenta previa

Lateral placenta previa

Marginal placenta previa

Posterior placenta previa (placenta previa on the posterior wall)

Anterior placenta previa (placenta previa on the anterior wall)

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

Placenta previa - causes

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

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

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

• Any surgical interventions on the uterus in the past (abortions, caesarean sections, removal of fibroids, etc.);
• Childbirth that proceeded with complications;
• Anomalies in the structure of the uterus;
• Underdevelopment of the uterus;
• Isthmic-cervical insufficiency;
• Multiple pregnancy (twins, triplets, etc.);
• Endocervicitis.

For fruitful reasons placenta previa include the following factors:

• Inflammatory diseases of the genital organs (adnexitis, salpingitis, hydrosalpinx, etc.);

• Burdened obstetric history (abortions, diagnostic curettage, difficult births in the past);
• Transferred in the past any surgical interventions on the uterus;
• Neuro-endocrine disorders of the regulation of menstrual function;
• Underdevelopment of the genital organs;
• Inflammatory diseases of the genital organs;
• uterine fibroids;
• endometriosis;
• Pathology of the cervix.

Diagnosis of placenta previa

• Bloody discharge from the genital tract of a bright scarlet color with a completely painless and relaxed uterus;
• High standing of the bottom of the uterus (the indicator is greater than that which is typical for a given period of pregnancy);
• Incorrect position of the fetus in the uterus (breech presentation of the fetus or transverse position);
• The noise of blood flow through the vessels of the placenta, clearly distinguishable by the doctor during auscultation (listening) of the lower segment of the uterus.

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

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

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

ultrasound diagnostics

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

Placenta previa - symptoms

Bleeding with placenta previa

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

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

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

• Sudden, profuse and painless bleeding, often occurring at night, when a woman wakes up literally "in a pool of blood" is characteristic of complete placenta previa. Such bleeding may stop as suddenly as it began, or it may continue in the form of a scanty discharge.
• The onset of bleeding in the last days of pregnancy or in childbirth is characteristic of incomplete placenta previa.

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

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

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

What threatens placenta previa - possible complications

• The threat of termination of pregnancy;
• Iron-deficiency anemia;
• Incorrect location of the fetus in the uterus (oblique or transverse);
• Breech or foot presentation of the fetus;
• Chronic fetal hypoxia;
• Delayed fetal development;
• Fetoplacental insufficiency.

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

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

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

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

Placenta previa - principles of treatment

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

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

• Tocolytic and antispasmodic drugs that improve the stretching of the lower segment of the uterus (for example, Ginipral, No-shpa, Papaverine, etc.);
• Iron preparations for the treatment of anemia (for example, Sorbifer Durules, Ferrum Lek, Tardiferon, Totem, etc.);
• Drugs to improve the blood supply to the fetus (Ascorutin, Curantil, Vitamin E, folic acid, Trental, etc.).

• Intramuscular injection of 20 - 25% magnesia, 10 ml;
• Magne B6 2 tablets twice a day;
• No-shpa 1 tablet three times a day;
• Partusisten 5 mg four times a day;
• Sorbifer or Tardiferon 1 tablet twice a day;
• Vitamin E and folic acid 1 tablet three times a day.

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

• Trental is given intravenously or taken as a tablet;
• Curantyl take 25 mg 2-3 times a day one hour before meals;
• Vitamin E take 1 tablet per day;
• Vitamin C take 0.1 - 0.3 g three times a day;
• Cocarboxylase is administered intravenously at a dose of 0.1 g in a glucose solution;
• Folic acid is taken orally at 400 mcg per day;
• Actovegin take 1 - 2 tablets per day;
• Glucose is administered intravenously.

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

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

Childbirth with placenta previa

Caesarean section with placenta previa

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

Childbirth through natural ways

• Absence of bleeding or its stop after opening the fetal bladder;
• Ready for childbirth cervix;
• Regular contractions of sufficient strength;
• Head presentation of the fetus.

Sex and placenta previa

The slightest changes in well-being during pregnancy cause concern. As a rule, a visit to the doctor immediately follows with the hope of hearing that there is no reason to worry and this is a false alarm and the suspiciousness inherent in all pregnant women is to blame. And suddenly it turns out that the fears were not in vain, and the diagnosis “marginal placenta previa” sounds. Instead of starting to panic and drive yourself crazy, you need to calm down, pull yourself together and figure out what it is and how dangerous it is.

The placenta is a unique and complex formation that appears in a woman's body at the moment when a fertilized egg attaches to the wall of the uterus. Like any living organism, it goes through all stages of life: appearance, maturation and aging. The life of a small creature that settled inside the mother's tummy depends on it. Through it, the baby breathes and receives nutrition. No wonder it is also called the "children's place." It serves as a kind of filter that supplies oxygen to the fetus, and removes carbon dioxide and metabolic products back. Through it, antibodies from the mother to the baby come, which perform immune protection. Without it, the same mother's antibodies would have recognized the child as a foreign body and provoked rejection.

The active development of the placenta begins from the 9-10th week. On the 12th child completely switches to placental nutrition and receives the official name "fetus". And by the 15-16th week, it is already, as a rule, a fully formed organ that will grow with the baby throughout the pregnancy. During planned ultrasounds, they monitor not only the development of the fetus, but also the condition, location and maturity of this vital “cake”.

In the normal course of pregnancy, the placenta is located on the back or front wall of the uterus at a distance from the uterine os. The most optimal and most common is the posterior attachment. With it, blood circulation is best, and the place itself is less prone to various injuries. But sometimes it is closer to the exit than it should be, or completely blocks it. This is called presentation, which, respectively, is complete (central) or incomplete.

The most dangerous is a complete presentation. With it, the birth canal is completely blocked, as a result of which the child can be born exclusively by caesarean section.

With incomplete presentation, the placenta is in the lower segment and partially blocks the exit from the uterus to the cervix. There are two types: lateral presentation, in which the pharynx overlaps by two-thirds, and marginal, when the lower part of the placenta hangs over the exit and obscures it by no more than a third.

Marginal placenta previa, in turn, occurs along the posterior and anterior walls, and has different prognosis depending on the location:

• On the front wall, on the one hand, is the most dangerous. With it, placental abruption occurs more often. The reason for this is that the placental tissue is not able to stretch as quickly as the uterine tissue. Simply put, it does not have time to grow behind it, and the risk of detachment of the hanging edge increases. In addition, this is aggravated by the active movements of the child, the physical activity of the mother. But, on the other hand, with such a marginal presentation, there is a high chance that with the growth of the uterus, the placenta will rise to a safe distance.
• Along the back wall occurs more frequently and poses less of a threat than in the previous case. This is due to the fact that this part has less load. With him, there is every chance to calmly endure the pregnancy and give birth on her own.

In fact, in the world from this pathology, 3-25% of pregnancies end tragically, or the baby is born with some deviations. Therefore, you need to take the regional and other types seriously, regularly monitor the dynamics and follow all the doctor's recommendations.

Causes of marginal placenta previa

One of the factors of such a pathology is the peculiarity of the fetal egg. After fertilization, the egg descends into the uterus and with its villi is attached to its wall in the upper part. Due to the hormonal background or the structure of the villi, this does not happen. The egg is unable to reach the bottom of the uterus and clings to the exit.

The main reason for the marginal attachment of the placenta is the female body, or rather the state of the mucous surface or endometrium of the main reproductive organ.

Factors that violate the integrity of the endometrium and cause presentation, including marginal, are:

• inflammation, ;
• underdevelopment of the uterus;
• repeated pregnancy;
• endometriosis, endocervicitis;
• genital infections;
• age over 35;
• scars after an abortion or curettage;
• operations on the uterus;
• and other benign tumors;
• congenital pathologies;
• diseases of the cardiovascular system;
• diseases of the pelvic organs.

In re-children, this anomaly is observed in 55% of cases, that is, almost every second. But in general, according to observations, the diagnosis of the marginal location is heard by a third of expectant mothers.

As a rule, they appear at the end of the second or third trimesters from 28 to 32 weeks. At this time, there is an active growth of the uterus. The placental tissue does not have time to stretch and marginal detachment occurs, which is accompanied by bleeding. The larger the detached area, the more intense they are. This can happen at an earlier date with or multiple pregnancies.

Any stress can cause detachment. This can happen with intra-abdominal pressure, which is often found in pregnant women, during passionate intercourse, and even with a banal raising of hands. An active baby with his movements can also contribute to this. Often a woman herself serves as a provocateur when she lifts weights or during overly active physical exertion. Bloody discharge can also appear during a visit to the sauna or taking a hot bath.

Bleeding begins suddenly, without pain syndromes, and also suddenly stops. At the same time, it is impossible to predict when this will happen next time and how plentiful they will be.

This pathology is sometimes noticed already at the first planned ultrasound at the 12-13th week or in the second trimester. As a rule, nothing bothers a woman, and such a diagnosis sounds very unexpected for her. But most often, a pregnant woman herself comes to the doctor with complaints of blood discharge or bleeding. After a thorough examination, a conclusion is made about the marginal or complete presentation, and the type of abnormal location and the degree of its danger to the fetus and expectant mother are determined. Given the complexity and risk of complications, in most cases, a woman is recommended to go to a hospital to monitor her condition and complete examination.

What complications can occur with marginal placenta previa?

Due to the fact that when the placenta is detached during the marginal location, the vessels are damaged, the child does not receive the necessary nutrition and oxygen. This is called fetal hypoxia. It threatens with a developmental delay and such consequences for the mother and child as:

• incorrect location of the fetus;
• — low level of hemoglobin — from lack of iron in the body;
• hypotension and, as a result, weakness, and fainting;
• profuse bleeding during childbirth.
• risk of miscarriage;

First of all, it is complete physical and psychological rest. Not all mothers manage to achieve this at home. Not everyone can afford not to go to work. And that is where the greatest emotional stress occurs. When there is a strong recommendation to lie down for preservation, the majority immediately panics with thoughts about who will work instead of me, as well as wash and clean. Trust me, the world won't stop without you. Your main task at the moment is not to submit an accounting report or walk your beloved dog, but to endure and give birth to a healthy, long-awaited baby.

Mom is given strict bed rest, an iron-rich diet and, if necessary, drugs that improve blood circulation, reduce uterine tone and "increase hemoglobin". Up to 24 weeks, if there is no bleeding and the general condition does not bother, then it is allowed to be treated on an outpatient basis, while strictly following the recommendations and protecting yourself from household duties as much as possible. In difficult situations and at a later date, mommy can be in the clinic until the very birth, and sometimes mostly in a supine position.

The placenta begins to migrate from the end of the second trimester along with the growing tummy. Therefore, after the 26th week, there is a high chance that the marginal presentation will return to normal on its own.

With all the complexity of the diagnosis, in some cases a woman is still allowed to give birth on her own, but only with a slight presentation. The main conditions for this are a good labor activity, a mature cervix and the head location of the fetus. When the neck is opened by more than 4 cm or a finger, the degree of location of the organ is determined and the amniotic sac is opened and further childbirth proceeds naturally. If after opening the bleeding does not stop, then an emergency caesarean section is performed. Most often, doctors prefer not to take risks and, with a marginal location of any stage, they perform surgical delivery. As planned, this happens at 38-39 weeks, when the baby is fully formed and ready to be born.

With a strong or complete presentation

During natural childbirth, there is a high risk of placental abruption, which is fraught with profuse blood loss and other consequences for both the mother and the fetus, up to death. Therefore, it is better not to take risks and entrust your life and the life of the crumbs to experienced professionals.

What precautions should be taken by pregnant women with marginal placenta previa

Such a diagnosis is not a sentence, and with it it is quite possible to endure pregnancy and become a happy mother of a newborn miracle. For this you need:

• do not miss scheduled clinic visits;
• seek help at the slightest deterioration in the condition or the appearance of new symptoms, such as a sharp pain in the abdomen, and so on;
• immediately call an ambulance in case of bleeding;
• just in case, find in advance for yourself several people of your blood type who can become donors for you;
• forget about sex for a while;
• more rest and walk, if this is not prohibited by the doctor;
• sleep for 8 hours;
• follow a diet and do not consume soda and foods that provoke gas formation;
• protect yourself from negative emotions and stressful situations;
• follow all the recommendations of the attending physician;
• exclude all physical activity: fitness, weight lifting and even cleaning the house or apartment;

And the most important thing is to enjoy your “interesting position” and believe that everything will be fine!

Video

Watch the video from which you will learn what presentation is, what other types there are other than marginal, and how it affects the course of pregnancy.

Often, a diagnosis voiced by a doctor serves as an incentive to take a closer look at your health. Especially when you are responsible not only for your life, but also for a small miracle that grows inside you.