Placenta previa - pathological attachment of the embryonic organ, providing communication between the mother and the fetus, at which there is a partial overlap of the internal os of the uterus (not more than a third). Clinically, the disease is manifested by bleeding of varying intensity, not accompanied by discomfort. It is possible to identify the regional presentation of the placenta using a planned ultrasound in the second trimester or in the event of pathological signs. Treatment involves hospitalization, bed rest, symptomatic therapy. Expectant tactics are shown before the term of the intended childbirth, provided the woman and fetus are in a normal condition.
Causes of placental previa
The regional presentation of the placenta may be due to abnormal attachment of the trophoblast during implantation or the anatomical features of the myometrium. In the latter case, the violation of the structure of muscle fibers in the uterine wall occurs against the background of inflammatory changes, the consequences of genital infections. The regional presentation of the placenta is more often diagnosed when myometrium is thinned, triggered by frequent curettage and abortion. Also, uterine deformities caused by benign tumors or resulting from congenital abnormalities can also cause abnormal attachment of a trophoblast.
Regional placenta previa often develops in women with concomitant diseases of internal organs, in particular, in the pathology of the cardiovascular system. Due to insufficient blood circulation and stagnation in the pelvis, the placenta can not fully attach. In addition, the regional presentation of the placenta is possible against the background of abnormal development of the embryo immediately after fertilization. A similar outcome is observed when the trophoblast enzymatic functions appear late. As a result, it is attached to the myometrium later than normal, being in the lower part of the uterus.
Classification of regional presentation of the placenta
Regional presentation of the placenta can be of two types, depending on the place of its attachment:
- Localization on the front wall - the most dangerous variant of the pathology. With the regional presentation of this type of placenta, there is a high risk of mechanical damage to it, followed by detachment due to the physical activity of the woman, movements of the baby, against the background of strong uterine stretching in the third trimester of pregnancy. Despite this, when placing an embryonic organ on the anterior wall of the uterus, there is a possibility of its moving upwards.
- Attach on the back wall - A more favorable variant of the regional presentation of the placenta. Accompanied by a lower risk of complications in the process of gestation and childbirth for the mother and baby.
Both types of abnormalities are the pathology of pregnancy and require mandatory monitoring by an obstetrician-gynecologist.
Symptoms and diagnosis of regional placenta previa
Regional presentation of the placenta has a characteristic symptom - the appearance of bleeding without deterioration of general well-being. Often this pathological symptom occurs at rest or at night. With regard to the timing of embryogenesis, the regional presentation of the placenta occurs mainly at 28-32 weeks. It is during this period that the uterus is characterized by increased activity due to the preparation of the myometrium for the upcoming delivery. Somewhat less frequently, anomalous discharge is observed already at the beginning of the second trimester. The amount of bleeding can be different and depends on the degree of damage to the blood vessels.
When the placenta previa in the third trimester of pregnancy, blood release can be triggered by physical exertion, sexual intercourse, fetal movement and other factors that trigger the rupture of the nutrient vessels. The appearance of this feature is possible even with a gynecological examination. Sometimes regional presentation of the placenta is combined with the threat of miscarriage. With this combination, there is discomfort in the lower abdomen, hypertonia of the uterus. With systematic bleeding in pregnant women with such a diagnosis of iron deficiency anemia develops. In such cases, there is increased fatigue, weakness. On the part of the fetus, it is possible to slow down growth and development, hypoxia due to insufficient intake of nutrients. Regional presentation of the placenta is often combined with the wrong position of the fetus, which can be oblique or transverse.
The preliminary diagnosis is established on the basis of the patient's complaints of bleeding in the absence of pain. Another characteristic feature of the abnormal location of the embryonic organ is the high standing of the bottom of the uterus, which does not correspond to the period of embryogenesis. It is possible to confirm the regional presentation of the placenta using ultrasound. During the scanning process, a specialist can accurately visualize the location of the placenta and the degree of overlap of the uterine throat, determine the condition of the child and assess the possible risks to the woman and the fetus.
Treatment of placenta previa
Treatment of regional placenta previa depends on the identified symptoms, the duration of embryogenesis, and the condition of the expectant mother and fetus. If the diagnosis is made only on the basis of ultrasound scanning and bleeding is not observed, control over the patient's condition on an outpatient basis is possible. Hospitalization is indicated if the regional presentation of the placenta is accompanied by discharge of any blood volume. In this case, requires careful monitoring in the hospital. Women with this diagnosis are given complete rest, it is recommended to exclude sex and stress. You must wear a bandage. In the second trimester, special exercise therapy for newborn babies sometimes helps correct the location of the placenta.
When regional presentation of the placenta often develops anemia due to systematic blood loss. Therefore, pregnant women are shown a diet enriched with foods high in iron. The diet should contain red fish, offal, buckwheat, beef, apples. Conducting pregnancy at the placenta previa suggests a protective regime in order to achieve the expected date of birth and the birth of a full-term baby. Also, patients with a similar diagnosis are prescribed medications, taking into account the general condition and associated pathologies.
In case of regional presentation of the placenta, symptomatic drug therapy is performed. With hypertonicity of the uterus, tocolytics and antispasmodics are used, preparations containing iron are prescribed to eliminate anemia. Vitamin complexes can be used to maintain the general condition of the patient and the fetus. Sometimes at regional presentation of a placenta the use of sedatives is expedient. According to indications, antiplatelet agents are administered, the physician counts the dosage of drugs in order to avoid a negative impact on the baby.
If the regional presentation of the placenta is accompanied by massive bleeding, delivery is carried out regardless of the duration of embryogenesis by emergency caesarean section. In the case of full-term pregnancy, childbirth in a natural way is permissible under the condition of cervical ripening, vigorous labor, and the good condition of the patient and fetus. When the cervix is opened 3 cm amniotomy is performed. In order to prevent bleeding, oxytocin is administered. If at the edge previa placenta significantly overlaps the uterine throat or delivery through the natural channel is not possible, a cesarean section is shown.
Forecast and prevention of regional placental presentation
The prognosis for regional presentation of the placenta is favorable. With timely diagnosis and compliance with medical recommendations, patients can bring the fetus up to 38 weeks and have a completely healthy baby. Territory placenta previa can cause the development of bleeding in the postpartum period. To prevent it, specialists use intravenous oxytocin. Pathology prevention consists in the treatment of gynecological diseases even before conception, excluding abortions and invasive interventions on the uterus. After the onset of pregnancy should follow the recommendations of the doctor, to give up physical activity, to avoid stress.
What is placenta previa
Incorrect positioning or presentation of a child's seat is a pathology that is found in early pregnancy. With this problem, the body overlaps the inner pharynx partially or completely. It is located in the cervix and may overlap the birth canal. Pathology occurs frequently in the first trimester of pregnancy, but in later periods a “migration of the placenta” may occur - during the development of the child, the uterus is stretched, the placenta is mixed further from the cervix.
The main clinical symptom of placenta previa is bleeding. Its cause is organ detachment: the presence of bleeding indicates that part of it moves away from the side walls of the uterus and damages the blood vessels. Allocate:
- vaginal bleeding,
- internal bleeding (with low previa).
With heavy and frequent bleeding, a woman may suffer from hypotension (low stable pressure) and anemia (hemoglobin level decreases). The pregnant woman is sent to the clinic for preservation in the hospital for continuous monitoring and examination. In difficult cases, with pathology, fetal death is possible. Bleeding is sudden and always during sleep.
Placental presentation occurs for many reasons. This can occur after active physical exertion, examination of the cervix by a gynecologist. Pathology may develop in the first weeks. Until the 24th week, the 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,
- endometrial pathology,
- cesarean section,
- perforation of the uterus,
- multiple delivery with complications
- anomalies of the uterus,
- uterine contraction
- diseases of the reproductive system.
There are several types of presentation in the area of the cervix and two main classifications. The first is determined using transvaginal ultrasound diagnosis. The second is determined during childbirth, when the cervix has opened 5 cm. The degree and type of pathology changes as the opening of the throat, cervix and uterus grows. In total, there are three options for presentation:
With full placentation, the placenta overlaps the inner os. That is, if the cervix fully opens, the child will not be able to be born, because the organ that blocks the exit from the uterus is blocking the path to it. With complete pathology, natural birth is not carried out. One variant of delivery is only the use of cesarean section. This location is the most dangerous pathology of the cervix. In 25% of cases, there are serious complications during labor that can lead to maternal or infant mortality.
In the case of partial presentation (incomplete closure), the organ partially overlaps the internal channel of the cervix: a small area remains in the opening. 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 desired speed. The lowest edge is flush with the cervical opening. The head of the child will not be able to pass through the narrow part of the lumen of the birth canal.
Classical low presentation of the chorion during pregnancy is determined by the wrong location, that is, the body is 7 cm or more from the perimeter of the cervical canal and does not reach the entrance. The entrance to the inner throat area of the cervix is not captured. May allow natural childbirth if the gestation is good. Low pathology is the most favorable of all dangerous complications. In obstetric practice with the help of ultrasound determine the degree of pathology during pregnancy.
With this presentation, the entrance to the cervical canal from 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, the natural labor activity is absent, therefore, a caesarean section is used. Central pathology is determined during childbirth or during vaginal examination.
During a vaginal examination with lateral previa, the doctor determines the part of the organ that closes the entrance to the cervical canal, next to which is a rough fetal membrane. With lateral placentation, an abnormal location is formed, which is determined after the examination and corresponds to the results of an ultrasound examination of the presence of incomplete pathology or 2-3 degrees in the first weeks of pregnancy.
Placenta previa on the back wall
This type of pathology is characterized by the attachment of an organ to the villi of the posterior wall of the uterus. This deviation is frequent with incomplete or low previa. The main part of the body is attached to the back wall of the uterus, the exit is blocked by the placenta, which prevents the natural labor activity. In this case, a caesarean section is performed - natural childbirth carries a risk to the life of the child.
Anterior pathology is marked by attaching an 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 body is attached to the anterior wall of the uterus, while this condition is considered not as pathology, but as the norm. This condition is determined during the ultrasound before 26 weeks of pregnancy. In this case, there is the option of migration of the placenta, which increases the likelihood that a woman will be sent to a natural normal delivery.
What threatens the presentation
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 point that the pregnancy ends with preterm labor. The consequences of the pathology can be the following:
- placental insufficiency,
- wrong location of the fetus inside the uterus,
- chronic fetal hypoxia,
- leg or pelvic presentation of the fetus,
- Iron-deficiency anemia.
Placental insufficiency due to the fact that the lower segment of the uterus has a low blood supply, compared with the body or the bottom, that is, it gets a little blood. If there is poor blood flow in the localization of the placenta, this means that there is not enough oxygen and nutrients that must come to the fetus, which does not satisfy its needs. Incorrect positioning of the child or pelvic presentation is due to an insufficient amount of free space in the lower part of the uterus for the head.
In order to determine the type or degree of pathology of the placenta, look at the risk factors in history, external uterine bleeding and data from an objective study. When external examination revealed a high standing of the bottom of the uterus (transverse or oblique location of the fetus). Sometimes auscultation of the noise of placental vessels in the uterine segment at the location of the placenta. During the ultrasound diagnosis is performed:
- size of placentation
- kind of
- structures that
- the degree of detachment
- threatened abortion,
- migration of the placenta.
During a gynecological examination, an examination of the cervix is performed to exclude vascular injury or pathology. When the outer throat is closed, part of the fetus cannot be determined. At full previa determine the massive soft formation (fetal bladder), which occupies the entrance of the vagina. When palpation examination of a pregnant, with complete pathology, the occurrence of bleeding is diagnosed. If during examination in the lumen of the uterus there are fetal membranes of the uterus and placental tissue, this means that you have determined incomplete presentation.
Among the methods of treatment of this pathology, there are two types - medication and non-drug. It is necessary to ensure complete peace 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 birth course. Caesarean section is prescribed for a narrow pelvis, polyhydramnios, multiple fetuses, 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 abnormal attachment of the placenta, this means that there may be a natural birth. During childbirth, the condition of the woman is continuously monitored, especially the volume of bleeding that accompanies the process, the indicators of childbirth and the fetal condition of the child.
Sometimes carry out urgent tests in the laboratory or ultrasound. If during labor, there are complications, heavy bleeding and full placentation, cesarean section is performed.Regardless of various complications during pregnancy, it is necessary to act in accordance with the advice of a specialist, therefore it is recommended to listen to your doctor. A caesarean section at low placentation may also be prescribed.
Preventive measures of abortion 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 conduct a rational pregnancy, taking into account all the threats and risks of complications, to correct the violations in a timely manner in order to obtain an optimal delivery.
Determination of placenta previa in pregnant women
Placenta previa is a violation of localization of the placenta, which is located in such a way that completely or partially blocks the cervical canal.
The atypical location is an obstacle to natural childbirth and threatens with severe complications for the fetus and the expectant mother.
Placenta previa increases the risk of death, so pregnant women with an established diagnosis are under special medical supervision.
Normally, the placenta is attached to the back of the uterus. The abnormal location of the temporary organ is classified by the place of localization and the overlap of the channel.
Presentation can be full or partial.
- Low presentation - the placenta is located so low that its edge is located very close to the cervical canal (approximately 6-7 cm), but does not touch it. The location of the placenta may change, for example, to drop completely, blocking the channel, or rise up. With low placentation complications of childbirth is not observed.
- Regional presentation - the edge of the placenta concerns the uterine isthmus, but does not completely cover it.
- Incomplete lateral - exit from the uterus is blocked by the placenta by more than 60% (more precisely, 68% or 2/3 of the lumen).
- Central placenta previa - the most dangerous type of placentation. Complete closure of the lumen of the uterine canal prevents natural childbirth. In addition, the anomaly threatens the development of bleeding due to the inability to stretch, unlike the cervical canal. Full placenta presentation threatens adverse pregnancy outcomes with unqualified or untimely care.
Causes of previa
The exact reasons provoking a pathology, it is not revealed.
As a result of the research, “stimulating” factors were identified, under the action of which, probably, localization violation occurs:
- Late pregnancy, when the mother at the time of the birth of the baby is over 35 years old,
- Prolonged absence of pregnancy due to primary or secondary infertility,
- Multiple pregnancy (especially dangerous when carrying three fetuses),
- The cesarean section in history, as well as other types of surgery on the genital organs,
- Increases the risk of previa with frequent pregnancies at short intervals,
- Low location of the egg, which, after fertilization for some reason, is implanted in the lower segment,
- Pregnancy with the help of modern assisted reproduction technologies - IVF.
Harmful addiction and bad habits, only increase the risk of incorrect placentation.
The use of narcotic or medicinal products contributes not only to the abnormal location, but also to the disruption of the structure of the temporary body.
What are pregnant women are at risk of pathology
The group of increased risk of developing abnormal placentation is represented by the following categories of pregnant women:
- Mother age over 35 years
- Pregnant Asian origin
- Pregnancy is a male fetus (XU chromosome),
- The development of pathology in previous pregnancies (the risk of complete or partial presentation increases by 4 times).
Symptoms placenta previa
The main sign testifying to the prevalence of a child’s place is the development of bleeding without painful sensations.
The appearance of vaginal blood can be observed at any time of gestation. In most cases, the pathology is recorded from 12 to 20 weeks of pregnancy.
- Iron deficiency anemia develops,
- The uterus on palpation becomes softer,
- The tone of the uterus remains unchanged,
- Bleeding occurs suddenly, and often during a night's sleep.
The following signs are characteristic of full placenta previa:
- the scarlet color of blood
- sudden occurrence and cessation of bleeding,
- complete absence of pain.
The clinical manifestation of pathology can be caused by several factors. For example, a hot bath, excessive exercise, cough or sexual intimacy.
Treatment of pathology during pregnancy
Drug therapy to eliminate the pathology does not exist.
The main treatment is to maintain a gentle regimen and medical supervision.
Abnormal placentation increases the risk of preterm or early delivery. The task of the doctors in this case is to prevent such a development of events and prolong the pregnancy as long as possible.
Therapy is aimed at preserving pregnancy:
- Hormonal therapy
- Sedative drugs
- Medications to increase blood clotting,
- Vitamin therapy,
- In some cases - plasmapheresis or transfusion of Er-mass,
- With full central presentation of the pregnant hospitalized for continuous monitoring of her condition and the condition of the fetus.
At the established diagnosis of a pregnant woman should refrain from any kind of stress, intimacy, and to comply with bed rest.
Effects of PP on the fetus
- Anomalies of organs
- Intrauterine growth retardation
- The incorrect position of the fetus in the womb,
- The need for resuscitation events,
- Mental retardation
- Neonatal mortality 1-2%, antenatal - 0.3%.
- Bleeding in childbirth period,
- Placental abruption,
- Increment child seats to another body. With such a pathology, hysterectomy is required to save maternal life - removal of the uterus,
- Postpartum endometritis,
- Emergency blood transfusion (thrombomy and plasma),
How to give birth with placenta previa
A pregnant woman with a placenta previa can be allowed into natural childbirth, only if the baby has changed its location and has risen higher. In other cases, cesarean section is indicated.
ACS is carried out in the period of 37 weeks, after determining the degree of maturity of the lungs of the fetus. In severe pregnancy and deterioration of the fetus, surgery is carried out ahead of time.
During surgery, the APTT, fibrinogen and PV are strictly controlled.