As you know, the placenta is responsible for the connection between the expectant mother and her crumbs: it is through it that the fetus receives nutrition with oxygen, while metabolic products “leave” in the opposite direction. The development of pregnancy (and sometimes the life of the child) directly depends on the state of the “child’s place”, therefore, the identification of “presentation” requires close supervision of specialists and special care.
The content of the article:
Causes of incorrect position of the placenta in the uterus during pregnancy – who is at risk?
The formation of a “child’s place” is carried out in the uterus at the site of attachment of the ovum. As for the site itself, it is the ovum that chooses it according to the principle of “the best” for survival (that is, without scars and various neoplasms – and, of course, with a thick endometrium).
In the case when the “best” place is in the lower part of the uterus, the egg is fixed there. This is called placenta previa (wrong location).
What are the reasons?
- Endometrial changes resulting from inflammatory diseases
- Operator / manipulation inside the uterus (approx. – caesarean section, abortion, diagnostician / curettage, etc.).
- Inflammatory diseases of the sexes / organs (approx. – salpingitis, adnexitis, etc.).
- Disrupted hormonal balance.
- Surgical interventions (cesarean section and performed abortions, removal of fibroids, etc.).
- Multiple pregnancy.
- Uterine fibroids or endometriosis.
- Abnormal structure of the uterus or its underdevelopment.
- Childbirth with complications.
- Isthmico-cervical insufficiency.
Given that women who give birth for the first time, with a cesarean section and suffered multiple pregnancies (as well as most female diseases) are not familiar, they have the lowest risk of placenta previa.
Who is at risk?
First of all, women with a history of …
- Difficult childbirth, abortion and diagnostician / curettage.
- Pathologies of the cervix and uterine fibroids.
- Any past surgery on the uterus.
- Menstrual dysfunction.
- Past diseases of the genitals or pelvic organs.
- Underdevelopment of the genitals.
Types of abnormal location and presentation of the placenta
In accordance with the specific features of the location of the placenta, specialists (note – on the basis of information obtained after an ultrasound scan) identify certain types of its presentation.
- Full presentation. The most dangerous thing. A variant when the internal pharynx is completely closed by the placenta (approx. – the opening of the cervix). That is, the baby simply cannot get into the birth canal (the exit is blocked by the placenta). The only option for childbirth is a cesarean section.
- Incomplete presentation. In this case, the placenta overlaps the internal pharynx only partially (a small area remains free), or the lower part of the “child’s place” is located at the very edge of the internal pharynx. In most cases, and with incomplete presentation, “classic” childbirth is also impossible – only a cesarean section (the child simply will not pass into a part of the narrow lumen).
- Lower presentation. The most favorable option regarding the danger in gestation and childbirth. In this case, the placenta is located 7 (approx. – and less) cm from the perimeter of the entrance directly to the cervic / canal. That is, the site of the internal pharynx does not overlap with the placenta (the path “from the mother” is free).
Symptoms and diagnosis of abnormal position of the placenta – how long can it be diagnosed?
One of the most “striking” symptoms of presentation – regular bleedingaccompanied by painful sensations. It can be observed from the 12th week until the very birth – but, as a rule, it develops from the 2nd half of pregnancy due to the strong stretching of the uterine walls.
In recent weeks, the intensity of bleeding may increase.
The following factors provoke bleeding:
- Excessive physical activity.
- Vaginal examination.
- Constipation or direct bowel movement with strong straining.
- Visit to the bathhouse or sauna.
- Sexual contact.
- And even a strong cough.
Bleeding is different, and the volume / intensity does not depend on the degree of presentation at all. In addition, it should be noted that bleeding can be not only a sign, but also a serious complication of presentation if it does not stop for a long time.
Also, the symptoms of presentation can additionally include:
- Deficiency of circulating blood volume.
- Severe anemia.
And some indirect signs:
- High fundus of the uterus.
- Abnormal presentation of the fetus (approx. – breech, oblique or transverse).
In the 2-3rd trimester, the placenta can change its location due to its growth in the direction of the most blood-supplied areas of the myometrium. In medicine, this phenomenon is called the term “Migration of the placenta”… The process usually ends closer to 34-35 weeks.
Diagnosis of placenta previa – how is it determined?
- Obstetric external examination (approx. – the height of the day of the uterus, the position of the fetus).
- Auscultation (with her, in case of presentation, placental / vascular noise is usually noted directly in the lower part of the uterus near the placenta).
- Gynecological examination with mirrors. Palpation determines full presentation if there is a soft and large formation that occupies all the fornix of the vagina, and incomplete – when only the lateral or anterior fornix is occupied by it.
- Ultrasound. The safest method (compared to the previous one). With its help, not only the fact of placenta previa is determined, but also the size, area and structure, as well as the degree of detachment, hematomas and the threat of termination of pregnancy.
Pregnancy with abnormal placenta placement and possible complications
Of the possible complications of presentation of the “child’s place”, the following can be listed:
- The threat of termination of pregnancy and gestosis.
- Breech / foot presentation of the fetus.
- Mom’s anemia and chronic fetal hypoxia.
- Placental insufficiency.
- Delay in fetal development.
It is worth noting that complete placenta previa in most cases ends in preterm labor.
How is pregnancy going with established placenta previa?
- Period 20-28 weeks… If the presentation is confirmed on the 2nd ultrasound, and there are no symptoms, then a regular examination of the expectant mother by her gynecologist-obstetrician is sufficient. Usually, additional agents are prescribed to reduce the tone of the uterus. In the presence of even spotting discharge, hospitalization is required.
- Period 28-32 weeks. The most dangerous period for both: with an increase in the tone of the uterus in its lower parts, the risk of detachment and serious bleeding increases with a small size and immaturity of the fetus. With a marginal or full presentation, a hospital is indicated.
- Period 34 weeks. Even in the absence of bleeding and pronounced suffering of the fetus, the expectant mother is shown a hospital until the very birth. Only constant supervision of specialists can guarantee a successful outcome of pregnancy and childbirth.
Features of childbirth with incorrect location and presentation of the placenta – is it always necessary to have a cesarean?
With this diagnosis, childbirth can indeed be natural.
True, under certain conditions:
- Appropriate health status of the mother and fetus.
- No bleeding (or its complete stop after opening the fetus / bladder).
- Contractions that are regular and strong enough.
- The cervix is completely ready for childbirth.
- Head presentation of the fetus.
- Slight presentation.
When is a cesarean section performed?
- First of all, with full presentation.
- Secondly, with incomplete presentation in combination with one of the factors (several factors): breech presentation of the fetus or multiple pregnancies, scars on the uterus, a narrow pelvis of the mother, polyhydramnios, burdened obstetric / anamnesis (abortions or miscarriages, operations, etc.), age over 30 years, subject to 1 birth.
- In case of persistent bleeding with severe blood loss (approx. – over 250 ml) and regardless of the type of presentation.
In natural childbirth, the doctor first waits until labor begins (by itself, without stimulants), and after opening the cervix by one or two cm, opens the fetus / bladder. If after this the bleeding has not stopped or is gaining momentum, then a caesarean section is urgently performed.
On a note:
Prevention of presentation, oddly enough, also exists. This – refusal or prevention of abortion by using contraceptives and using them correctly, timely treatment of inflammatory diseases and consideration of women’s health.
Take care of yourself and be healthy!
The Bologny.ru website warns: self-medication can harm your health! The diagnosis should be made only by a doctor after an examination. Therefore, if you find alarming symptoms, be sure to contact a specialist!
Must share this useful content with your loved one's
Visit Bologny for more useful and informative articles!