Placenta previa. What does complete placenta previa mean and why is it dangerous during pregnancy?

Placenta previa is the most common reason painless bleeding from the vagina later gestation (after the 20th week).

The placenta is a temporary organ that connects the organisms of the mother and fetus. Oxygen and nutrients are transmitted through its vessels. It has the shape of a disk, the diameter of which is 20 cm at the end of the gestational period. The placenta is attached to the wall of the uterus, usually at the side or top, and is connected to the fetus through the umbilical cord. Its presentation is a complication that occurs as a result of the attachment of the “baby place” near or directly above the cervix.

The placenta is rich in blood vessels. Therefore, when the cervix and lower segment of the uterus are stretched, bleeding may occur.

Basic facts about the disease:

• Placenta previa is a condition when it is attached to the uterine cavity in such a way that it partially or completely blocks the exit from it.
• The main sign of the pathology is bleeding after the 20th week of gestation.
• Ultrasound is used to diagnose the disease.
• Treatment includes activity restriction and bed rest. Depending on the severity of the condition, medications to relax the uterus, intravenous fluids, and blood or plasma transfusions may be needed.
• At full form presentation required C-section.

With this pathology, other complications are possible, but most patients give birth to healthy children.

Development mechanism

The placenta develops near the site where the embryo implants into the uterine wall, usually in the lower part. As it grows and develops, it can block the internal uterine os. It is believed that the main reason for the development of placenta previa is inflammatory or atrophic changes in the normal endometrium.

Why is placenta previa dangerous?

This is the main cause of bleeding from the genital tract at the end of pregnancy. Bloody issues arise due to distension of the lower segment of the uterus in the third trimester. As you prepare for birth, this area stretches and the placenta gradually separates from it. In this case, the myometrium cannot contract in the area of ​​abnormal attachment and blood is constantly released from the gaping vessels.

In response to blood loss, the body increases the production of thrombin - this substance promotes spasm of blood vessels and muscles for the formation of blood clots. The result is a vicious circle: bleeding from placenta previa – uterine contraction – further tissue separation – continued blood loss.

Classification

Previously, the following types of placenta previa were distinguished: complete, incomplete and marginal. Now they are combined into two concepts - complete and marginal.

Complete presentation is defined as the overlap of the uterine pharynx, that is, the transition of the uterus to the cervix. If the edge is less than 2 cm from the inner hole cervical canal, but does not completely close it, this is an incomplete presentation.

There is another, more accurate classification of this pathology (see figure below):

• low - the edge of the placenta is less than 7 cm from the uterine os, but does not touch it;
• marginal presentation - only the edge of the “child’s place” touches the uterine pharynx;
• lateral (incomplete) – the organ closes the internal pharynx by 2/3;
• central (complete) – the placenta completely covers the uterine os.

Classification of placenta previa: 1-low; 2 - marginal; 3 - incomplete; 4 - full

The main threat of this pathology is complications of childbirth, which can lead to the death of the mother or child. Therefore, according to ICD-10, there are 2 main types of disease - complicated by bleeding or without it.

Also, according to ultrasound data, the exact position of the “baby spot” is determined - on the anterior or posterior surface of the uterus (anterior and posterior presentation, respectively).

Causes

The exact reason for the development is not clear. It is believed that the condition occurs under the influence of several factors. The main ones:

• age over 35 years;
• previous infertility treatment;
• short interval between repeated pregnancies;
• previous operations on the uterus, curettage, abortions;
• previous caesarean section;
• previously suffered presentation of the “baby place” (recurrence rate ranges from 4 to 8%);
• submucosal uterine fibroids;
• low social and economic status;
• smoking and drug use.

A violation of the properties of the fertilized egg can also cause the position of the “children's place” to be too low. For unknown reasons, the production of substances that dissolve endometrial proteins may be disrupted in its membrane. As a result, the fertilized egg seems to slide into the lower segment, where it is implanted.

Placenta with umbilical cord

Childbirth with placenta previa is often complicated by secondary bleeding. This is due to the intense dilation of the cervix and the separation of the placental membrane from it. In this case, ineffective contractions of the uterine muscles develop, and bleeding cannot be stopped.

The following groups of pregnant women are at higher risk:

• Asian origin;
• with a male fetus;
• over 35-40 years old;
• have had placenta previa during one of their previous pregnancies.

Frequency of pathology and prognosis

The disease occurs in 1 case in 200 pregnancies. The risk increases by 1.5-5 times with a previous caesarean section.

At the age of over 40 years, the incidence of pathology reaches 5%, which is 9 times more common compared to women under 20 years of age.

If pathological low presentation placenta was detected by ultrasound early stages pregnancy, there is no need to worry too much. Up to 90% of such cases are no longer registered by the third trimester, that is, “ children's place" takes a normal position. If the pathology persists beyond 20 weeks of pregnancy, the risk of complications increases.

Complications

Presentation of the baby's place can cause the following complications on the part of the mother:

• bleeding during childbirth;
• placenta accreta or abruption; such a complication accompanies 5-10% of cases of presentation and usually requires a cesarean section;
• need for blood transfusion;
• early rupture of water and premature birth;
• postpartum endometritis;
• sepsis;
• thrombophlebitis.

Mortality rates are approximately 0.03% and are associated with severe bleeding that cannot be controlled and the development of disseminated intravascular coagulation.

In addition, like other complications of pregnancy, this pathology has a negative impact on the emotional comfort of the expectant mother, causing long-term stress.

For a newborn, placenta previa is also dangerous and can cause the following complications:

• congenital malformations;
• intrauterine growth restriction;
• fetal anemia, Rh conflict;
• abnormal presentation, most often breech;
• incorrect position baby inside the uterus, for example, oblique;
• low birth weight;
• prolonged jaundice;
• the need for treatment in the intensive care unit, long-term hospitalization;
• increased risk of sudden infant death and mental retardation.

Newborn mortality with this pathology is recorded in 1.2% of cases.

Advice for patients during pregnancy with breech presentation that will help avoid serious complications:

• avoid intense physical activity, vaginal examinations and sexual intercourse;
• consume sufficient amounts of iron and folic acid to prevent possible anemia (we talk about the importance of consuming folic acid during pregnancy);
• notify the supervising doctor about a previous presentation.

First symptoms and their assessment

The main clinical symptom of placenta previa is painless discharge of bright red blood from the vagina, which stops and then recurs, especially with exertion. Most often, this symptom appears in the second trimester, during the third, or with the onset of contractions. This symptom may occur before the 30th week (in 34% of patients) or after this period (in 45% of women). This symptom may be absent.

Additionally, it can be determined malpresentation child or high position of the uterine fundus.

Placental presentation in 44% of cases leads to earlier than 37 weeks.

Clinical guidelines state that any woman who experiences vaginal bleeding at 12 weeks or later should be seen by a doctor followed by an ultrasound. Due to the risk of life-threatening bleeding, any vaginal examination is absolutely contraindicated until the possibility of this pathology has been excluded.

When examining a woman with placental presentation, the following objective signs are determined:

• low blood pressure;
• cardiopalmus;
• softening of the uterus;
• normal fetal heart sounds.

Differential diagnosis should be performed to exclude the following conditions:

• cervical or vaginal rupture;
• miscarriage;
• premature placental abruption (read about this pathology);
• cervicitis, vaginitis, vulvovaginitis;
• DIC syndrome;
• normal birth;
• early rupture of water or premature birth;
• rupture of the uterus during pregnancy, for example, due to failure of sutures after a caesarean section.

Diagnostics

In diagnosing pathology, ultrasound of the uterus with visualization of the placenta is crucial. Its location should be determined at 16 weeks (up to 20 weeks of gestation). If pathology is detected, a repeat ultrasound is indicated at 32 weeks to select the method of delivery.

Laboratory research

If placenta previa is suspected, the following laboratory tests must be performed:

• determination of the Rh factor and the likelihood of Rh conflict;
• fibrinogen and fibrin levels;
• prothrombin or activated partial thromboplastin time;
• determination of blood group;
• extended blood test;
• if necessary, and determining the degree of maturity of the fetal lungs.

Ultrasonography

Ultrasound is necessary not only to determine the location of the placenta. It helps to assess the gestational age, fetal weight, suspected malformations, presentation, and umbilical cord position.

More information about ultrasound examination during pregnancy (when it is performed, how it is interpreted) can be read at.

Transvaginal ultrasound

This is the “gold standard” for diagnosing placental presentation. This type of research is well tolerated and provides accurate information. False-positive results are recorded in 1% of cases (that is, in fact there is no pathology), and false negatives - in 2% (there is a pathology, but it cannot be recognized).

Transvaginal ultrasound is also used to determine cervical length. Its shortening before 34 weeks indicates the likelihood of having a baby by caesarean section.

When planning birth tactics important also has a distance between the edge of the placenta and the internal uterine os, determined after 35 weeks. If it exceeds 2 cm, natural childbirth is possible. If the gap is shorter, a caesarean section is most often performed, although in some cases a normal birth is still possible.

According to ultrasound data, the following degrees of pathology are distinguished:

• I – the edge of the placenta is located at a distance of more than 3 cm from the internal os;
• II – the edge reaches the pharynx, but does not close it;
• III – the placenta covers the internal os, with both anterior and posterior presentation possible, that is, it is located asymmetrically;
• IV – the placenta lies symmetrically, with the central part located directly above the uterine os.

Transabdominal ultrasound

It's simple and safe method diagnosis, however, it is less accurate than the transvaginal method. Thus, the frequency of false-positive diagnostics is 7%, and false-negative – 8%.

Transperineal ultrasound

With this method, the sensor is located in the perineal area. This is an alternative to vaginal examination when this is not possible. However, this method is also not sufficiently accurate.

MRI

Magnetic resonance imaging can be used to determine labor management tactics. It is especially useful for diagnosing concomitant symptoms.

Pregnancy management

If a pregnant woman is diagnosed with placenta previa, the doctor must determine:

• exact gestational age;
• presence of bloody discharge;
• intensity of blood loss and the presence of posthemorrhagic anemia.

If the pathology is diagnosed in the second trimester, there is no bleeding, then the patient is observed as usual, under conditions antenatal clinic. Additionally, she is prescribed a blood coagulation test (coagulogram) and bed rest is recommended.

About bed rest

Bed rest improves blood flow to the placenta and blood supply to the fetus. When placenta previa occurs, it reduces the load on the lower parts of the uterus and thereby helps prevent bleeding and premature birth.

The doctor may prescribe different degrees of activity:

• in some cases, you can move around the house, but do not do heavy housework or lift heavy objects;
• More often it is recommended to remain in a sitting or lying position for a long time, getting up only to use the toilet or take a shower.

• sexual contacts;
• douching;
• using vaginal suppositories or tampons;
• repetitive squats;
• fast walking.

Bed rest during pregnancy can cause some complications, including:

• deep vein thrombosis of the legs;
• decreased bone mass (bone demineralization);
• deterioration of the function of the musculoskeletal and cardiovascular systems;
• maternal weight loss or gain;
• Stress due to having to lie in bed, especially if this involves financial problems or no one to care for children;
• depression and anxiety.

When prescribing bed rest, you should ask your doctor:

1. Why is this necessary, how long will it last?
2. Is it possible to squat and climb stairs? Do you need to lie in bed in a certain position? What measures should be taken to prevent venous thrombosis?
3. Is it possible to get up and go to the toilet or shower? Is it possible to wash your hair while bending forward?
4. Is it possible to have lunch while sitting at the table? Is it possible to use washing machine? Is it possible to drive a car?
5. Is it possible to have sex, what options are acceptable?

Hospitalization

If the pathology persists in the third trimester, but there is no bleeding, the issue of hospitalization is decided individually:

• if a woman, if necessary, can get to the maternity hospital in 5-10 minutes, she continues to be observed in consultation and is recommended to exclude physical work, sex life and any trips;
• if rapid delivery of the patient to a medical facility is impossible, she is hospitalized at 32-33 weeks; in this case, the pregnancy should be extended until 37-38 weeks, and then the issue of a planned caesarean section should be decided.

Any bleeding after the 30th week requires hospitalization. To decide on treatment when bleeding develops, the following factors are taken into account: various factors, in particular:

• volume of blood loss;
• whether the bleeding stopped at the time of hospitalization;
• gestational age;
• maternal health status;
• state of fetal development, signs of oxygen deficiency;
• position of the head and exact location of the placenta.

If the bleeding is heavy, a cesarean section is performed, regardless of the stage of pregnancy (read about how it is performed, recovery, consequences).

For minor discharge, therapy is carried out in the hospital to stop the bleeding. Fresh frozen plasma is used, anemia is corrected, and ultrasound monitoring of the position of the placenta is performed.

Questions to ask your doctor:

1. Can the presentation disappear over time in my case?
2. What to do if bleeding from the vagina occurs?
3. What kind of monitoring and testing will I need for the rest of my pregnancy?
4. Is it necessary to limit physical and sexual activity, and for how long?
5. For what symptoms do I need to visit an antenatal clinic unscheduled?
6. For what symptoms do I need to urgently go to the maternity hospital?
7. Will I be able to have a baby naturally?
8. How much does this condition increase the risk of a subsequent pregnancy?

Management of childbirth

Upon hospitalization, the patient must provide the doctor with the following information:

• when signs of bleeding appeared;
• the episode was one-time or the discharge recurred;
• how severe the bleeding was or is;
• whether it is accompanied by abdominal pain or contractions;
• were there any complications during previous pregnancies;
• whether you have had uterine surgery, including caesarean section, fibroid removal or curettage.

The treatment protocol for placenta previa recommends always taking into account the risk of massive bleeding and premature birth. Therefore, doctors should be prepared to stop bleeding using one of the following methods:

• suturing the placenta insertion site;
• bilateral ligation of the uterine arteries;
• ligation of the internal iliac artery;
• circular suturing of the lower segment of the uterus;
• tamponade with gauze or a special inflatable catheter;
• C-section.

Additionally, for postpartum hemorrhage, blood transfusions are used. Treatment includes the use and medications– oxytocin, methylergonovine, misoprostol. The risk of bleeding increases if the placenta is located on the anterior wall.

Independent childbirth

Management of childbirth naturally possible with incomplete presentation and absence of bleeding. After opening the amniotic sac and pressing the head to the lower segment, the vessels of the placenta are compressed, and then the birth process proceeds without complications.

If there is weakness of labor forces or the head is not tightly pressed to the entrance to the pelvis, it is possible by administering oxytocin. If this does not stop the bleeding, an emergency caesarean section is performed.

Tactics for vaginal bleeding

If bleeding occurs in the 3rd trimester, hospitalization is indicated; it is necessary first to assess the condition of the mother and fetus and, if necessary, begin an urgent blood transfusion. After the condition has stabilized, the cause of blood loss is determined. A transperineal or transabdominal ultrasound is prescribed and the vagina is examined.

Important! A vaginal examination is never performed when the diagnosis has already been established, since it can lead to placental separation and profuse bleeding.

If the gestational age is less than 36 weeks, vaginal bleeding has stopped, the condition of the fetus is normal, expectant management is indicated. When pregnancy is less than 34 weeks, the use of glucocorticoids is indicated. If the condition is stable, the pregnant woman is observed for at least 2 days, after which she can be discharged. If the bleeding does not stop or the fetus suffers, an emergency caesarean section is indicated.

Surgical interventions

The optimal timing for delivery with placenta previa has not been precisely determined. In women with placenta accreta, delivery is recommended at 36-37 weeks, and in the absence of placenta accreta, at 38-39 weeks. This ensures a minimal risk of bleeding and reduces the likelihood of prematurity. Earlier delivery is indicated if the patient has recurrent bleeding or has previously had a preterm birth.

Caesarean section is indicated for:

1. The distance between the placenta and the center of the cervix, not exceeding 2 cm. During this operation, especially if the “baby place” lies along back wall, a low transverse uterine incision is usually used. Anterior presentation may be an indication for a vertical incision.
2. The presence of concomitant placenta accreta or placenta accreta. During spontaneous childbirth, this pathology is accompanied high level mortality (up to 7%), as well as the risk of infection of the uterus or damage to neighboring organs. In this case, the uterus may need to be removed.
3. Previous cesarean section or abortion, as well as central placenta previa.

If there is no bleeding, the operation can be performed under epidural anesthesia. In other cases, general anesthesia is required.

C-section

In the 3rd stage of labor, you should definitely examine the birth canal using mirrors, since placenta previa is often accompanied by them. Additionally, medications that contract the uterus are administered, and antibiotics are started, since in the postpartum period there is a high probability of developing endometritis.

Possible complications of the early postpartum period:

• hypotonic and atonic bleeding, which may be an indication for manual examination of the uterus and separation of the placenta, and if such measures are ineffective, for removal of the uterus;
• amniotic fluid embolism;
• pulmonary embolism;
• ascending genital tract infection.

Both during a natural birth and during a surgical operation, a neonatologist must be present, since the child is often born in a state of asphyxia, which requires immediate treatment.

Features of nursing care

During childbirth with placenta previa, the midwife plays a major role. She constantly monitors the pregnant woman. Her responsibilities include:

• measuring blood pressure every 5-15 minutes;
• fetal heart rate assessment;
• contraction control;
• determining the volume of blood lost by weighing vaginal pads;
• instilling confidence in the pregnant woman in a favorable outcome of childbirth;
• answers to all the mother’s questions, which will help her cope with stress;
• competent provision of obstetric care during childbirth.

How the patient will feel and how high the level of adrenaline in her blood will be, which can adversely affect the course of labor, largely depends on the midwife. Therefore, medical personnel should treat the pregnant woman with understanding, kindness, politeness, and provide quick and confident assistance.

Information for pregnant women

To prevent long-term psychological stress, the following recommendations are given:

1. Learn more about this complication. Information will help reduce a woman's fears and concerns. You should talk to your doctor who is leading the pregnancy, search for information on your own, or talk to women who have already suffered such a complication.
2. Precisely determine the method of hospitalization, do not be left alone in case of calling an ambulance.
3. Prepare for a caesarean section, including creating conditions at home that make housework easier for the first time. If there are other children in the family, determine who will care for them at least during the first month after the operation. Make a supply of frozen foods, semi-finished products, clean clothes, possibly disposable dishes, prepare a room and trousseau for the child, agree with a loved one or a cleaning company to clean the apartment. Pack your bag for the maternity hospital in advance (everything should be ready after the 30th week).
4. Get as much rest as possible, preferably lying in bed.
5. Take care of your emotional peace.

Prevention

Taking into account the main causes of the development of pathology, prevention of placenta previa includes:

• reducing the number of abortions and intrauterine interventions;
• refusal unnecessary operations conservative myomectomy;
• reducing the number of caesarean sections due to more careful preparation and management of childbirth.

However, pathology can occur even in completely healthy woman. Therefore, it is impossible to completely get rid of the risk of placental presentation, as well as to cure this condition during pregnancy.

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

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

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

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

Placenta previa during pregnancy: types of pathology and their characteristics

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

Types of presentation according to ultrasound results

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

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

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

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

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

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

Causes of placenta previa

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

Uterine factors in the development of placenta previa

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

Uterine factors include:

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

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

Fetal factors of placenta previa

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

Among the fetal factors we note:

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

Indicators of placenta previa during pregnancy

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

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

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

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

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

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

Why is placenta previa dangerous during pregnancy?

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

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

Treatment of placenta previa during pregnancy

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

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

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

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

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

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

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

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

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

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

Thirdly, when treating a pregnant woman with placenta previa, be sure to monitor intrauterine condition baby. To eliminate fetoplacental insufficiency and prevent the development of oxygen starvation in the fetus, the following drugs are prescribed to the pregnant woman:

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

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

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

Placenta previa during pregnancy and sexual activity

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

Placenta previa during pregnancy: reviews

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

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

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

Several factors are necessary for the normal course of pregnancy and proper development of the fetus. The dominant place is occupied by the “baby place” or placenta. The life and health of the unborn child depends on its condition. The diagnosis of placenta previa indicates a deviation from its normal structure.

Determination of placenta previa in pregnant women

Placenta previa is a violation of the localization of the placenta, which is located in such a way that it completely or partially blocks.

The atypical location is an obstacle to natural childbirth and threatens serious 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.

Classification of presentation

Normally attached to the posterior wall of the uterus. The abnormal location of the temporary organ is classified according to its location and channel occlusion.

Presentation can be complete or partial.

1. – the placenta is located so low that its edge is very close to the cervical canal (approximately 6-7 cm), but does not touch it. The location of the placenta may change, for example, it may descend completely, blocking the canal, or it may rise up. With low placentation, complications during childbirth are not observed.
2. Marginal presentation - the edge of the placenta touches the uterine isthmus, but does not completely cover it.
3. Incomplete lateral - the exit from the uterine cavity is blocked by the placenta by more than 60% (more precisely, 68% or 2/3 of the lumen).
4. Central placenta previa is 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. Complete placenta previa threatens an unfavorable pregnancy outcome if unqualified or untimely assistance is provided.

Causes of presentation

The exact causes of the pathology have not been identified.

As a result of research, “stimulating” factors were identified, under the influence of which localization may be disrupted:

• when the mother is over 35 years old at the time of the baby’s birth;
• Long-term absence of pregnancy due to primary or secondary infertility;
• Multiparity;
• Multiple pregnancy (especially dangerous when carrying three fetuses);
• A history of cesarean section, as well as other types of surgical interventions on the reproductive organs;
• The risk of breech presentation increases 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.

Addictions and bad habits, only increase the risk of abnormal placentation.

The use of drugs or medications contributes not only to the abnormal location, but also to disruption of the structure of the temporary organ.

Which pregnant women are at risk of developing pathology?

The group at increased risk of developing abnormal placentation is represented by the following categories of pregnant women:

• Mother's age is more than 35 years;
• Pregnant Asian women;
• Pregnancy with a male fetus (XY chromosome);
• Development of pathology in previous pregnancies (risk of complete or partial presentation increases 4 times).

Symptoms of placenta previa

The main sign indicating a previa baby is the development of bleeding without pain.

The appearance of vaginal blood can be observed at any stage of gestation. In most cases, pathology is registered from 12 to 20 weeks of pregnancy.

• Iron deficiency develops;
• The uterus becomes softer upon palpation;
• remains unchanged;
• Bleeding appears suddenly, and often during night sleep.

The following signs are characteristic of complete placenta previa:

• scarlet color of blood;
• sudden appearance and cessation of bleeding;
• complete absence of pain.

The clinical manifestation of pathology can be caused by several factors. For example, taking a hot bath, excessive physical activity, coughing or sexual intercourse.

Diagnosis and degree of presentation in pregnant women

Pathology can only be identified using ultrasound diagnostics. According to the results of transvaginal echography, 4 degrees of pathology are distinguished:

• in grade 1, the placenta is located in the lower segment, the distance to the cervical canal is 3 cm;
• grade 2 is characterized by touching the edge of the child's place of the uterine pharynx without blocking the lumen;
• 3rd degree - the internal os is overlapped by the edge of the placenta in such a way that its location is asymmetrical, that is, it passes to the other (opposite) part of the segment;
• When diagnosing stage 4 placentation, the baby's place is located asymmetrically, covering the anterior and posterior walls of the uterine cavity. The channel is completely blocked by the central part.
• Thanks to this, not only the nature of the presentation is revealed, but also the size of the placenta and its structure. The condition of the fetus is assessed and the issue of treatment tactics is decided.

In addition to ultrasound, laboratory test and taking a medical history of the pregnant woman.

If you suspect previa gynecological examination is not carried out. The risk of bleeding increases.

Treatment of pathology during pregnancy

There is no drug therapy to eliminate the pathology.

The main treatment consists of following a gentle regimen and medical supervision.

Abnormal placentation increases the risk or early birth. The task of doctors in this case is to prevent such developments and prolong the pregnancy as long as possible.

Therapy is aimed at maintaining pregnancy:

• Antispasmodics;
• Hormone therapy;
• Sedatives;
• Medicines to increase blood clotting;
• In some cases - plasmapheresis or transfusion of Er-mass;
• In case of complete central presentation, the pregnant woman is hospitalized for constant monitoring of her condition and the condition of the fetus.

Once the diagnosis has been established, the pregnant woman should refrain from any type of exercise, intimacy and maintain bed rest.

As you know, the placenta is an embryonic organ located inside the uterus, which appears and functions only during pregnancy. It is intended to provide nutrition to the fetus, to remove metabolic products, and also to provide the fetus with oxygen. In this regard, not only the structure, but also the location of the placenta is extremely important for the intrauterine development of the fetus. Placenta previa is a serious pathology of pregnancy associated with the incorrect location of this organ in the uterus. There are central, marginal, low and complete presentations. We will talk about complete placenta previa.

The normal course of pregnancy implies the location of the placenta on the posterior wall of the uterus, that is, in the area where the best blood supply is provided and where this organ is maximally protected from accidental injury. Placenta previa is characterized by its location in the lower parts of the uterus, where this organ partially or completely covers the area of ​​the internal os. In the case when the internal os is completely blocked by the placenta, there is every reason to talk about its complete presentation. Fortunately, according to statistics, this pathology occurs in 2-3 cases per 1000 pregnancies.

There are quite a few causes of placental pathology. Most often its location in the uterus is influenced by pathological changes endometrium (inner layer of the uterus). Presentation can occur as a result of inflammation, repeated complications of childbirth or surgical interventions, for example, curettage, removal of fibroids, or as a result of cesarean section. In addition, the location of the placenta can be seriously affected by diseases such as uterine fibroids, endometriosis, uterine underdevelopment, cervical inflammation, isthmic-cervical insufficiency or multiple pregnancy. It should be noted that placenta previa is more common in repeatedly pregnant women.

The most common symptom of complete presentation is bleeding from the genital tract, which recurs regularly. It can occur at any stage of pregnancy, but is more common in the second half and intensifies before childbirth, when uterine contractions are more intense. This happens due to repeated placental abruption, which is unable to stretch along with the stretching walls of the uterus. The fetus, in this case, does not lose blood, but it faces oxygen starvation, since the detached part of the placenta ceases to participate in gas exchange. Bleeding during pregnancy can be triggered by sexual intercourse, vaginal examination, physical activity, a sharp cough, as well as increased intra-abdominal pressure and thermal procedures (sauna, hot bath).

Complete placenta previa is characterized by sudden and very heavy bleeding without pain. Such bleeding may stop abruptly and resume after some time, or continue with scanty discharge. But closer to childbirth it becomes more frequent and intensifies. In most cases, regular blood loss threatens a pregnant woman with anemia. With placenta previa, pregnancy is often complicated by the threat of miscarriage. In patients with complete presentation, premature birth occurs quite often.

30-40% of pregnant women with this pathology have low blood pressure. In addition, they often have nephropathy and late toxicosis. These complications significantly worsen the nature of recurrent bleeding. Complete presentation often causes placental insufficiency, fetal growth retardation and lack of oxygen. Quite often, this pathology also forms an incorrect position of the fetus in the uterus (oblique, transverse) or even breech presentation, which, in turn, further complicates the birth process.

Diagnosing placenta previa is not particularly difficult. Often, a pregnant woman’s complaints about periodic bleeding become a reason for vaginal examination, in which characteristic diagnostic signs of presentation are revealed. However, the safest and most objective method for diagnosing previa is ultrasound examination, which establishes exactly the type of presentation, assesses the size, as well as the degree of placental abruption. In cases where the area of ​​placental abruption does not exceed 1/4 of its area – the prognosis for the fetus is relatively favorable. When the placenta has detached over more than 1/3 of its own area, this fact very often leads to the death of the fetus.

Management of pregnancy with complete placental presentation depends on the amount and severity of blood loss. If there is no bleeding in the first half of pregnancy, the woman can stay at home, but under outpatient supervision. Monitoring of pregnancy over 24 weeks with this pathology occurs exclusively in a hospital. If bleeding is not heavy, doctors provide treatment aimed at prolonging pregnancy to 38 weeks. Even the cessation of bleeding cannot serve as a reason for discharge from the hospital before delivery. Doctors, in this case, prescribe medications that normalize contractile activity and treat fetal-placental insufficiency and anemia.

Complete placental previa is an absolute indication for a cesarean section, since the birth of a child through the natural birth canal is impossible. The operation is performed at the 38th week of pregnancy. In an emergency, surgery can be performed earlier if there are frequently recurring bleeding, immediate heavy blood loss, or a combination of blood loss with decreased blood pressure and anemia.

Prevention of possible placenta previa involves early diagnosis and treatment hormonal disorders, inflammation of the reproductive system, as well as in reducing the number of abortions. Take care of yourself!

Successful pregnancy depends on many factors. One of them is the place of attachment of the amniotic sac. In case of deviations, placenta previa occurs during pregnancy. To prevent complications, it is necessary to identify pathology and determine the causes of its occurrence.

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What is placenta previa

Often, when examining a pregnant woman’s condition, placenta previa is diagnosed. There is a need to study what it is and how it manifests itself.

Note! The amniotic sac plays an important role in the life support of the gestating fetus.

The bladder ensures interaction between the body of mother and child. This body performs the following functions:

• gas exchange;
• nutritious;
• immunoprotective;
• hormonal.

The physiological location of the fertilized egg suggests its location on:

• fundus of the uterus;
• posterior and lateral walls of the uterine body.

This area is least subject to change. It is also the area of ​​best vascularization.

Attachment to the posterior wall ensures that the embryo is protected from unexpected damage. When the bubble is attached from the pharynx, then a violation occurs.

Placenta previa is pathological location amniotic sac.

As a result, the embryo develops in the wrong place. It should be borne in mind that this condition directly affects the outcome of labor.

The danger of the pathology lies in limiting delivery. Since the organ is located in the lower part of the uterus, the birth canal is blocked.

This condition poses a threat to fetal development. Subject to detection of pathology the likelihood increases:

• prematurity of the child;
• fetoplacental insufficiency;
• premature birth;
• perinatal death;
• maternal death (due to blood loss and hemorrhagic shock).

This disorder is more often diagnosed in the early stages pregnancy. Closer to 40 weeks, the number of pathological cases decreases. This is due to "bubble migration". As the fetus develops, the uterus stretches, causing the embryo to move away from the cervix.

Causes of placenta previa

There is still no consensus on what influences the appearance of pathology. There is also no way to influence placental formation. Generally reasons for presentation Placentas can be divided into the following categories:

1. Aspects of embryonic development.
2. Aspects that determine the health of a pregnant woman.

To the features embryonic structure it is customary to refer to:

• trophoblast implantation failure;
• weak enzymatic action;
• delay in the development of the fertilized egg.

The presence of these factors makes it impossible for the fetus to implant in the upper section.

The state of the maternal body is determined by the following phenomena:

• inflammation in the endometrial area (often frequent);
• processes of endometrial atrophy;
• diseases of infectious nature;
• stagnant processes in the reproductive organs (are a consequence of chronic pathologies of the cardiovascular and endocrine system, as well as slow blood supply);
• surgical intervention in the uterine area;
• cases of gestation period;
• complications after previous labor;
• anomalous structure uterus;
• detection of endometriosis and uterine fibroids;
• underdevelopment of the uterus;
• the presence of isthmic-cervical insufficiency;
• the presence of endocervicitis;
• pathological processes in the cervical area;
• neuro-endocrine disorders;
• previously diagnosed facts of pathological location;
• exposure to addictions (systematic use of nicotine, alcohol-containing liquids and narcotic substances);
• multiple births;
• hormonal imbalance.

These causes of placenta previa affect the formation of the mucous membrane in the uterine area. If it is underdeveloped, the lower part of the cavity is an acceptable place.

Placenta previa: types

In medical practice it is customary to distinguish different kinds violations . Their classification is based on the following factors:

• determining the location of the ovum using transvaginal ultrasound;
• identification of the location of the ovum during labor (the condition for fulfillment is the presence of a 4-centimeter cervical dilatation or more).

The results of transvaginal examination allow us to divide pathology into the following types:

• full;
• incomplete;
• low.

Data obtained during delivery determine the existence of the following types of disorders:

• central;
• lateral;
• regional

Complete placenta previa

Complete presentation is presented in the form of a thorough overlap of the uterine pharynx with placental tissue.

This position of the amniotic sac creates restrictions for natural delivery. Even with the cervix fully dilated, the fetus won't be able to continue movement along the birth canal.

Full presentation is also known as centric position.

Its peculiarity is the need to carry out . Other types of pathology do not exclude the possibility that the amniotic sac will move. In the case of the central type, such an outcome of events does not exist.

Central placenta previa dangerous with the following consequences:

• complete placental abruption long before labor;
• the occurrence of embryonic hypoxia;
• slow development of the child;
• ovum accretion;
• early rupture of membranes.

This attachment provides for complete exclusion of intimacy and minimizing physical stress.

Incomplete placenta previa

Incomplete placenta previa is partial overlap internal opening of the cervix. With this arrangement, a small area remains free.

Incomplete placenta previa is also known as partial placenta previa. A subtype of this pathology is the marginal and lateral location.

The marginal location determines the presence of the lower part of the fertilized egg near the edge of the internal opening of the cervix. In this case, it can be either along the front wall or along the rear arch. A single level is noted for the cervix and placental edge. When positioned sideways, there is partial overlap.

This violation determines the impossibility of passing the child's head into the neck. This feature makes it possible to carry out caesarean section.

Regional placenta previa can be diagnosed by the anterior wall.

Anterior placement of the placenta is an option gynecological norm. Such a case is not usually classified as a pathological attachment.

This is due to the likelihood of stretching the uterus under the weight of the fetus and its further movement along the anterior wall.

Marginal presentation of the placenta along the posterior wall is usually classified as low or incomplete attachment of the membranes. It manifests itself as being on the posterior fornix.

This option is less dangerous than placing it on the front wall. This is explained by the difference in the load on the uterine area. However, they can bleeding occurs.

Low placenta previa

What is low placenta previa during pregnancy, what threatens the condition of the expectant mother and child - aspects of interest for study.

The low position suggests that the amniotic sac is at the level less than 7 cm from the beginning of the cervical canal. There is no overlap of the internal cervical os by the placenta.

This situation not considered a contraindication to natural delivery. Among existing pathologies, it is considered the most favorable for the period of gestation and childbirth.

There is the following classification of low location:

1. 1st degree (distance to the cervical canal – 3 cm);
2. 2nd degree (there is fixation of the fertilized egg near the beginning of the cervical canal without blocking the entrance);
3. 3rd degree (partial or complete overlap is noted, as well as placental displacement along the vault);
4. 4th degree (pronounced complete blocking).

With the first two degrees, natural delivery is possible. The latter degrees presuppose surgical intervention.

The danger of low presentation

Experts often diagnose low placenta previa during pregnancy. What threatens this condition is the main question for pregnant women.

Among the complications that arise against the background of this arrangement, it is customary to highlight:

• Risk of spontaneous termination of pregnancy(occurs as a result of partial placental abruption; accompanied by increased tone in the uterine area, systematic bleeding and lack of nutrients).
• Decreased blood pressure (accompanied by headaches, dizziness, fatigue).
• Anemia (caused by blood loss; is the root cause of hemorrhagic shock).
• Incorrect attachment of the embryo (response to insufficient space in the lower part of the organ).
• and risk delayed development child (impaired blood flow causes a limitation in the oxygen volume and nutrients supplied to the fetus).
• The risk of placental displacement during natural labor with the impossibility of normal delivery.

The low location determines the importance of systematic monitoring of the course of pregnancy.

Caesarean section for pathology

C-section in case of placenta previa it is carried out if there is:

• anamnesis in the form of diseases with a pronounced inflammatory nature;
• detection of polycystic disease or uterine fibroids;
• previous abortive interruption of the gestation period;
• multiple births;
• pregnancy at a late age;
• early surgical intervention with violation of the integrity of the uterus;
• systematic blood loss in a volume exceeding 0.2 l;
• complete low location of the amniotic sac;
• leg or pelvic fetal position.

The above aspects serve as the basis for planned surgical intervention. If there are no indications for a cesarean section with placenta previa, natural delivery occurs. If there is a threat to the life of the expectant mother or child, emergency intervention.

Note! It should be remembered that after surgery, a woman still has the possibility of subsequent childbearing.

Useful video: types of placenta previa

Conclusion

The gestation period may be accompanied by various anomalies. One of these pathologies is the placental location. This condition is diagnosed through a vaginal examination. Timely detection of pathology allows you to choose the optimal method of delivery.