😾 😈 👩🏾‍🤝‍👨🏼 What is placenta previa: symptoms, causes, threats, physical examination and diagnosis, treatment and recovery period ⛏️ 🚾 🥩

What is placenta previa? This is a medical term by which various types of attachment of the placenta to the uterus are indicated. "Presentation" indicates that the placenta is located (attached) near the birth canal or even blocks them. Placenta previa during pregnancy is an anomaly, about its types and features of localization in the uterus of a pregnant woman, and we will discuss this article.

General terminology

The placenta is the connection between the baby and the mother, it is with the help of her that he receives oxygen and nutrition from her body, and it is through her that he gives the metabolic products.

The life of the child and how well the pregnancy develops directly depend on the state of this organ. That is why, when any pathology of pregnancy is diagnosed, a woman needs close monitoring by doctors.

So what is placenta previa? In obstetrics, it is believed that this is a pathology or abnormality of pregnancy that develops:

in the last weeks of pregnancy in about 0.4% of cases;
for a period of 20-33 weeks in 5-12% of cases.

As the child grows and the uterus is stretched, the placenta migrates, in this case, doctors note that placenta previa has risen. That is, the body took the place that was intended by nature.

To understand what placenta previa is, one should remember how the uterus is arranged. It is a muscular organ that consists of the body, bottom and neck. The bottom is located at the top of the organ, the cervix is at the bottom of the uterus, and between them the body extends. The outer part of the neck goes into the vagina.

During the birth process, the cervix opens under the pressure of the baby’s head and its body passes from the uterus into the vagina. But the baby will not be born if his path is blocked by something. It is this barrier that the placenta becomes, which occupies the space next to the cervix. It interferes with normal delivery, and this condition is regarded by doctors as a threat to the development and birth of the baby.

With placenta previa, the probability of death of a newborn is very high, it ranges from 6 to 25% of all cases. This level of mortality occurs due to premature birth, the incorrect position of the child in the uterus. Placenta previa can cause serious bleeding in a woman and lead to death. For example, about 3% of women die from bleeding. Due to infant and maternal death, placenta previa is considered a serious and dangerous pregnancy pathology.

Views

Depending on the features of the localization of the placenta, several types of presentation are distinguished. There are currently two classifications:

The first is based on determining the location of the placenta during pregnancy using ultrasound.
The second - on determining the location of the placenta during the birth process.

You should know that the type and degree of previa changes with the growth of the baby and the increase in the uterus.

According to ultrasound, there are such types of placenta previa during pregnancy:

Full - the placenta closes the entire intrauterine opening of the neck. Even if the cervix fully opens before childbirth, the baby will not be able to advance to the birth canal, since the placenta will interfere with it. Natural birth with such a pathology of the location of the placenta is impossible. The only way out in this situation is a cesarean section. It should be noted that this position of this organ in the uterine cavity is observed in 30% of cases from the total number of diagnosed presentations and is the most dangerous.
Incomplete placenta previa or partial - the organ partially overlaps the cervix, leaving a small free area. With this position of the placenta during the birth process, the baby’s head, as a rule, cannot pass through the narrow gap. Therefore, the natural birth process in this case is also not possible.
Low placenta previa during pregnancy is diagnosed when the placenta is attached at a distance of seven or less centimeters from the cervix. That is, the placenta does not overlap it. Against the background of low placenta previa during pregnancy, a natural birth process is quite possible. This is the most favorable type of pathology in terms of the development of complications.

A special case of low or incomplete is the posterior placenta previa. In this position, it is attached to the posterior wall of the uterus.

Front placenta previa is another option for low or incomplete placenta location. In this position, it is attached to the front wall of the uterus. This arrangement is also called "placenta previa on the front wall." This position of the organ is not considered a pathology, but reflects a variant of normal localization. In most cases, posterior and anterior presentation are determined by ultrasound up to 25-28 weeks of gestation, the organ can migrate for 10 weeks and by the time the birth begins, take a normal position.

This classification reflects the types of placenta previa during pregnancy, which are determined by ultrasound.

In addition to this typology, a clinical one was used for a long time, which is based on determining the position of the organ during the birth process.

Based on the vaginal type of research during the birth act, these types of posture are distinguished:

Central placenta previa.

The cervix is completely blocked. With central placenta previa, a natural birth process is not possible. Relatively speaking, this is such an arrangement, which is determined during the study before childbirth and corresponds to the complete presentation established as a result of ultrasound during pregnancy.

Lateral presentation.

During a vaginal examination, the doctor discovers a portion of the placenta that closes the cervix. This situation during childbirth corresponds to incomplete presentation established as a result of ultrasound.

Regional presentation of the placenta on the posterior wall.

The placenta is located near the cervix. The posterior marginal presentation of the placenta corresponds to the incomplete presentation established during pregnancy by ultrasound.

Causes

Placenta previa is most often associated with pathological changes in the endometrium, which develop due to inflammation, surgery, complicated by previous births.

Also, causes of placenta previa can be abnormalities of the uterus, endometriosis, multiple pregnancy, myoma, polyps of the cervix.

All these factors lead to the fact that the timeliness of implantation of a fertilized egg in the upper segment of the uterus is violated, and it attaches to its lower part. Most often, placenta previa develops in re-giving birth women.

Symptoms

The most important symptom of this pathology is bleeding, which, as a rule, is painless and periodically repeated. With placenta previa, bleeding can develop at any stage of pregnancy, but most often it is noted in the second trimester due to a strong and rapid increase in the uterus.

Bleeding causes detachment of the placenta, that is, the exposure of blood vessels occurs, from which blood flows bright red.

Various factors can provoke bleeding: vaginal examination, strong physical exertion, cough, sexual intercourse, severe straining during bowel movements, visiting a sauna or bath.

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

Abundant, sudden, painless, often occurs at night, characteristic of complete placenta previa. Such bleeding begins suddenly and can also suddenly stop, and can last a long time in the form of scanty discharge.
Bleeding in the last weeks before childbirth or during childbirth itself is characteristic of incomplete presentation.

Bleeding can be not only a symptom of the pathology of pregnancy, but also become a complication if it lasts for a long time.

Pregnant women with prolonged bleeding may experience anemia, low blood pressure, and fainting.

Indirect symptoms of placenta previa may be improper presentation of the child and the high bottom of the uterus.

Diagnostics

Diagnosis of pregnancy pathology can be based on the characteristic complaints of the woman, on the results of ultrasound or vaginal gynecological examination.

The characteristic signs of placenta previa are:

Bloody bright red discharge with a relaxed and painless uterus.
High condition of the bottom of the uterus.
Incorrect positioning of the baby in the uterus.

If a pregnant woman has such symptoms, then the doctor will suspect placenta previa. In this case, a vaginal examination is not performed, as this can provoke profuse bleeding and the onset of premature birth.

To confirm the preliminary analysis, the woman is sent for an ultrasound scan, with the help of which they accurately determine whether placenta previa and the degree of overlap of the cervix are present. Based on these data, the doctor makes a decision about the treatment and chooses the method of delivery.

Ultrasound scan

Ultrasound is the most harmless, harmless and informative method of diagnosing this pathology. This method of research allows you to accurately establish the type of presentation, measure the area and thickness of the child's place (placenta), determine the areas of detachment, if any. To diagnose various characteristics of the afterburn, ultrasound is performed with a moderately full bladder.

If pathology is detected, then an ultrasound scan is performed every 2 weeks in order to determine the migration rate. Doctors send the pregnant woman for diagnosis at 16, 24 and 36 weeks to determine the location of the placenta. If the pregnant woman has opportunities and desire, then the examination can be done weekly.

Possible complications

What threatens placenta previa? With this pathology of pregnancy, the following complications may develop:

anemia;
acute oxygen deficiency in the fetus;
risk of miscarriage;
preeclampsia;
improper location of the child in the uterine cavity;
developmental delay of the child.

The threat of termination of pregnancy occurs due to periodically repeated detachment of the placenta, which leads to acute fetal oxygen deficiency and bleeding.

Anemia is caused by persistent bleeding. Chronic hemorrhage develops, a deficiency of blood volume, its coagulability is impaired, which can lead to death of a pregnant woman in the birth process.

The incorrect position of the child in the uterus, that is, his pelvic presentation is due to the fact that in the lower part of the organ there is no place to place the baby's head, since it is partially occupied by the placenta.

Intimate proximity and placenta previa

With such a pathology of pregnancy, intimacy is contraindicated, as this can provoke its detachment and bleeding. Any kind of arousal is contraindicated, as this can lead to intensive contraction of the uterus, which is also unfavorable for placenta previa and can provoke not only detachment, bleeding, but also the onset of premature birth.

Treatment

Unfortunately, there is currently no specific treatment technique that can change the location and attachment of the placenta in the uterine cavity.

Therefore, therapy with this pathology is aimed at stopping (stopping) bleeding and maintaining pregnancy, in the most ideal case, before the onset of labor.

When placenta previa is present, the pregnant woman must follow a regimen throughout the period that is aimed at eliminating the causes that can cause bleeding. She needs to limit physical activity, not to have sex, not to jump, not to run, not to fly in an airplane, to avoid stressful situations, not to carry heaviness. You should from time to time lie on your back with your legs up. In this position, you need to rest at every opportunity.

After 20 weeks with placenta previa, if bleeding is not heavy and stops on its own, a woman should undergo a course of conservative treatment, which is aimed at maintaining pregnancy until 38 weeks. Therapy includes the following medicines:

Antispasmodics such as No-Shpa, Ginipral, Papaverin, which improve the stretching of the lower part of the uterus.
Iron medications for the prevention and treatment of anemia, for example, Ferrum Lek, Totem, Sorbifer Durules, Tardiferon.
Medicines to improve the blood supply to the fetus, for example, vitamin E, Trental, folic acid, Ascorutin, Curantil.

Often, conservative treatment for moderate bleeding consists of the following drugs: magnesia (intramuscularly), Magne B6, No-Shpa, Partusisten, Sorbifer, vitamin E, folic acid. The dosage and regimen are selected by the doctor individually for each woman.

These drugs will have to be taken throughout the term. If the bleeding is heavy, you should immediately call an ambulance or get to the hospital yourself. In a hospital, a woman is administered intravenously "Partusisten" and "No-Shpu", and in large doses, so that the muscles of the uterus are relaxed and her lower section is well stretched. After which the woman will again take medication in the form of tablets.

The following drugs are used to treat and prevent oxygen starvation of the fetus:

Trental (intravenously or in tablets);
Curantyl
Vitamin E
vitamin C;
Cocarboxylase;
folic acid;
"Actovegin";
glucose - intravenously.

Therapy with these drugs is carried out throughout the pregnancy. If these funds allow you to extend the pregnancy up to 36 weeks, then the woman will be hospitalized in the hospital and choose how she will give birth: natural birth or cesarean section.

If with this pathology of pregnancy severe bleeding develops, which the doctors cannot stop for several hours, then an emergency cesarean section is performed to save the woman's life. In this situation, they do not think about life and saving the fetus, since an attempt to maintain pregnancy with severe bleeding will lead to the death of both the mother and the baby. Emergency cesarean for placenta previa is performed with the following indications:

Repeated bleeding with severe blood loss.
Regular bleeding with scanty blood loss, while a woman has low blood pressure and severe anemia.
Simultaneous bleeding with severe blood loss (more than 250 ml).
Heavy bleeding and complete placenta previa.

Childbirth

Childbirth with this pathology of pregnancy can be both natural and using caesarean section. The choice of the method of delivery is carried out by the doctor, depending on the condition of the fetus and the pregnant woman, the type of placenta previa, the presence or absence of bleeding.

Caesarean section is currently performed in 70-80% of women with placenta previa. Indications for surgery are the following cases:

Complete overlap of the placenta of the cervix.
Incomplete overlap of the cervix, but combined with the incorrect position of the child in the uterus, as well as in the presence of scars and other injuries on the uterus, with multiple pregnancy, if the woman has a narrow pelvis, polyhydramnios, age of birth (over 30 years).
Continuous bleeding, in which the volume of blood loss is more than 250 ml.

If the indicated indications for surgery are absent, then the doctor will decide on the possibility of having a birth in a natural way.

Such childbirth can be carried out with placenta previa in such cases:

The absence of bleeding, or its complete stop, after an autopsy of the fetal bladder was performed.
A sufficient opening of the cervix has occurred, and she is ready for childbirth.
Fights are regular and of sufficient strength.
Head (correct) presentation of the child.

With all this, doctors are waiting for the birth process to begin without the use of stimulant drugs. In the birth process, the fetal bladder is opened with the opening of the cervix by 2 centimeters. If bleeding starts or does not stop after an autopsy, an emergency cesarean section is performed. But in the absence of bleeding, childbirth is a natural way.

Forecast for mother and baby

With not severe bleeding and timely surgery, the prognosis for the child and mother is favorable. – , .

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