One of the most unpleasant and often unexpected situations for a woman in labor: the child has already been safely born, but instead of a relaxing rest and congratulations from relatives, there is anesthesia and surgical intervention.
Why is the afterbirth not separated, how does manual separation of the placenta occur, and what consequences will this have?
What is the placenta attached to: the decidua layer
The embryo enters the uterus at the blastocyst stage. This is no longer just a fertilized egg, but several hundred cells, divided into outer and inner layers. But even the blastocyst is too small to easily attach to the wall of the uterus. This requires special conditions and a “particularly hospitable” internal environment.
That is why, on days 25-27 of the cycle, the endometrium - the inner layer of the uterus - begins to change dramatically. The cells become larger, glycogen accumulates in them - this is the main way our body stores nutritious glucose, which is what the embryo will feed on in the first days after implantation. An increase in the level of the hormone progesterone in the blood, which occurs during successful fertilization, spurs changes in endometrial cells - they form the so-called decidual layer. After implantation of the embryo, it is literally everywhere: between the wall of the uterus and the embryo (basal membrane), around the embryo (capsular membrane) and on the entire surface of the uterus (parietal membrane).
” The last two gradually become thinner and merge with each other as the baby grows, but the basal membrane, located under the placenta, grows, thickens and becomes double-layered. A compact layer (stratum compactum) faces the inside of the uterine cavity, in which the excretory ducts of the glands pass. Behind it is a spongy (porous) layer (stratum spongiosum), which consists of many hypertrophied glands.
The basal decidua is not smooth: by the third month of pregnancy, outgrowths-septa (septa) appear on it, which form peculiar “cups” where maternal blood flows. The chorionic villi are immersed in these cups (the chorion is the embryonic part of the placenta, and its villi are structures formed by the blood vessels of the fetus). They seem to “line” the cups from the inside.
Why does the placenta separate or not separate?
You may have noticed that there is no rigid connection between the placenta and the wall of the uterus. They are adjacent to each other, but normally the chorionic villi do not grow deep into the basal membrane: its internal porous layer becomes an insurmountable barrier. During the subsequent (third) period of labor, after the baby is born, the uterus begins to shrink. In this case, the placenta exfoliates easily and relatively painlessly.
” To better imagine what is happening, imagine balloon, to which a thin plasticine cake was attached. As long as the ball is inflated and retains its dimensions, the structure is stable. However, if you deflate the balloon, the plasticine cake will peel off.
Unfortunately, this does not always happen. If the basal layer is thinned and deformed, then the chorionic villi grow directly into it in search of nutrition. Now, if we return to our analogy and “blow away balloon", the plasticine cake will stretch the rubber, and you will have to make an effort to unstick this structure. The placenta will not allow the part of the uterus to which it is attached to contract and, accordingly, will not separate itself.
” This is how a tight attachment (or false accretion) of the placenta occurs. This is a relatively rare pathology - 0.69% of all births.
It can be even worse - if the decidua layer is not developed at all, which usually happens at the site of scars after surgical interventions and inflammation, the chorionic villi grow to the muscular layer of the uterus, grow into it and even grow through the walls of the uterus! This is how true placenta accreta occurs - an extremely rare and dangerous pathology, due to which the uterus is amputated immediately after the birth of the child. We talked about this situation in detail in the article. « » .
Why does the placenta attach tightly?
The causes of false and true placenta accreta are the same - this is local dystrophy of the endometrium (inner layer of the uterus), which occurs for a number of reasons.
Scars on the wall of the uterus. They can occur after any surgical procedure: caesarean section, abortion, removal of tumors and even diagnostic curettage.
Inflammatory process in the uterus- endometritis. It can be caused by chlamydia, gonorrhea, other sexually transmitted diseases, and bacterial infections, for example, complications after medical intervention.
Neoplasms in the uterus, for example, large submucosal fibroids.
High chorion activity: due to an imbalance in the enzymatic balance, the chorionic villi penetrate into the deep layers of the basal membrane.
Gestosis caused by nephritis(kidney inflammation) during pregnancy.
Tight attachment of the placenta: how to determine
Unlike true placenta accreta, placenta accreta is rarely detected by antenatal ultrasound. Suspicion may arise if changes appear in the placenta itself. It is thickened or, on the contrary, thinned (leathery placenta), it has additional lobules, sometimes remote from the main placental site. But more often the obstetrician makes a diagnosis during childbirth if:
within 30 minutes after the birth of the baby there are no signs of placental separation and no bleeding;
blood loss exceeded 250 ml, and there were no signs of placental separation.
” Although it is believed that spontaneous separation of the placenta can be expected within two hours, this rule only applies if there are no signs of bleeding; the loss of 400 ml of blood is considered critical, and the loss of a liter of blood already carries the risk of developing hemorrhagic shock.
If the placenta does not separate, the obstetrician has two tasks. First, understand whether the placenta is still attached to the wall of the uterus or simply cannot leave its cavity. There are a number of clinical tests for this. If the placenta is still attached to the wall of the uterus, then:
Alfeld sign- the outer part of the umbilical cord does not lengthen;
Dovzhenko sign- the umbilical cord is retracted into the vagina with a deep breath;
Klein's sign- the umbilical cord lengthens when straining, but after pushing it is pulled back;
Küstner-Chukalov sign- when pressing with the edge of the palm on the abdominal wall slightly above the pubis, the umbilical cord does not retract into the vagina, but, on the contrary, comes out even more.
Secondly, the doctor must determine whether this is a true placenta accreta, which was not noticed during prenatal care, or a false one. Unfortunately, this is only possible when attempting to manually separate the placenta.
Manual separation of tightly attached placenta: procedure and consequences
Manual separation of the placenta is carried out, as the name suggests, by hand. The obstetrician fixes the fundus of the uterus with one hand from the outside (that is, presses on it from above, from the side of the chest), and inserts the other hand directly into the uterine cavity.
” It sounds, of course, creepy, but, firstly, you just had a whole baby in your uterus - in comparison with it, the obstetrician’s hand has a very modest size. Secondly, you will not feel anything - this procedure is performed only under full intravenous anesthesia.
What does an obstetrician do? He carefully feels the edge of the placenta and makes “sawing” movements with his fingertips. If the placenta is not accrete, the chorionic villi have not grown through the basal membrane, then it is relatively easily separated from the uterine wall. To speed up this process, medications are administered intravenously to cause spasm of the uterine muscles.
The doctor does not remove his hand from the uterine cavity immediately after this: first he conducts a manual examination - is there an additional lobe left somewhere, is the placenta itself torn?
If the chorionic villi have grown tightly into the body of the uterus, then when attempting to manually separate the placenta, the doctor will inevitably injure the muscle layer. Difficulties during separation, and most importantly, heavy bleeding when trying to influence the placenta (after all, the muscle is damaged!) indicates that doctors are dealing with true placenta accreta. Unfortunately, in this case, the uterus will most likely have to be removed immediately.
Of course, after such an intervention complications of varying severity may arise.
Excessive bleeding and hemorrhagic shock(critical condition of the body associated with acute blood loss). The likelihood of complications developing is especially high if the placenta is partially firmly attached.
Perforation of the uterus- rupture of the uterine wall can occur when the obstetrician tries to separate the accreta placenta.
Inflammation of the uterus (endometritis) and sepsis (blood poisoning). After childbirth, the uterus is practically a continuous wound surface. The likelihood of accidentally introducing an infection even if all precautions are taken is quite high. This is why women are prescribed a course of antibiotics after manual separation of the placenta.
Unfortunately, the likelihood of placenta accreta or even placenta accreta, as well as placenta previa, will only increase in subsequent pregnancies.
Prepared by Alena Novikova
The placenta is the most important organ for supporting the vital functions of the embryo. It is through it that nutrients and oxygen enter, and waste products are eliminated. The placenta serves as a protective barrier against infections and viruses.
Not every woman knows about all the features of pregnancy and how the process of conception and formation of an embryo occurs. Often, the diagnosis of improper attachment of the placenta makes you panic. How should the organ be attached normally? What to do if the location of the placenta is incorrect? What is presentation? What does the diagnosis of “low placentation” mean?
The optimal place for the placenta to attach
Placenta, or children's place, ensures the safety of the fetus, so the optimal zone of its attachment should be safe. From a physiological point of view, such a place is the fundus of the uterus or its posterior wall. As the baby grows, the uterus will stretch, but the back part will remain dense.
Hence there are several advantages:
- the placenta remains motionless, in this position its descent practically does not occur;
- with the tone of the uterus and its contractions, the placenta is not affected, and the risk of its detachment is reduced;
- the child’s movements have minimal impact on the child’s seat;
- the risk of damage to the placenta due to abdominal injuries is reduced;
- the likelihood of bleeding during childbirth is reduced.
Reasons for incorrect localization of a child's seat
Cases when the baby's place is attached to the side walls of the uterus are not uncommon. This is not scary; such attachment is not considered pathological. Anterior presentation the placenta, or rather, its attachment to the front wall (see photo) requires more careful observation. Low attachment is considered especially unfavorable, when the internal os is partially or completely blocked.
Reasons for fastening ovum to the anterior wall of the uterus or close to the uterine os:
- inflammatory processes or operations on the uterus that have changed its inner layer;
- endometriosis of the cervix (hormonal disease characterized by proliferation of the mucous membrane of the organ);
- myoma (fibroids) of the uterus (benign tumor);
- multiple pregnancy;
- pathology of the uterus (inverted or curved uterus);
- numerous births;
- presence of a cesarean section scar;
- history of abortion;
- The woman is over 40 years old.
The cause of the pathology is not only the mother’s health condition, but also the delayed development of the fertilized egg. Sometimes the egg does not have time to attach to the endometrium in time. As a result, it clings to the front wall or descends to the lower parts of the organ, where it remains.
Features of the course of pregnancy and childbirth
A placenta on the anterior wall is not a death sentence. Modern doctors do not consider such a diagnosis to be a pathology. It matters how high the placenta is located from the os of the uterus. Low fastening, especially on the front side, is fraught with miscarriage.
Incorrect position of the baby's place is diagnosed at the first planned ultrasound. The height of its location changes; a low mount is fixed in the first or second trimester. Next, the uterus stretches and the placenta begins to migrate. By the third trimester of pregnancy, only 3% of women still have the problem.
When attached to the back wall
Placenta by back wall the uterus is the most physiologically correct option its location. It is not subject to stretching or external influence, which ensures the safety of both the fetus and the protective organ itself. The risk of placental abruption in this location is minimal.
When the placenta is localized on the posterior wall, the cervix of the uterus is not blocked by anything. If the baby is in the correct position (head down) before birth, there are no other contraindications, labor proceeds naturally. The risk of complications during them is minimized.
If the placenta is attached to the anterior wall
With anterior attachment of the placenta, they speak of an unfavorable option. The organ is located in the part of the uterus that is greatly stretched. The placenta is not so elastic, and there is a high risk of detachment. With such a localization, it is very difficult to listen to the baby’s heartbeat and perform palpation; fetal movements may not be felt. For research you will have to use ultrasound.
Women with an anterior (especially low) position of the baby's place need to be especially careful, since any abdominal injuries threaten placental abruption and premature birth. When combined with a breech or lateral presentation, a natural birth may not be possible.
It is impossible to change the incorrect location of the placenta, in best case scenario it rises on its own as the fetus grows. However, this situation requires constant monitoring. The condition of the baby and mother is monitored throughout pregnancy. Attachment of the placenta to the anterior wall threatens bleeding - which means blood tests will be required for coagulation and hemoglobin levels. It is important to prevent the development of anemia.
If bleeding occurs before 24 weeks, the woman is hospitalized. Depending on the severity of blood loss, a decision is made to terminate or continue the pregnancy. In the latter case, the expectant mother is prescribed complete rest, she is left in the hospital, and conservation therapy is prescribed. The main task of doctors in this case is to extend the pregnancy until the child becomes viable. Next, a caesarean section is performed.
With lateral attachment
Lateral attachment of the placenta on the right or left side is not uncommon. It is important for doctors to monitor whether the baby's place is blocking the exit from the uterus. This is done using ultrasound. Often the decision to manage labor is made after it has begun. After the cervix opens 4 centimeters or more, an examination is performed. If the uterine os is blocked, the fetal membranes and the placenta or part thereof are visible during an ultrasound examination.
Symptoms, types and dangers of low placentation
Low placentation is a pathology that has no early stage no symptoms. Only on later a woman may notice nagging pain in the lower abdomen and the appearance of blood. By this time, with constant monitoring, the problem has already been identified. The location of the placenta is visible on the first planned ultrasound, then the dynamics of its migration are monitored.
There are 4 degrees of presentation:
- the child seat is attached from below at a distance of less than 3 cm from the internal pharynx;
- the placenta is localized near the internal os, but does not block the baby’s exit;
- the lower part of the organ covers the pharynx, the center and top are localized at the top and bottom of the uterus, the location is asymmetrical;
- the exit is completely blocked by the main part of the placenta, its edges are attached to the walls of the uterus.
Low placentation can be characterized by fastening of the baby's place along the posterior or anterior wall of the uterus. The difference is that in the first case the prognosis is more favorable - the localization of the placenta may change to a higher one. In the second case, as the fetus grows, the placenta will most likely sink even lower, which can lead to the following complications:
- overlap of the uterine os;
- incorrect position of the fetus, entanglement of the umbilical cord;
- fetal hypoxia;
- premature placental abruption;
- risk of bleeding during childbirth.
There are risks for women too. During the expulsion of the placenta, the pregnant woman does not always feel discomfort; the blood may not come out, but may remain in the uterine cavity. Uteroplacental apoplexy occurs. In this case, an urgent caesarean section is necessary, the uterus is completely removed. Untimely assistance threatens the woman’s life.
Is it possible to influence the location of the placenta?
It is impossible to have a direct influence on the location of the child's place, but it is possible to minimize the indirect causes of the development of pathologies. Measures to prevent low, anterior attachment or placenta previa include:
- exclusion of abortion;
- timely treatment of gynecological diseases;
- early registration for pregnancy;
- avoiding stress and physical activity early stages;
- healthy lifestyle: maintaining good physical shape, proper nutrition, walks in the open air;
- preparation for pregnancy: examination, taking vitamins.
All these factors not only improve the health of the expectant mother, but also make the embryo stronger and more resilient, and increase the likelihood of the correct location of the placenta. For most women, low placentation does not cause pregnancy complications, which means there is no need to panic. Localization of the baby's place at the bottom (central presentation) practically excludes the possibility of carrying a healthy baby. Timely diagnosis allows you to carry the baby to 38–39 weeks, after which a caesarean section is performed.
Every woman, having discovered two treasured lines on the test, eagerly awaits the first ultrasound to get to know her baby and make sure that everything is fine with him (her).
It is during the first study that a woman hopes to receive the bulk of the answers to her many questions and fears, but, as a rule, after an ultrasound, even more concerns and questions arise.
The doctor’s usual phrase, which says that the placenta is located on the back wall of the uterus (as well as on the front wall, on the bottom, side or bottom) causes not only bewilderment, but also fear, as well as worries about whether this is normal and whether it poses a threat to the baby.
Placenta - what is it, and the essence of its action, location
On the 9th day of pregnancy, in the place where the fertilized egg was attached to the wall of the uterus, a special villous chorion is formed, which precedes the appearance of the placenta, which occurs already at the 16th week. This organ is truly unique. It appears only during the period of gestation of the baby and, being born with it, dies, having fulfilled its purpose.
The purpose of the placenta is to provide the growing baby with everything necessary for normal and full development. It is through this organ that the baby gets everything he needs for life and gives away the products of his vital activity. In fact, this organ is necessary to create the maximum comfortable conditions during the period of intrauterine life of the baby.
The function of the organ is incredibly multifaceted and until the moment when the baby enters this world and begins to live independently, it is the placenta that performs the functions of almost all of its systems and most important organs, for example:
- digestive systems;
- respiratory organs, in particular the lungs;
- excretory system (kidneys);
- takes over all the functions of the skin;
- replaces endocrine glands.
The production of all hormones in the body of the baby and its expectant mother, as well as their level of metabolism, depends on the placenta. The organ grows along with the baby, constantly increasing in size and the development and health of the growing baby almost completely depends on its condition, as well as on proper functionality.
The egg, leaving the tube, can attach itself almost anywhere, for example, to the back wall or, conversely, to the front, in the side on any side. It can also be attached at different heights. In some cases, the predominant localization of the placenta even at the initial stage is in the lower part, which causes many complications.
There is a certain myth that says that the position of the baby at the time of birth will depend on where and how the placenta is located. But in reality, one has practically no connection with the other.
To the place where the placenta can be localized by ultrasound, the growing baby is attached motionless only at the very beginning, exactly until the umbilical cord and a sufficient volume of fluid appear in the uterus, allowing the baby to begin to move, roll over and change its position.
Therefore, it is impossible to predict exactly what position he will be in by the time the birth process begins based on the location of the placenta. Of course, the place where the placenta can attach to the uterine wall is of great importance, since a lot depends on it, for example, the presence (or absence) of certain complications.
Placenta placement options:
This term in medicine refers to the location of the placenta being too low, which often becomes an indication for a cesarean section, especially if the edge of the organ blocks the birth canal. This condition requires the utmost attention of doctors, since it poses many dangers and complications, in particular:
The location of the placenta during pregnancy has special meaning, since it is on this organ and its condition that the development of the baby, its health and reserve of strength at the time of birth depend. Do not despair if the attachment of the chorion is not perfect along the back wall, modern medicine allows you to cope with any problem in this area, it is only important to consult a doctor in time.
The placenta is an important organ, the condition of which plays a big role in the course of pregnancy and its outcome. The key point is the location of attachment. After all, the higher the location, the more favorable the pregnancy will be. The ideal option is a placenta along the posterior wall. In this case, the fetus develops and grows normally. This arrangement is good because there is sufficient blood supply and the placenta is protected from injury. Pregnancy will proceed with the least risk possible complications.
There is another opinion, according to which it is not important where the placenta is attached, but at what distance from the internal pharynx the so-called “baby place” is located. Each case should be considered individually.
The placenta forms during pregnancy to provide nutrition to the fetus. It is a temporary organ that can be called a connecting link between mother and child. Thanks to the placenta, the fetus receives all the necessary nutrients, as well as oxygen. The baby's lungs are not yet functioning, and nature has come up with a simple method of life support.
The attachment of the placenta matters - there are several options. The most optimal of them is along the back wall, at the bottom of the uterus.
The more the pregnancy progresses, the more the walls stretch, and the process occurs unevenly. The front is more stretchable, while the back is less elastic. Thanks to this fact, the fetus is well supported and protected.
It is still unknown why the placenta attaches along the back wall and closer to the fundus of the uterus. But there are several assumptions:
- This area is equipped with a large number of vessels, and the temperature there is higher than anywhere else.
- Nearby is the exit from the fallopian tubes. The egg cannot move on its own, so it remains where the contractions of the fallopian tubes brought it.
- Inside it are the mechanisms that are responsible for choosing a place for fastening.
Advantages of this location
It is easy for obstetricians to control the pregnancy process if the placenta is located on the posterior wall of the uterus - the fetus is accessible for palpation, ultrasound and a stethoscope. Even if there are some physical impacts on this area, amniotic fluid they will be softened.
There are several points according to which it is proven that the placenta along the back wall of the uterus is the best option:
- The immobility of the placenta is ensured. The back wall can remain dense for a long time and is little subject to change. It increases slightly in size, which reduces the level of stress on the placenta.
- The risk of injury is reduced. If the placenta is localized along the posterior wall, then we can talk about less susceptibility external factors, child's kicks.
- Risk is reduced. Very often in the early stages of pregnancy, ultrasound detects posterior presentation placenta. She gradually rises up and assumes a normal position. When attachment occurs to the anterior wall, this process does not exist.
- Risk is reduced.
- The likelihood of placenta accreta and tight attachment is reduced. This point applies only to those cases where a woman had to undergo surgery with the formation of a scar on the anterior wall. If during pregnancy it is discovered that the placenta is attached there, there is a risk of true accreta.
In all respects, the location of the placenta along the posterior wall is better than along the anterior wall. Indeed, in the second case, it may not have time to respond to changes, and hematomas may form. These 2-3 cm compactions interfere with listening to the fetal heartbeat, and the woman later begins to feel movements.
Features of the condition
It happens that the placenta is located low on the back wall. The doctor understands that its edge lags behind the internal os by less than 6 cm. The reasons for a low placenta on the posterior wall are: frequent pregnancies, presence of abortions, inflammatory diseases infectious endometrium.
A dangerous diagnosis is posterior placenta previa. In this case, the distance between its edge and the internal os is less than 6 cm. Because of this, there is a risk of premature placental abruption. As a result of this condition, heavy bleeding occurs.
Women whose placenta is low-lying should undergo an ultrasound scan at certain dates. Sometimes this is necessary more often than during normal pregnancy. If the diagnosis is confirmed at 36 weeks, hospitalization and surgical delivery are required. However, most cases end favorably.
There are factors that prevent the placenta from attaching to the optimal location:
- Defects in the area of the egg shell.
- The presence of fibroids, inflammatory, purulent phenomena in a woman, the presence of physical deformations of the uterus.
- An unproven factor is the effect of gravity during sleep.
More often, abnormal attachment is observed in women who have given birth.
It is important to remember that the posterior location of the placenta is not something for which all expert recommendations should be avoided. An ultrasound scan once per trimester allows you to determine whether a woman has a problem. If presentation is diagnosed, the doctor carefully plans monitoring of the pregnant woman.
Any deviation from the norm discovered in an expectant mother during an examination makes her worry. The course of pregnancy largely depends on where the placenta attaches. The ideal location is the upper third of the posterior wall of the uterus, but sometimes an anterior attachment is observed. Having heard such a diagnosis from a doctor, a woman needs to know why this pathology appeared, why it is dangerous, as well as what needs to be done and what precautions to take.
Placenta and its functions, types of location
When the fertilized egg completes its journey through fallopian tube and enters the uterus, it attaches to one of its walls. At the point of attachment, the placenta, or “baby place,” gradually begins to form.
What is placenta
The placenta is a unique organ that appears only during pregnancy, and after the birth of the child it emerges naturally through the birth canal. It is the placenta that connects the bodies of mother and baby, providing the fetus with everything it needs.
This organ is fully formed only by 15–16 weeks of pregnancy. That is why the first weeks, when there is no placenta yet, are the most dangerous for the fetus.
The placenta does not contain nerve cells, therefore it is not connected either to the brain or to the spinal cord of the expectant mother. Thus, this is the only organ that works completely autonomously - without control from the maternal body.
Functions of the placenta
The placenta is called upon to perform a number of functions that ensure the vital functions and proper development of the fetus. These include:
- delivery of nutrients to the baby;
- removal of metabolic products from the child’s body;
- gas exchange - delivery of oxygen and removal of carbon dioxide;
- filtering harmful substances entering the mother’s blood;
- defence from immune cells mothers who recognize the fetus as a foreign element and try to “attack” it;
- synthesis of hormones - hCG (which is an indicator of pregnancy when using tests), prolactin and others responsible for the growth and development of the child.
Types of placenta location
The following types of location of the placenta are determined by the place of attachment in the uterus:
The optimal position of the placenta is closer to the fundus of the uterus.
And if the location that closes the entrance to the uterus is called partial or full presentation placenta and requires a cesarean section, then attachment of the fetus along the anterior wall is not so dangerous pathology and is not considered an indication for surgical delivery.
Causes of anterior insertion of the placenta
The attachment of the egg to the anterior wall of the uterus may not have obvious reasons, being a matter of chance. But more often specific factors contribute to the incorrect positioning of the baby:
Thus, if any negative changes are present in the uterus, the egg chooses the safest and most optimal place under the given conditions - along the front wall.
Risks of placenta attaching to the anterior wall
Despite the fact that today the anterior insertion of the placenta is considered one of the normal variants and requires only special observation, this condition has its own pitfalls. They are connected primarily with the fact that the placenta does not tend to stretch. But it is the anterior wall of the uterus that changes during the growth of the fetus. 
Blood is one of the symptoms of incipient placental abruption
Possible complications of placenta attachment to the anterior wall include the following pathologies:
- downward movement of the placenta. When the growing uterus suddenly stretches, the placenta may begin to move around to maintain its integrity. If this organ migrates to a distance of less than 4 centimeters from the uterine os, the problem of placenta previa will arise;
- detachment. It is observed in conjunction with placental insufficiency and is a dangerous condition requiring immediate hospitalization and, possibly, emergency delivery;
- bleeding. Is a consequence active movements fetus with anterior attachment. It is fraught with hypoxia and even the death of the child, so at the first signs of bleeding it is necessary to call an ambulance;
- placenta accreta. Too strong an attachment is dangerous because after the birth of the child, the placenta will not be able to be removed naturally, and curettage will be required.
How to determine that the placenta is located on the anterior wall of the uterus
There are no clear and obvious symptoms of the location of the placenta along the anterior wall. The expectant mother will most likely learn about this pathology only during an ultrasound scan.
Symptoms of localization of the placenta along the anterior wall
There are several indirect signs, indicating possible anterior attachment:
- lower intensity of fetal movements felt by the mother compared to the posterior attachment;
- difficulty listening to the fetal heartbeat during a medical examination;
- large belly size.
These signs can be observed in other cases. For example, a large belly also indicates a large fetus, the presence of two or more fetuses, and polyhydramnios. And the heartbeat may be difficult to hear due to cardiovascular pathologies of the child. That is why the most informative way to determine the type of placental attachment is considered ultrasound diagnostics.
More obvious symptoms may appear when complications begin. So, during the process of the placenta moving down or during its detachment future mom Often observes the following conditions:
- pain in the lower segment of the abdomen of a pulling nature, as well as a feeling of heaviness;
- spotting brown discharge;
- bleeding of varying intensity.
Diagnostic methods
Attachment of the placenta to the anterior wall of the uterus can be detected or suspected in the process gynecological examination, during conducting CTG(cardiotocography) of the fetus. But an ultrasound will certainly determine its location. 
Ultrasound is today the safest and most informative method for determining the placenta insertion site
Ultrasound diagnostics will help not only to identify the fact of anterior attachment of the placenta, but will also reliably show the condition of this organ and the fetus itself - whether hypoxia has appeared, whether there is hidden bleeding or incipient detachment.
This is why it is so important not to ignore the doctor’s orders for an ultrasound, even if it is prescribed very often - a specialist may recommend this examination up to 2-3 times a week. It is important to understand that ultrasound diagnostics does not harm the developing baby and allows you to promptly identify the presence of problems.
What should an expectant mother do?
Although pregnancy with anterior attachment of the placenta is today recognized as a normal variant, nevertheless, a woman carrying a baby is often advised to follow a protective regime.
Features of pregnancy
The expectant mother should:
- exclude significant physical activity, especially on the abdominal muscles;
- Replace running with walking at a leisurely pace;
- spend more time outdoors;
- If possible, minimize the risk of abdominal trauma - wear non-slip shoes in winter in icy conditions, hold on to the handrails in transport;
- limit the weight of lifting objects to two kilograms;
- avoid stressful situations.
And one more moment from personal experience. Starting from the third trimester, it is strongly recommended to carry your pregnancy exchange card with you everywhere. This applies to any pregnancy, but especially to a situation with such a nuance. Because in the event of an emergency cesarean section, the doctor simply must be aware of the anterior insertion of the placenta in order to avoid complications. And you may not be able to tell him about this (in case of strong contractions, “there is no time for that”). Therefore, be sure to place an exchange card in your purse.
Childbirth with placenta on the anterior wall
At natural childbirth The location of the placenta is usually not important. After the baby is born, the placenta comes out after 10–15 minutes.
The situation is more complicated with a caesarean section. The fact is that the incision can be made at the placenta attachment site, and this increases the risk of large blood loss. Therefore, before performing this operation, the doctor will carefully study the location of the placenta and try to minimize the risks.
I also carried a child with a diagnosis of “attachment along the anterior wall of the uterus,” which was also complicated by low placentation and increased tone. It was precisely because of the hyperactivity of the uterus that I was prescribed a protective regime - do not engage in sports, walk more often, do not lift weights of more than 2 kg. Maybe this Taken measures precautions played their role, but, be that as it may, I did not experience any complications. The pregnancy proceeded absolutely normally, ultrasound showed the good condition of the fetus and placenta. Yes, I heard the baby a little later than my pregnant friends - at 19 weeks. And the tremors were felt weaker, although I would consider this a good thing: many of my friends, who were pregnant and had already given birth, complained of painful movements - the result of the activity of an older baby. I didn't have it. The delivery was performed by cesarean section for reasons other than the placenta. But despite the fact that the operation was not planned, but an emergency, and the doctor did not have the opportunity to carefully prepare for it, the intervention was successful - my daughter was born. Without complications and without any consequences. Therefore, despite the impressive list of possible complications, I am a supporter of the point of view that perceives the anterior insertion of the placenta as a variant of the norm.
