Childbirth with an 'obstacle'. What is placenta previa? How does complete placenta previa affect the course of pregnancy?

Update: October 2018

Placenta previa is rightfully considered one of the most serious obstetric pathologies, which is observed in 0.2 - 0.6% of all pregnancies resulting in childbirth. Why is it dangerous? this complication pregnancy?

First of all, placenta previa is dangerous due to bleeding, the intensity and duration of which no doctor can predict. That is why pregnant women with such obstetric pathology belong to a high-risk group and are carefully monitored by doctors.

What does placenta previa mean?

The placenta is a temporary organ and appears only during pregnancy. With the help of the placenta, the connection between mother and fetus is carried out, the child receives through its blood vessels nutrients and gas exchange occurs. If the pregnancy proceeds normally, the placenta is located in the area of ​​the uterine fundus or in the area of ​​its walls, usually along back wall, moving to the sides (in these places the blood supply to the muscle layer is more intense).

Placenta previa is said to be present when the latter is located incorrectly in the uterus, in the area of ​​the lower segment. In fact, placenta previa is when it blocks the internal os, partially or completely, and is located below the presenting part of the baby, thus blocking the path for birth.

Types of choreon presentation

There are several classifications of the described obstetric pathology. The following is generally accepted:

Separately, it is worth highlighting low placentation or low presentation placenta during pregnancy.

Low placentation- this is the localization of the placenta at a level of 5 or less centimeters from the internal os in the third trimester and at a level of 7 or less centimeters from the internal os during pregnancy up to 26 weeks.

A low location of the placenta is the most favorable option; bleeding during gestation and childbirth rarely occurs, and the placenta itself is prone to so-called migration, that is, an increase in the distance between it and the internal os. This is due to the stretching of the lower segment at the end of the second and third trimesters and the growth of the placenta in the direction that is better supplied with blood, that is, to the uterine fundus.

In addition, the presenting vessels are identified. In this case, the vessel/vessels are located in shells, which are located in the area of ​​the internal pharynx. This complication poses a threat to the fetus if the integrity of the vessel is damaged.

Provoking factors

The reasons that cause placenta previa can be associated both with the condition of the mother’s body and with the characteristics of the fetal egg. The main reason for the development of complications is degenerative processes in the uterine mucosa. Then the fertilized egg is not able to penetrate (implant) into the endometrium of the fundus and/or body of the uterus, which forces it to descend lower. Predisposing factors:

Chronic endometritis, numerous intrauterine manipulations (curettage and abortion), myomatous nodes lead to the formation of an incomplete second phase of the endometrium, in which it prepares for implantation of a fertilized egg. Therefore, when forming the chorion, she looks for the most favorable place, which is well supplied with blood and optimal for placentation.

The severity of the proteolytic properties of the embryo also plays a role. That is, if the mechanism for the formation of enzymes that dissolve the decidual layer of the endometrium is slowed down, then the egg does not have time to implant in the “right” part of the uterus (in the fundus or along the back wall) and descends lower, where it is implanted into the mucosa.

Symptoms of placenta previa

The course of pregnancy, complicated by placenta previa, is conventionally divided into “silent” and “pronounced” phases. The “silent” phase is practically asymptomatic. When measuring the abdomen, the height of the uterine fundus is greater than normal, which is due to the high location of the presenting part of the child. The fetus itself is often located incorrectly in the uterus; there is a high percentage of pelvic, oblique, transverse positions, which is due to the localization of the placenta in the lower part of the uterus (it “forces” the child to occupy correct position and presentation).

Symptoms of placenta previa are explained by its incorrect localization. The pathognomic sign of this obstetric complication is external bleeding. Bleeding from the uterus can occur at any stage of pregnancy, but more often in the last weeks of gestation. This has two reasons.

• Firstly, in term (Braxton-Hicks contractions), which promotes stretching lower section uterus (preparation for childbirth). The placenta, which does not have the ability to contract, “comes off” from the uterine wall, and bleeding begins from its ruptured vessels.
• Secondly, the “unfolding” of the lower segment of the uterus in the second half of pregnancy occurs intensively, but the placenta does not have time to grow to the appropriate size and it begins to “migrate,” which also causes placental abruption and bleeding.

Typically, bleeding always begins suddenly, often against the background of absolute rest, for example, in sleep. It is impossible to predict when bleeding will occur and how intense it will be.

Of course, the percentage of profuse bleeding with central presentation is much greater than with incomplete presentation, but this is not necessary. The longer the gestational age, the greater the chance of bleeding.

• For example, marginal placenta previa may not manifest itself at all at 20 weeks, and bleeding will occur (but not necessarily) only during childbirth.
• Low placentation most often occurs without clinical symptoms, pregnancy and childbirth proceed without any special features.

One of typical characteristics bleeding during presentation is their recurrence. That is, every pregnant woman should know about this and always be on guard.

• The volume of bleeding varies: from intense to insignificant.
• The color of the blood released is always scarlet, and the bleeding is painless.

Any minor factor can provoke bleeding:

• straining during bowel movements or urination
• cough
• sexual intercourse or vaginal examination

Another difference between placenta previa is the woman’s progressive anemia (see). The volume of blood lost almost always does not correspond to the degree of anemia, which is much higher. During repeated bleeding, the blood does not have time to regenerate, its volume remains low, which leads to reduced blood pressure, the development of disseminated intravascular coagulation syndrome or hypovolemic shock.

Due to the incorrect location of the placenta, progressive anemia and reduced volume of circulating blood, it develops, which leads to intrauterine growth retardation and the occurrence of intrauterine hypoxia.

Case study: A 35-year-old woman was seen at the antenatal clinic; she was pregnant for the second time and was wanted. At the first ultrasound at 12 weeks, she was diagnosed with central placenta previa. An explanatory conversation was held with the pregnant woman, and appropriate recommendations were given, but my colleague and I observed with fear and expectation of bleeding. During the entire period of pregnancy, she experienced bleeding only once, at 28–29 weeks, and even then, it was not bleeding, but slight discharge bloody. Almost the entire pregnancy the woman was on sick leave, she was hospitalized in the pathology ward at a dangerous time and during the period of bleeding. The woman reached her term safely and at 36 weeks she was referred to maternity ward, where she successfully prepared for the upcoming planned caesarean section. But, as often happens, on a holiday she started bleeding. Therefore, an operating team was immediately convened. The baby was born wonderful, even without signs). The afterbirth was separated without problems, the uterus contracted well. The postoperative period also proceeded smoothly. Of course, everyone breathed a sigh of relief that such a huge burden had been lifted from their shoulders. But this case is rather atypical for central presentation, and the woman, one might say, was lucky that everything ended with little bloodshed.

How to diagnose?

Placenta previa is hidden and dangerous pathology. If the pregnant woman has not yet had bleeding, then presentation can be suspected, but the diagnosis can only be confirmed using additional methods examinations.

A carefully collected anamnesis helps to suggest a placenta previa (there have been complicated births in the past and/or postpartum period, numerous abortions, diseases of the uterus and appendages, operations on the uterus, etc.), the course of this pregnancy (often complicated by the threat of termination) and data from external obstetric examination.

During an external examination, the height of the uterine fundus is measured, which is greater than the expected gestational age, as well as abnormal position of the fetus or breech presentation. Palpation of the presenting part does not give clear sensations, as it is hidden under the placenta.

If a pregnant woman complains of bleeding, she is hospitalized in a hospital to exclude or confirm the diagnosis of such a pathology, where, if possible, an ultrasound is performed, preferably with a vaginal sensor. A speculum examination is carried out to determine the source of bloody discharge (from the cervix or varicose veins of the vagina).

The main condition that must be observed when examining with mirrors: the examination is carried out against the backdrop of a deployed operating room and always with heated mirrors, so that in case of increased bleeding, the operation can be started without delay.

Ultrasound remains the safest and precise method definitions of this pathology. In 98% of cases, the diagnosis is confirmed; false positive results are observed when the bladder is overly full, therefore, when examining with an ultrasound probe bladder should be moderately filled.

Ultrasound examination allows not only to determine the presentation of the choreon, but also to determine its type, as well as the area of ​​the placenta. The timing of ultrasound examinations during the entire period of gestation is somewhat different from the timing of normal pregnancy and correspond to 16, 24 - 26 and 34 - 36 weeks.

How pregnant women are managed and delivered

If placenta previa is confirmed, treatment depends on many circumstances. First of all, the gestational age when the bleeding occurred, its intensity, the amount of blood loss, general state pregnant woman and the readiness of the birth canal.

If chorionic presentation was established in the first 16 weeks, there is no bleeding and the woman’s general condition does not suffer, then she is treated on an outpatient basis, having previously explained the risks and given necessary recommendations(sexual rest, limitation of physical activity, prohibition of taking baths, visiting baths and saunas).

Upon reaching 24 weeks, the pregnant woman is hospitalized in a hospital, where preventive therapy is carried out. Also, all women with bleeding are subject to hospitalization, regardless of its intensity and stage of pregnancy. Treatment of the described obstetric pathology includes:

• medical and protective regime;
• treatment of fetoplacental insufficiency;
• anemia therapy;
• tocolysis (prevention of uterine contractions).

The protective treatment regime includes:

• prescription of sedatives (tincture of peony, motherwort or valerian)
• maximum restriction of physical activity (bed rest).
• Therapy of fetoplacental insufficiency prevents fetal development delay and consists of prescribing:
  • antiplatelet agents to improve the rheological qualities of blood (trental, chimes)
  • vitamins ( folic acid, vitamins C and E)
  • , cocarboxylase
  • Essentiale-Forte and other metabolic drugs
  • It is mandatory to take iron supplements to increase hemoglobin (sorbifer-durule c, tardiferon and others).

Tocolytic therapy is carried out not only in the case of a threatened miscarriage or threatening premature birth, but also for the purpose of prevention, the following are indicated:

• antispasmodics (magne-B6, magnesium sulfate)
• tocolytics (ginipral, partusisten), which are administered intravenously.
• in the case of threatening or beginning premature labor, prevention of respiratory disorders with corticosteroids and (dexamethasone, hydrocortisone) is mandatory for a duration of 2–3 days.

If bleeding occurs, the intensity of which threatens the woman’s life, regardless of the gestational age and the condition of the fetus (dead or nonviable), abdominal delivery is performed.

What to do and how to deliver a child with chorionic presentation? Doctors ask this question when they reach 37–38 weeks. If there is a lateral or marginal presentation and there is no bleeding, then in this case expectant tactics (start of spontaneous labor). When the cervix is ​​dilated by 3 centimeters, an amniotomy is performed for prophylactic purposes.

If bleeding occurs before the onset of regular contractions and there is a soft and distensible cervix, an amniotomy is also performed. In this case, the baby’s head lowers and is pressed against the entrance to the pelvis, and, accordingly, presses the detached lobules of the placenta, which causes the bleeding to stop. If the amniotomy has no effect, the woman is delivered abdominally.

Caesarean section is routinely performed for those pregnant women who have been diagnosed with complete presentation, or in the presence of incomplete presentation and concomitant pathology (improper position of the fetus, pelvic end presentation, age, uterine scar, etc.). Moreover, the surgical technique depends on which wall the placenta is located on. If the placenta is localized along the anterior wall, a corporal cesarean section is performed.

Complications

This obstetric pathology is very often complicated by the threat of miscarriage, intrauterine hypoxia, and delayed fetal development. In addition, placenta previa is often accompanied by its true accretion. In the third stage of labor and early postpartum period high risk of bleeding.

Case study: A multiparous woman was admitted to the obstetric department with complaints of bleeding for three hours from the birth canal. Diagnosis on admission: Pregnancy 32 weeks. Regional placenta previa. Intrauterine growth restriction of the 2nd degree (according to ultrasound). Uterine bleeding. The woman had no contractions, the fetal heartbeat was dull and irregular. My colleague and I immediately called the doctor. aviation, since it is still unclear how the matter may end other than the mandatory caesarean section. During the operation he was extracted alive. Attempts to remove the placenta were unsuccessful (true placenta accreta). The scope of the operation was expanded to hysterectomy (the uterus along with the cervix is ​​removed). The woman was transferred to the ward intensive care where she stayed for a day. The child died on the first day (prematurity plus intrauterine growth retardation). The woman was left without a uterus and a child. This is such a sad story, but, thank God, at least the mother was saved.

The placenta is a vital organ for the baby as long as it is in the womb. Through the nursery, the baby receives all the nutrients and vitamins that allow him to develop correctly. The placenta is connected to the baby's tummy by the umbilical cord. This is where blood exchange continuously occurs.

Approximately four out of every thousand women have to deal with the incorrect position of the child's seat. Regional placenta previa - what is it and how to treat it? This question worries many expectant mothers who are faced with a similar problem. You will receive the answer after reading the article. You can also find out what treatment there is for marginal placenta previa. What this condition threatens for the expectant mother and how it is diagnosed is described below. It is worth mentioning separately about the process of delivery in this case.

Placenta - what is it and how is it located?

The placenta or baby's place is the organ that exchanges between mother and baby. This formation also performs a protective function. So, if a mother takes any medications, the placenta does not allow them to fully penetrate into the baby’s blood. Education also protects the baby from harmful influence some factors. The placenta, in turn, tends to age. Doctors distinguish zero, first and second degrees of maturity. During pregnancy, calcified areas form in the child's place.

The baby's place appears around the third month of pregnancy. Doctors set a period of 12 weeks. However, the time period may shift in one direction or another depending on the ovulation that took place, which led to conception. The placenta remains in the woman’s body until childbirth and is released only after the fetus is expelled in the third period. The distance from the entrance to the uterus to the wall of the baby's place should be more than seven centimeters by the beginning of the third trimester.

Normally, the baby's place can be located on the front or back wall of the uterus. Lateral placement is also common. However, this is not always the case. Regional presentation of the placenta along the anterior, posterior or lateral wall is quite common. However, as you already know, the diagnosis is confirmed in only one woman in labor out of two hundred.

Pathological location of the child's place

Regional placenta previa occurs in approximately half of cases of incorrect placement of the baby's place. A woman may also experience complete blockage of the entrance to the uterus. In this case we are talking about absolute presentation. The lateral location of the placenta with the obstruction of the birth canal means that the baby's place is located on the wall of the uterus, but also affects it bottom part.

Marginal placenta previa is the position of the baby's place very close to the birth canal. In this case, the entrance to the uterus is not blocked. The placenta can only touch this opening with its edge. If the baby's place is located lower than seven centimeters from the entrance to the uterus, then this is marginal placenta previa.

Diagnostic methods: how does the problem manifest itself?

Quite often, during the next ultrasound screening examination, marginal placenta previa is detected. 20 weeks is the most common period for detecting this pathology. This fact can also be detected during a gynecological examination. However, this happens over a long period of time.

Abnormal positioning of the fetus sometimes indicates that the placenta is in the wrong place. In this case, the baby is forced to take an unnatural position. Often the baby lies down with his legs down. This allows the umbilical cord not to stretch and the baby to move freely.

Bleeding during pregnancy in the second and third trimester in most cases indicates marginal placenta previa. If a woman has this symptom, then she needs to be examined as soon as possible. Otherwise, the situation may get out of control and become very dangerous.

Pain in abdominal cavity may also indicate an incorrect position of the child's seat. At the same time, expectant mother a soft abdomen is noted. This is what distinguishes the pain in the described pathology from the sensations of labor.

Sometimes, when the placenta is located along the edge of the pharynx, a woman develops anemia and decreased blood pressure. It is worth noting that these symptoms can occur in the absence of bleeding. Often in such situations, without the lack of medical intervention, intrauterine growth retardation occurs.

Regional placenta previa: why is this condition dangerous?

This condition poses a serious danger not only for the child, but also for the expectant mother. That is why women with this diagnosis are taken under special control and monitored more carefully. If marginal placenta previa is detected along the posterior wall, the prognosis will be as follows.

1. For a child, a banal lack of nutrients is possible. As a result, children are born with small weight and height. They are often diagnosed with intrauterine growth retardation.
2. When placental abruption occurs, a woman develops massive bleeding. In this case, approximately ten percent of children die. This complication is also dangerous for the mother in labor. Doctors often have to completely remove the reproductive organ to save a woman’s life.
3. Often, if the position of the baby's place is incorrect, labor begins prematurely. Sometimes doctors are simply unable to save unplanned babies.
4. The danger of this pathology also lies in the fact that after the diagnosis is made, the woman begins to experience stress and anxiety. This, in turn, does not lead to anything good.

Why does this happen: reasons for the pathological location of the child's place

Why is a woman diagnosed with marginal placenta previa on the posterior wall or in the front? Doctors name several reasons for this circumstance. However, a direct dependence on them has not yet been proven.

Doctors say that the fertilized egg attaches to the uterus in the place where the best blood circulation occurs. So, if a woman has previously had miscarriages, abortions, diagnostic curettage- they lead to the chorion being located in the wrong place. This is also affected by some of the woman’s illnesses. These include inflammation in the pelvis, endometritis or endometriosis, cardiac and vascular pathologies. It is impossible not to mention uterine fibroids, polyps and other neoplasms. They also contribute to the risk of placenta previa.

Is there a chance for luck?

If you have been diagnosed with marginal placenta previa (17 weeks), then there is every chance to avoid complications and problems. The fact is that the baby's place is formed from the chorion at approximately 11-14 weeks. During this period, the placenta is located in the most favorable place for it. If she lies on the pharynx or near it, then everything can still change. We can talk about placenta previa only in the third trimester of pregnancy. Until this time, the fairer sex has a few more months.

It often happens that a low-lying nursery migrates. This is due to the fact that the main growth and stretching of the uterus occurs in the third trimester. During this period, the placenta simply rises higher due to changes in the inner lining of the uterus. Regular ultrasound examinations are necessary to diagnose changes in the condition.

Regional placenta previa: what to do?

If you have had to deal with the fact that during ultrasound diagnostics was identified this pathology, then you should first visit your gynecologist. Tell him about the problem and tell him about the presence or absence of symptoms. It is worth noting that a gynecological examination is excluded when this phenomenon develops. Therefore, remember that even if the doctor asks you to sit on the chair, this is strictly prohibited. The expectant mother can only be examined when the operating room in the maternity ward is ready.

If your term is still short, then placenta previa will be treated in the form of expectant management. The doctor simply gives time until the third trimester. In this case, regular ultrasound examinations to monitor dynamics. If the picture has not changed by 36 weeks, then select suitable method delivery.

When a woman develops symptoms such as bleeding or pain, treatment is indicated. Correction is prescribed exclusively by a gynecologist or obstetrician. In this case, you cannot act independently. Among medicines drugs that relieve spasms are selected and muscle tone. These include “Papaverine”, “No-Shpa”, “Magnesia” and so on. For more later The drug "Ginepral" is prescribed. At the same time, the woman is prescribed medications that increase hemoglobin: “Sorbifer”, “Rutin”, ascorbic acid. If bleeding develops, medications “Tranexam”, “Ditsinon” and others are prescribed. In addition, the patient is prescribed sedatives. Those allowed during pregnancy include Motherwort and Valerian. Compliance with the regime and diet is mandatory.

Measures to prevent complications

If you are diagnosed with anterior marginal placenta previa, then this is not a death sentence. In order to avoid complications, you must follow your doctor's recommendations.

Gynecologists recommend that such patients treat themselves very carefully. Do not lift heavy objects or strain yourself. You should absolutely exclude sports and any stress. It is also recommended to avoid stressful situations. For the entire period of pregnancy, such women are prescribed vitamin Magne B6, as well as Valerian.

It is worth abstaining from sexual intercourse until birth. Contraction of the uterus can contribute to the development of bleeding. In this case, sometimes it is necessary to accept the issue of urgent delivery.

Try to lie down and think about good things. Also watch your diet and bowel regularity. If constipation occurs, you need to take medications that relax your intestines. If symptoms occur in the second trimester of the child's development, the woman may be hospitalized. The expectant mother is advised to remain in the hospital until the birth.

How is childbirth?

Childbirth with marginal placenta previa can be carried out by two by known methods: caesarean section and natural process. The decision on this issue is always made by the doctor. It is worth noting that in most cases, cesarean section is performed for marginal placenta previa. This choice is explained by safety not only for the child, but also for the woman in labor.

During natural childbirth, complications often arise in the form of severe bleeding, weakness of labor and deaths. This is exactly what doctors try to avoid when prescribing surgery. However, some desperate women do not agree to the proposed conditions and consciously go for natural childbirth. In this case, when bleeding develops, it breaks through amniotic sac. The baby lowers himself and presses his head against the detached placenta, preventing it from leaving. A very large number of similar natural birth ends emergency surgery with complete removal of the uterus.

Caesarean section is a good choice

The only healthy choice for marginal placenta previa is a cesarean section. This manipulation will allow you to safely remove the baby from the uterus and prevent possible complications. Many patients refuse surgery simply because they do not want to be asleep during the birth of the baby. Nowadays medicine allows a woman in labor to be given anesthetics that block painful sensations in the lower part of the body. At the same time, the expectant mother does not sleep, but sees everything that is happening. If desired, preference can be given to the usual general anesthesia.

During the procedure, the doctor dissects abdominal wall women in labor. After this, the same goes for the muscles. Having reached the uterus, it is palpated. The doctor notes exactly where the placenta is located and makes an incision where it is not. After removing the baby, a standard separation of the child's seat and toilet of the abdominal cavity are performed. The operation is completed by suturing the incisions and treating the wound.

Forecasts for the future or consequences of marginal placenta previa

Many representatives of the fairer sex are concerned about the consequences of marginal placenta previa. Does this somehow affect the ability to conceive further? Is it possible to give birth on your own? How will the pregnancy proceed?

If a woman once had to deal with marginal placenta previa, then in most cases this situation does not recur in subsequent pregnancies. However, after a cesarean section, other difficulties may arise, such as the placenta accreting into the scar. It is also worth noting that women after surgery will most likely have to give birth the same way. However, in last years More and more modern clinics are providing natural births after caesarean sections.

After delivery through surgery, the woman’s body recovers within one month. If a natural birth was carried out with a complication, then this time can increase several times. In this case, repeated bleeding, inflammatory processes in the uterus and other problems often occur.

Separately, it is worth mentioning the development of bleeding during the birth of a baby. In this case, the fetus experiences severe hypoxia, which can lead to its death. With complete amputation of the reproductive organ, a woman becomes infertile. Because of this, representatives of the fairer sex experience extreme stress. This applies even to those women who do not plan to have any more children.

Summarizing the article or conclusion

You now know what marginal placenta previa is and how it can manifest itself. You also met possible complications, which are caused by pathology. Before delivery, you need to carry out diagnostics several times and consult with several doctors. Only after this can any decision be made. Be sure to listen to the advice of your gynecologist. After all, it was this doctor who monitored your condition throughout the entire period of pregnancy and knows all the nuances. Have an easy birth and good health!

Reading time: 7 minutes

During pregnancy, the baby is in the placenta. With the help of this shell, the child receives oxygen and nutrients from the mother's body. If the organ is in order and is attached to the back wall of the uterus, then the life of the fetus is not in danger. A serious pathology during pregnancy is placenta previa syndrome (low or marginal). What danger it poses to the fetus, the symptoms of the disease are described below.

What is placenta previa

Incorrect location or presentation of a child's place is a pathology that is found on early stages pregnancy. With this problem, the organ blocks the internal os partially or completely. It is located in the cervix and can block the birth canal. In the first trimester of pregnancy, pathology is common, but in later stages “placenta migration” may occur - during the development of the child, the uterus stretches, the placenta moves further from the cervix.

Symptoms

Basic clinical symptom placenta previa - bleeding. Its cause is organ detachment: the presence of bloody discharge indicates that a part is moving away from the side walls of the uterus and damaging the blood vessels. Highlight:

• vaginal bleeding;
• internal bleeding (with low presentation).

With heavy and frequent bleeding, a woman may suffer from hypotension (low stable blood pressure) and anemia (hemoglobin levels decrease). The pregnant woman is sent to the clinic for inpatient care for constant monitoring and examination. In difficult cases, pathology may result in fetal death. Bleeding occurs suddenly and always during sleep.

Causes

Placental presentation occurs for many reasons. This can happen after active physical activity, examination of the cervix by a gynecologist. Pathology may develop in the first weeks. Until the 24th week, doctors do nothing: there is a chance of normal movement of the organ and attachment to the walls of the uterus. Other factors that cause pathology include:

• features characteristic of a fertile egg;
• endometrial pathology;
• C-section;
• perforation of the uterus;
• scraping;
• multiple births with complications;
• myomectomy;
• abnormalities in the location of the uterus;
• contraction of the uterus;
• diseases of the reproductive system.

Kinds

There are several types of presentation in the cervical region and two main classifications. The first is determined using transvaginal ultrasound diagnostics. The second is determined during childbirth, when the cervix has opened by 5 cm. The degree and type of pathology changes as the opening of the pharynx, cervix and uterine growth increases. In total, there are three options for presentation:

• complete;
• low;
• incomplete;
• central;
• lateral.

Complete

With complete placentation, the placenta covers the internal os. That is, if the cervix opens completely, the child will not be able to be born, because his path is blocked by an organ that completely closes the exit from the uterus. In case of complete pathology, natural childbirth is not carried out. One option for delivery is the use of caesarean section. This location is the most dangerous pathology of the cervix. In 25% of cases, appear during childbirth serious complications which can lead to maternal or child mortality.

Incomplete

In the case of partial presentation (incomplete closure), the organ partially blocks the internal canal of the cervix: a small area remains in the opening. Incomplete pathology is compared to a plug, because the organ covers part of the tube, which does not allow amniotic fluid to move at the required speed. The lowest edge is level with the opening of the cervix. The baby's head will not be able to pass through the narrow part of the birth canal.

Low

Classic low presentation of the chorion during pregnancy is determined by its incorrect location, that is, the organ is located 7 cm or more from the perimeter of the cervical canal and does not reach the entrance. The entrance to the area of ​​the internal os of the cervix is ​​not captured. They may allow natural childbirth if gestation is progressing well. Low pathology is the most favorable of all dangerous complications. In obstetric practice, ultrasound is used to determine the degree of pathology during pregnancy.

Central

With such a presentation, the entrance to the cervical canal from the side of the uterus is completely closed by the new organ. During a vaginal examination, the gynecologist will not be able to determine membranes. In this case, there is no natural labor, so a caesarean section is used. Central pathology determined during childbirth or during a vaginal examination.

Lateral

During a vaginal examination with lateral presentation, the doctor determines the part of the organ that covers the entrance to the cervical canal, next to which there is a rough membrane. With lateral placentation, an incorrect location is formed, which is determined after examination and corresponds to the results of ultrasound about the presence of incomplete pathology or grade 2-3 in the first weeks of pregnancy.

Regional placenta previa

At regional pathology During a vaginal examination with the help of fingers, the gynecologist is able to identify the rough membranes of the fetus that protrude into the lumen of the cervical canal. Marginal placentation during pregnancy is determined by the fact that the organ is located near the edge of the internal os. It is determined during a vaginal examination and corresponds to the results of ultrasound for incomplete presentation or grade 1-2.

Placenta previa on the posterior wall

This type of pathology is characterized by the attachment of the organ to the villi of the posterior wall of the uterus. This deviation is common with incomplete or low presentation. The main part of the organ is attached to the back wall of the uterus, the exit is blocked by the placenta, which prevents natural labor. In this case, a caesarean section is performed - natural childbirth poses a danger to the child’s life.

Placenta previa on the anterior wall

Anterior pathology is marked by the attachment of the organ to the anterior wall of the uterus. This case is common with low or incomplete presentation. That is, the main part of the organ is attached to the anterior wall of the uterus, and this condition is considered not a pathology, but the norm. This condition is determined during an ultrasound scan before the 26th week of pregnancy. In this case, there is the option of placenta migration, which increases the likelihood that the woman will be sent for a normal natural birth.

What are the dangers of breech presentation?

Placental presentation recurs periodically, placental abruption can provoke fetal hypoxia and bleeding, therefore, there is a threat of miscarriage. For example, with complete pathology, it comes to the point that the pregnancy ends premature birth. The consequences of the pathology may be the following:

• gestosis;
• abortion;
• fetoplacental insufficiency;
• incorrect positioning of the fetus inside the uterus;
• chronic fetal hypoxia;
• foot or pelvic presentation of the fetus;
• Iron-deficiency anemia.

Fetoplacental insufficiency is due to the fact that the lower segment of the uterus has low blood supply compared to the body or fundus, that is, little blood reaches it. If there is poor blood flow in the localization of the placenta, this means that there is not enough oxygen and useful substances, which must go to the fetus, which does not satisfy its needs. Incorrect positioning of the baby or breech presentation is caused by insufficient free space in the lower part of the uterus for the head.

Diagnostics

In order to determine the type or degree of pathology of the placenta, they look at risk factors in the anamnesis, external uterine bleeding and objective research data. An external examination reveals a high position of the uterine fundus (transverse or oblique position of the fetus). Sometimes auscultation of the noise of placental vessels in the uterine segment at the location of the placenta is performed. During an ultrasound, diagnostics are carried out:

• size of placentation;
• stages;
• type;
• structures;
• degree of detachment;
• presence of hematomas;
• threats of abortion;
• placental migration.

During gynecological examination carry out an examination of the cervix to exclude vascular injuries or pathologies. When the external pharynx is closed, the part of the fetus cannot be determined. In case of complete presentation, a massive soft formation (fetal sac) is identified, which occupies the vaginal opening. During a palpation examination of a pregnant woman, with complete pathology, the occurrence of bleeding is diagnosed. If during examination there are membranes of the uterus and placental tissue in the lumen of the uterine pharynx, this means that you have an incomplete presentation.

Treatment

Among the methods of treating this pathology, there are two types - medicinal and non-medicinal. It is necessary to ensure complete rest for the woman (exclude physical activity, sex, stressful situations or other). She is prescribed bed rest and medications such as Drotaverine, Fenoterol, Dipyridamole, Dexamethasone, which contribute to a better progress of labor. Caesarean section is prescribed when narrow pelvis, polyhydramnios, multiple pregnancies, the presence of scars in the uterus.

Childbirth with placenta previa

With this diagnosis, doctors select individual approach to delivery. If the mother does not have obstetric complications and other pathologies with low placental implantation, this means that a natural birth can occur. During childbirth, the woman’s condition is continuously monitored, especially the amount of bloody discharge that accompanies the process, labor indicators and the intrauterine condition of the child.

Sometimes urgent tests are performed in the laboratory or ultrasound. If complications occur during labor, profuse bleeding and complete placentation, a cesarean section is performed. Regardless of various complications during pregnancy, it is necessary to act in accordance with the advice of a specialist, so it is recommended to listen to your doctor. A caesarean section for low placentation may also be prescribed.

Prevention

Preventive measures for previa include preventing abortions, detecting and treating hormonal dysfunction or genital pathology. Pathology develops during pregnancy and at this time it is necessary to diagnose abnormalities. It is recommended to manage the pregnancy rationally, taking into account all the threats and risks of complications, and to correct violations in a timely manner in order to obtain an optimal delivery.

Video

The placenta is one of the the most important organs, appearing during pregnancy. It is thanks to it that the child’s nutrition and breathing, as well as the removal of metabolic products, are possible. In addition, placental tissue produces hormones necessary for normal course and development of pregnancy.

Placenta previa is a pathology caused by the placenta being attached and developing in the wrong place.

Normally it is located at the bottom of the uterus, in the part that is least susceptible to change. If the placenta is from the pharynx, then they talk about presentation. It can be partial, when the uterine os is covered by the placenta by 1/3 or 2/3, or complete, when the center of the placenta is compatible with the uterine os. According to statistics, complete is almost 5 times less common than incomplete.

In case of incomplete presentation(lateral or marginal) there is hope that the placenta will independently move to the intended area closer to the day of birth. In the case of complete presentation, unfortunately, this option is completely excluded.

Typically, placenta previa is caused by the fact that the fertilized egg cannot implant in the right place due to damage to the endometrium of the uterus. The causes of abnormalities of the mucous layer can be:

• abortions and other operations performed by curettage, that is, removal of the upper layer of the uterus with a special instrument;
• deformation of the endometrium as a result of various inflammatory processes and diseases. Such deformities include scars, violation secretory function, smoothing out the folds of the mucous layer, fibroids;
• endometrial atrophy of varying degrees;
• poor blood supply to the uterus due to diseases of the liver, kidneys and cardiovascular system.

These factors fully explain why complete placenta previa is more often diagnosed in multiparous women women than those who are expecting their first baby.

In addition, the cause of central placenta previa may be delayed development of the fertilized egg. If it is formed behind the norm, then a situation is likely where the egg, without reaching the bottom of the uterus, attaches in the area of ​​the pharynx, where the placenta begins to develop.

Symptoms and complications

Vaginal bleeding is a complication of placenta previa and its main symptom. In the case of complete presentation, heavy bleeding begins already in the second trimester and can occur periodically until childbirth.

Why does bleeding occur with placenta previa? In order to answer this question, you need to understand how the placental tissue is attached to the body of the uterus.

Placental tissue consists of villi - formations filled with conducting vessels. Some villi grow together with the uterus, others are immersed in the mother’s blood, which fills the so-called intervillous space (thickening of the endometrium in the place where the placenta is attached). Blood enters this space from small arterial vessels, the walls of which are partially destroyed by enzymes secreted by placental villi.

All this complex mechanism works to ensure exchange between the organisms of mother and child: nutrients and oxygen come from the mother’s blood, and the placenta removes waste products from the fetus.

The child receives nutrition from the placenta through the umbilical cord, namely two arteries and a vein passing through it.

So we see that the placenta is literally fuses with the uterus. Time is running, the fetus develops and the uterus increases in volume: this is especially noticeable in its lower part, where the pharynx is located, that is, exactly where the placenta is attached in the case of central presentation. Since the placental tissue is low-elastic, it “does not have time” to stretch after the rapidly enlarging uterus.

Happening partial detachment placenta. The connection is broken, and the vessels begin to bleed into the uterine cavity, pouring out from the genital tract with profuse bleeding, followed by spotting.

Usually, the first time this happens is when the woman is at rest or sleeping at night. As a rule, there is no pain during bleeding - this distinguishes it from bleeding during self-termination of pregnancy, when cramping pain in the lower abdomen is possible.

Closer to 30 weeks bleeding can be caused by sex, others physical activity or even an examination on a gynecological chair.

In addition to bleeding in women diagnosed with complete placenta previa“Pain in the lower abdomen and lower back, uterine tone, and hypotension may be observed. Low pressure in turn, it is expressed in a depressed state, weakness, drowsiness and dizziness.

If a pregnant woman has periodic, heavy bleeding in most cases, develops anemia. This condition is characterized by a decrease in hemoglobin levels and can lead to more serious complications during pregnancy.

The lack of oxygen in the mother’s blood (namely, hemoglobin carries oxygen from the respiratory system to all organs and tissues of the body) negatively affects the baby’s condition. As a rule, it happens fetal growth restriction, growth retardation. Plus, this will affect the health of the already born child: with a high probability, he will also suffer from anemia in the first year of life.

Most likely, if there is heavy bleeding and a drop in the hemoglobin level of the expectant mother, the doctor will prescribe appropriate treatment, but she herself can additionally take care of her health by eating foods rich in iron and which have a positive effect on the level of hemoglobin in the blood:

• meat products, liver - with caution: it is rich not only in iron, but also in other vitamins, an excess of which can adversely affect the course of pregnancy;
• fruits: apples, pomegranates (be careful as they can cause constipation), peaches, apricots, dried fruits, etc.;
• berries; the richest in iron are blueberries, blueberries, as well as black currants and cranberries;
• vegetables and herbs: tomatoes, beets, pumpkin, dill, parsley, spinach, etc.;
• cereals and legumes: buckwheat, lentils, beans, peas;
• walnuts, dark chocolate.

In order for iron to be well absorbed, it is necessary to take it along with vitamin C (citrus fruits, broccoli, cranberries, pineapple), a sufficient amount of protein and not to consume black tea, coffee and milk at the same time as iron-containing foods, as they interfere with its absorption. It is necessary to ensure that constipation does not occur, which can cause bleeding.

Associated complications

The central presentation itself and the bleeding it causes can cause other pregnancy complications, for example:

• premature complete placental abruption;
• premature rupture of membranes;
• delayed fetal development;
• the likelihood of incorrect fetal position (transverse, oblique, pelvic presentation);
• placenta accreta; they speak of accretion when the villi of the placental tissue have grown into the deep layers of the uterus, and the placenta cannot separate from it on its own during childbirth. In this case, doctors perform the separation manually; it is clear that this is fraught with critical consequences. heavy bleeding, sometimes in such a situation there is only one way to save the life of a woman in labor - to remove the uterus;
• fetal hypoxia, the child actually lies on the placenta and with its movements can put pressure on it, pinching the vessels and impeding the access of oxygen.

Diagnostics

Complete placenta previa is diagnosed, usually by ultrasound, but can also be detected during a routine gynecological examination.

Observation and treatment

As such drug treatment Complete placenta previa does not exist. All that doctors can do is to carefully monitor the condition of the expectant mother and keep her other diseases under control, since many factors can provoke complications of the pathology. If a woman is not bothered by bleeding, then observation can be carried out on an outpatient basis.

Otherwise, from 24 weeks until the very moment of birth, she will have to stay in the hospital. Typically, in such a situation, the pregnant woman is prescribed strict bed rest, restorative drugs, iron supplements (for anemia), as well as medications to relieve uterine tone and improve blood supply in order to prevent fetal hypoxia

They always try to prolong pregnancy as long as possible, by at least until the moment when the child can be saved and left.

Behavior rules

A few simple rules will help you alleviate your condition and avoid irreparable complications.

1. Minimum physical activity. You cannot understand the heaviness and commit sudden movements, which displace the uterus, as this is fraught with placental abruption. Visit more often fresh air, but if peace is prescribed, then it is advisable to exclude walks, but you can sit with a book in the park;
2. Try not to worry and completely eliminate intimacy, since all this leads to uterine tone and can provoke bleeding;
3. Eat right, we already talked about this above;
4. If possible, visit crowded places as little as possible so as not to be at risk of becoming infected with something. In addition, you may be accidentally pushed in a crowd;
5. Don't do it long trips. It will be better if, if bleeding occurs, you have the opportunity to easily get to your doctor. If you are going somewhere, be sure to take an exchange card with pathology data.

Childbirth with complete placenta previa

The main problem of delivery with any type of placenta previa is Great chance bleeding.

Central (complete) placenta previa does not even suggest the possibility of natural childbirth, since the placental tissue completely blocks the fetus’s access to the birth canal, and any attempt may cost the life of both mother and child.

Caesarean section for central placenta previa carried out at 38 weeks if the woman feels satisfactory. If before this period she begins to experience massive bleeding, then the operation is performed urgently.

Surgical delivery with complete presentation is always carried out using general anesthesia , since bleeding, or even the likelihood of it, serves as a contraindication for regional anesthesia.

Postoperative period

Even if the operation was completed without complications, there is a high risk of bleeding after delivery. The reason for this is low contractility the body of the uterus in the place where the placenta was located. Considering the hypotension and anemia that almost all women diagnosed with central placenta previa suffer from due to bleeding, the new mother must remain in the hospital for some time under the close attention of doctors.

After discharge

Of course, it is very difficult to be in the hospital for a long time, especially when your husband is waiting at home and there is a mountain of household chores that vitally need to be done. However, after discharge from the maternity hospital, you need peace, both emotional and physical.

Ask your relatives to help with household chores, and get plenty of rest, sleep a lot and walk with your baby. It is very important to eat properly and nutritiously in order to bring your hemoglobin level back to normal. And this applies to both mother and baby.

This may be problematic, but try to fix it anyway. breast-feeding . This is very necessary for both mother and her child. Baby breast milk will provide strong immunity, which is very important for anemia, and also the iron that the mother consumes with food will be transferred to it. For mommy, breastfeeding is the key to intense contractions of the uterus, and, consequently, reducing the risk of recurrent bleeding. Read about how to establish breastfeeding after a caesarean section

As a conclusion, I would like to reassure expectant mothers who had to deal with complete placenta previa. Today, medicine has reached such a level that with this diagnosis, live and healthy children are born. The main thing is to follow the recommendations of specialists and take care of yourself.

Answer

Placenta previa is a serious complication of pregnancy when the placenta is displaced into the lower segment of the uterus. And then part of the placenta or all of it turns out to be present in front of the head or pelvic end of the fetus. With a transverse position of the fetus, when its head lies to one side of the uterus, and the legs or pelvic end to the other. With this position of the fetus, there is nothing directly at the exit of the uterus or the fetal arms are flickering. And the placenta lies ahead...

This is facilitated, firstly, by the same sexually transmitted infections, STIs.

Chronic inflammation caused by these pathogens affects the inner lining of the uterus - the endometrium, making it defective; the fertilized egg cannot properly attach to any defective wall and ends up in the lower segment, where the endometrium is not so fatally damaged. The second reason may be a genetic defect of the embryo, the absence of an enzyme that dissolves the surface of the endometrium so that the fertilized egg gets into such a hole and “buries” under the endometrial defect. The fertilized egg without the enzyme also falls down, and by gravity falls into a hole made by itself in a not so thick endometrium of the lower segment.

Also, in the formation of placenta previa, defects in the structure of the uterus can be important, when the additional uterine horn has a poor endometrium, unsuitable for hooking the fetus to the egg. The embryo also ends up in the lower segment of the uterus. Or the presence of a myomatous node protruding into the uterine cavity makes the endometrium defective and the fertilized egg cannot attach.

Endometrial deficiency can also develop in women who have had abortions or uterine curettage before an existing pregnancy.

In a situation where the placenta lies in front of the head or pelvic end of the fetus, any episode of uterine tension during fetal movement, threat of miscarriage, or Braxton-Hicks contractions can displace the placenta and cause its detachment from the uterine wall. This occurs due to the fact that when the entire uterus is tense, the lower segment of the uterus does not tense or contract. Because of this, displacement and detachment of the placenta previa occur.

This can cause bleeding into the uterine cavity, impaired circulation of the fetus, and severe hypoxia - depletion of oxygen content in the body. Lack of qualified medical care in this acute situation can lead to fetal death and dangerous blood loss for the woman.

Fortunately, partial or even complete placenta previa diagnosed at 7-8 weeks or 20-21 weeks with subsequent ultrasound most often records a gradual “creeping” - migration of the placenta, with the growth of the uterus, away from the exit from the uterus, up the wall of the uterus. This happens when the placenta is predominantly located on the anterior wall of the uterus, because during pregnancy, it is mainly the anterior wall that grows and stretches. When the placenta is located on the posterior wall, the hope for placental migration is weakened, since the posterior wall grows to a much lesser extent.

The placenta has many functions during pregnancy - delivering nutrients and oxygen to your baby from your blood through the umbilical cord. Usually it is attached high to the walls of the uterus; but problems can arise if the placenta covers the cervix instead. This condition is called placenta previa.

Risk factors

Risk factors include the following:

• numerous births;
• previous cesarean section;
• pathology of the uterus that prevents normal implantation (uterine fibroids, previous curettage);
• smoking;
• multiple pregnancy;
• advanced age of the mother.

Which situation is normal?

During labor, the baby moves forward of the placenta, passing through the cervix and vagina. It's important that things happen this way because the baby needs the placenta to breathe until he can do it himself.

What situation is abnormal

If the placenta is low and partially or completely covers the cervix, which leads into the vagina. This occurs in about one in 200 cases. Women who have had multiple children, late births, smokers or those who have already had a caesarean section are at greater risk.

What to worry about

Placenta previa may increase the risk of life-threatening hemorrhage before and after birth. This heavy, uncontrollable bleeding can occur because while the cervix thins and dilates for labor, the connection between the placenta and uterus can rupture due to the placenta being improperly positioned. If this happens, you may experience painless bleeding. The doctor will do an ultrasound to find out the cause of the bleeding. An ultrasound at 18-20 weeks may show a low-lying or placenta previa. It will be done again in the 3rd trimester, when in most cases the placenta will not be as low due to the growth of the uterus. If it's still completely covering your cervix in the 3rd trimester, it's probably still there. The diagnosis of placenta previa is usually made during the last 2 months of pregnancy.

Placenta previa can be:

• complete (the placenta “lies” on the internal os of the cervix, completely blocking it);
• partial (part of the placenta extends onto the internal os of the cervix);
• low (the edge of the placenta is slightly higher than the internal os of the cervix).

Symptoms and signs of placenta previa during pregnancy

Signs of placenta previa usually appear as sudden, painless, heavy bleeding of bright red blood, sometimes leading to hemorrhagic shock.

In some pregnant women, bleeding is accompanied by contractions.

The main symptom of placenta previa is bleeding from the genitals in the second half of pregnancy, at 28-30 weeks. It occurs suddenly, without apparent reason, in the absence of symptoms of a threat of miscarriage.

Such bleeding can be repeated until the end of pregnancy, they lead to anemia - anemia of pregnant women. It is advisable to carry out an ultrasound diagnosis after the first episode of bleeding, which will determine the presentation itself and its degree: complete, partial, marginal, etc. A woman with placenta previa should be hospitalized and stay in the maternity hospital until delivery. In the department of pregnant women, such women are prescribed strict bed rest and medications that relax muscles - antispasmodics. Anemia is also treated with vitamins and iron supplements. Such observation and treatment in a hospital provide the very qualified assistance to prevent life-threatening bleeding for the mother and fetus. The method of delivery is cesarean section, since during labor and uterine contractions, abruption can progress and lead to bleeding that is dangerous for both lives. Only with marginal placenta previa, when only a thin crescent of the marginal sinus of the placenta partially blocks the exit from the uterus, can you open the amniotic sac at the beginning of labor and lower the fetal head so that it presses against this edge, and thus prevent bleeding. This is only possible when the fetal head is positioned above the presenting part or the entire placenta. Placenta previa is very often combined with breech presentation, transverse or oblique position of the fetus. In such cases, the only method of delivery is cesarean section.

There are partial and complete placenta previa. Presentation is called complete if the placental tissue completely covers the internal os of the cervix. There is a concept of low placentation - this is a condition intermediate between normal location placenta and its previa. In this case, the edge of the placenta is not located high enough from the internal os, below 7 cm from it.

Threats of placenta previa during pregnancy

In the first half of pregnancy, placental precipitation is observed more often than in the third trimester of pregnancy. This is because as pregnancy progresses, the placenta migrates upward. It rises with the growth of the uterus from the internal os and no longer threatens pregnancy.

But if this does not happen, placenta previa can lead to.

• the appearance of a threat of miscarriage and bleeding (a low-lying placenta can detach, which entails bleeding and death of the embryo);
• iron deficiency anemia of a pregnant woman (a low-lying placenta can provoke bleeding that deprives a woman of iron);
• chronic hypoxia and delayed fetal development (the poor placenta attachment site is less well supplied with blood, because of this the baby suffers from a deficiency of oxygen and nutrients);
• incorrect position of the fetus in the uterus (if the placenta lies on the internal os, it interferes with the normal insertion of the baby’s head into the pelvis).

A pregnant woman can guess about some change in her condition by bloody discharge from the genital tract of a bright scarlet color. They are usually not accompanied painful sensations but may cause symptoms hemorrhagic shock against the background of anemia of a pregnant woman. The child’s condition depends on the amount of blood loss, since with heavy bleeding he experiences acute hypoxia (oxygen starvation).

Causes of placenta previa during pregnancy

Causes of placenta previa:

• the presence of abortions and uterine curettage before a real pregnancy. Intrauterine interventions lead to damage to the uterine mucosa, the occurrence of inflammatory process. After inflammation, changes occur in it that do not allow the fertilized egg to penetrate the uterine wall (implant) in the right place, so it sinks lower and attaches to the lower part of the uterus with the subsequent development of placenta previa;
• The presence of malformations of the uterus, sexual infantilism (underdevelopment of the internal genital organs), uterine fibroids, a scar on the uterus after a previous cesarean section or removal of fibroids - all these factors can interfere with the correct implantation of the fertilized egg;
• There is a violation of the ability of the fertilized egg to produce substances that facilitate its penetration into the wall of the uterus and fixation in it. In this case, the fertilized egg either produces an insufficient amount of special enzymes that help melt the mucous membrane of the uterine wall, or the production of these substances begins with a delay, when the fertilized egg has already descended into the lower part of the uterus.

It must be remembered that as pregnancy progresses, the placenta is able to move upward along the uterine wall. The anterior wall stretches as the uterus grows, and the placenta is pulled along with it towards the fundus of the uterus (migrates). If the placenta is located on the back wall of the uterus, then there is little hope of its moving upward due to the slight stretching of this part of the uterus during pregnancy. Thus, if the diagnosis of placenta previa is made at a short period of time (up to 25 weeks; pregnancy and the placenta is located in the front, then most likely by the time of delivery its location will be normal.

Placental abruption occurs as a result of minor uterine contractions (Braxton-Hicks contractions) that begin during pregnancy, serve to prepare the uterus for childbirth and are practically not felt by the pregnant woman. At the site of placental abruption, the vessels of the placental area of ​​the uterus are exposed, from which bleeding begins. Most often it occurs during pregnancy 28-30 weeks. Bleeding usually begins for no apparent reason, against the background wellness women. Its duration and the amount of blood loss are individual and do not depend on the degree of placenta previa (complete or partial). Bleeding with placenta previa most often recurs regularly throughout the rest of the pregnancy. They, even if not very abundant, due to their recurrence, lead to the development of anemia in a pregnant woman (a decrease in the content of red blood cells and hemoglobin in the blood). Severe anemia can cause fetal development problems. Repeated blood loss also leads to the fact that even minor bleeding during childbirth can cause a threat to a woman’s life.

An incorrectly positioned placenta prevents the presenting part of the fetus (head) from positioning correctly in the uterus. Very often there is a combination of placenta previa with abnormal fetal positions: breech presentation, transverse or oblique position.

The diagnosis of placenta previa is based on ultrasound examination, as well as according to vaginal examination (in a hospital setting).

Diagnosis of placenta previa during pregnancy

Transvaginal ultrasound. Placenta previa should be considered in all women with bleeding after 20 weeks. If previa is present, manual vaginal examination may increase bleeding or cause sudden heavy bleeding; therefore, if bleeding occurs after 20 weeks, such a study is contraindicated unless placenta previa is excluded by ultrasound. Sometimes presentation cannot be differentiated from abruption otherwise than with ultrasound.

Fetal cardiac activity should be monitored in all women suspected of having symptomatic placenta previa. If the clinical situation is not urgent, at 36 weeks the amniotic fluid is examined to determine the degree of maturity of the fetal lungs in order to determine the feasibility of delivery.

Treatment of placenta previa during pregnancy

• Hospitalization and bed rest for the first episode of bleeding before 36 weeks of gestation.
• Delivery if the condition of the mother or fetus is unstable.

For the first (signal) episode of vaginal bleeding before 36 weeks, treatment consists of hospitalization, bed rest and sexual rest, because sexual intercourse may cause bleeding due to uterine contractions or direct trauma. After the bleeding stops, discharge for outpatient observation is possible.

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Delivery is indicated in the following cases:

• heavy or uncontrollable bleeding;
• unsatisfactory results of monitoring fetal cardiac activity;
• hemodynamic instability in the mother; maturity of the fetal lungs (usually at 36 weeks).

Delivery is almost always done by caesarean section, but vaginal delivery is also possible if the fetal head is firmly attached and labor has already begun, or if the gestational age is less than 23 weeks and the fetus is expected to be delivered quickly.

Hemorrhagic shock should be treated. Rh0(D) immunoglobulin should be prescribed prophylactically if the mother has Rh-negative blood.

Women diagnosed with placenta previa should be hospitalized. In case of marginal placenta previa and the absence of uterine bleeding, it is considered best for the pregnant woman to stay in the hospital from the moment of diagnosis until delivery.

In case of complete placenta previa or marginal presentation and the presence of at least one episode of uterine bleeding, the presence of the pregnant woman in the hospital before birth is mandatory and vital.

Such pregnant women in the hospital are recommended to adhere to strict bed rest, antispasmodic drugs, multivitamins, and iron supplements are prescribed. The woman is under 24-hour supervision by medical personnel; her blood pressure is regularly measured and laboratory blood tests are performed. In addition, after 32 weeks of pregnancy, a cardiotocographic examination of the fetus is performed (once a week) and an ultrasound examination of the uterus and fetus (once a month).

Currently, the main method of delivery for pregnant women with placenta previa is cesarean section. This is due to the fact that during labor pains placental abruption intensifies, bleeding also intensifies and can become profuse (massive), which will pose a threat to the life of the woman and child.

Treatment depends on the stage of pregnancy, whether the placenta has begun to separate from the walls of the uterus, and the health of the baby. If placenta previa is diagnosed but there is no bleeding, you will likely be advised to have bed rest or activity restrictions to reduce the risk of bleeding until the baby is old enough for a caesarean section. If bleeding starts, you will be admitted to hospital; how long you stay there depends on several factors. In this case, a caesarean section is almost always done, because during a normal birth the placenta will tear away from the walls of the uterus, and bleeding will begin, dangerous for the mother and child.

A pregnant woman with bleeding should be hospitalized in a maternity hospital to provide timely medical care. The doctor compares data on bleeding, its volume, gestational age, ultrasound data and decides on the tactics of medical care for the woman. It is possible that the doctor will monitor the pregnant woman’s condition for some time, but may immediately suggest conservative treatment or surgical intervention (caesarean section).

In case of complete placenta previa (the placenta blocks the baby's exit from the uterus), in order to avoid massive bleeding in the woman and asphyxia of the fetus during childbirth, a planned cesarean section is indicated until the 38th week.

If the placenta is partially present, the woman may be allowed to go into natural labor, but only the maternity hospital doctor who is caring for the expectant mother can resolve such an issue.

Placenta previa is a dangerous situation for mother and baby, so it is necessary to follow all the recommendations of the treating obstetrician-gynecologist (exclusion of physical activity, exclusion of travel, exclusion of sexual activity, regular ultrasound examinations, hospitalization if necessary, etc.).