Placenta previa - Causes, symptoms and treatment. MF.

First of all, in order to talk about placenta previa, you need to imagine what kind of body it is. Absolutely amazing, isolated both from the mother's body and from the fetal organism and at the same time is a bridge between them, the placenta "lives" only a few months, but without it the appearance of a baby would not be possible.

Normal location and functions of the placenta

The name appeared not accidentally, placenta - translated from Latin - "cake", so we can immediately imagine its appearance. It has the shape of a disc, soft and friable to the touch, the placenta grows throughout the pregnancy to 36 weeks and reaches the size of an average pancake pan. Placenta( a synonym for a child's place) performs many functions, the main ones are the nutrition of the developing baby, protection from harmful substances entering into his organism, and also hormone-forming. The placenta is an endocrine organ, that is, a number of hormones are formed in it - active substances that contribute to the proper functioning of the maternal organism for gestation.

The placenta has two surfaces: the maternal and the fertile. Its mother surface is intimately connected to the inner lining of the uterus, and the umbilical cord emanates from the fruit surface, which carries along the blood vessels the substances necessary for the development of the fetus. Where the umbilical cord joins the tummy of a toddler, the scar remains forever, reminding us that we all came from a "child's place."

In normal pregnancy, the placenta is usually located in the region of the uterine fundus, with a transition to the posterior and lateral walls. Rarely, it is located on the front wall, and it is not accidental. The anterior wall of the uterus undergoes much more transformation than the posterior wall. Thus, nature has taken care of the preservation of pregnancy. In addition, located close to the abdominal wall, the front wall of the uterus is subject to accidental injuries. Do not forget that the main role of the placenta - the transfer of nutrients and oxygen from the mother's body to the developing fetus in the womb, and nutrients spread throughout the body through the blood vessels. This is why the baby's place is located in the uterus in the most blood-supplying places.

During labor, uterine contractions that expel the fetus after its birth lead to a disruption of the intimate connection between the uterus and the placenta, and the latter is born during the post-natal period( the third stage of labor), which lasts from several minutes to half an hour, depending on the tactics of labor, adoptedin this maternity hospital. The latter includes a placenta with fruiting membranes.

Degrees of placenta previa

Being not in the right place, the placenta prevents the normal development of pregnancy. The term "placenta previa" includes all pathological variants of its location in the uterus from attachment in the lower segment to complete overlapping of the internal uterine throat. Despite all the variety of options, 3 main degrees of anomalous location are distinguished:

• the lower edge of the placenta is located below 7 cm above the inner throat, but does not reach it
• the lower edge of the placenta reaches the boundaries of the internal uterine throat or the placenta partially overlaps its
• completeplacenta previa.

More often this pathology occurs in many-reared women, with repeated abortions and other intra-uterine operations, in patients who have had inflammatory diseases of the uterus( endometritis).Significantly increases the incidence of this disease with uterine myomas.

Diagnosis of placenta previa

To date, diagnosis of placenta previa is not difficult. This pathology is revealed by screening ultrasound, during which it is possible to determine the localization of the placenta in the uterine cavity with high accuracy, as well as other important features such as thickness, structure, blood flow characteristics, etc. In addition, there are a number of clinical signs that allow suspect an abnormal location of the placenta, which is called "hands".

First of all it is a long high standing of the presenting part of the fetus over the entrance to the small pelvis at the late stages of pregnancy, the wrong position of the fetus, bright scarlet bleeding painless discharge from the genital tract, especially repeatedly repeated.

The course of pregnancy in this type of pathology is often complicated by the threat of interruption, abnormal fetal position in the uterine cavity, as well as the development of placental insufficiency and delayed fetal development. High risk of bleeding. Moreover, unlike bleeding related to other causes during pregnancy, with placenta previa, it carries a painless character.

Treatment of placenta previa

There are no cardinal treatments for this pathological condition. It is not possible to "transplant" the placenta into another more favorable place. However, when you hear a phrase "previa" or "low location of the placenta" at your gynecologist's reception, you should not panic. Medicine today has enough funds to help the development of pregnancy, even with a wrong placenta. And the main point is the dynamic observation of a doctor in a women's consultation.

There is such a thing as "migration of the placenta".Of course, the placenta does not move by itself, however, hitting in unfavorable conditions, that is, implanting in places with poor blood flow, it often grows to the bottom of the uterus, where the blood supply is much better. In addition, the muscular wall of the uterus undergoes significant changes during pregnancy, and some of the layers "move" into the upper parts of the uterus, along with them the removal of the placenta from the internal throat. These changes are most pronounced in the anterior wall of the uterus, as already mentioned above. Thus, the location of the placenta on the front wall of the uterus worsens the prognosis in terms of its sufficient blood supply, on the other hand there is more chance that the placenta "migrates", due to a change in the structure of the wall.

Complications of placenta previa

The most formidable complication of placenta previa is its detachment, which can result in severe bleeding from the opened vessels of the uterus, which can often be stopped only by emergency delivery by cesarean section. In addition to the woman's health, placental abruption in her presentation also endangers the life of the fetus. The larger the detachment surface, the greater the risk of massive bleeding and the stronger the fetus suffers from a lack of oxygen and nutrients. In contrast to another type of pathology - premature detachment of the normally located placenta - in case of presentation, bleeding is always external, that is, blood does not accumulate in the uterine cavity, but flows through the cervical canal in the neck. At the slightest suspicion of placental abruption the woman should be urgently hospitalized in the nearest obstetric hospital. If the gestational age does not allow expecting a baby's readiness for childbirth and extra-uterine life( up to 35-37 weeks), the condition of the patient and his baby is satisfactory, the amount of bleeding is small, possibly prolonging the pregnancy with medicinal methods. A woman is assigned a bed rest, hemostatic drugs, medicinal substances that reduce the tone of the uterus( tocolytics).The fetal condition is monitored dynamically by controlling the number of perturbations the patient conducts herself, by cardiac monitoring of the fetus. It may be necessary to administer glucocorticoid hormones in order to prepare the lungs for a baby outside of the mother's womb with the threat of premature birth. If a woman's condition is extremely difficult, even with a short period of time, pregnancy is interrupted by her mother's vital indications.

Given the threat of the above complications, a woman who has pregnancy with a placenta previa should observe the following rules. At home, she should avoid unnecessary physical exertion, lifting weights, jumping, shaking, you may need to limit sex.

It is necessary to exclude long-distance and long-distance travel, even if the road conditions are excellent and shaking is excluded. Air travel due to a sudden change in atmospheric pressure is also contraindicated. Relatives and relatives should help a pregnant woman to fulfill these conditions, in addition, they must know in advance which hospital should be hospitalized for complications. The environment of a pregnant woman should promote emotional calm and reduce stressful influence.

Birth with placenta presentation

The approach to delivery is always individual. In the absence of other obstetric complications and other somatic pathology, the patient's satisfactory condition, in the case of low attachment of the placenta, planned delivery through natural birth can be possible, which among women is often referred to as "giving birth to herself".In childbirth, continuous monitoring of the general condition of the mother, the volume of bloody discharge, hemodynamic parameters( pulse, arterial pressure), fetal status of the fetus, indicators of labor. If necessary, urgent laboratory tests and ultrasound can be performed. With the development of complications, massive bleeding, as well as with complete placenta previa, only operative labor( caesarean section) is possible.

Regardless of the presence of any complications of pregnancy, always follow the advice and recommendations of specialists. It is necessary to remember: even the most good doctor can not help you, if you do not want it.

Doctor obstetrician-gynecologist Nikulichev Dmitry Vyacheslavovich