Central placenta previa during pregnancy. Migration of the placenta with full presentation. Complete placenta previa Placental migration

Low placenta previa is a pathological condition in which the fetal site is located closer than 7 cm from the internal pharynx. This condition is considered completely normal up to 28 weeks, but equates to pathology at a later date. If by the time of delivery the placenta has not migrated above the specified border, the issue of performing a cesarean section is decided.

Causes of low placentation

On the mother's side, there are several factors that lead to a low location of the fetal site:

• chronic endometritis - inflammation of the lining of the uterus (including postpartum);
• a large number of births in the anamnesis (three or more);
• suffered miscarriages or abortions;
• any instrumental interventions in the uterine cavity;
• scar on the uterus after cesarean section or other operations;
• polyps, fibroids and other formations in the uterine cavity;
• endometriosis;
• anomalies in the development of the uterus (two-horned, saddle-shaped).

All these conditions change the lining of the uterus, lead to dystrophic processes, and at the time of implantation the embryo does not find a suitable place for attachment. Normally, the ovum is attached to the bottom or body of the uterus, along its back or front wall - where the blood supply is best, and therefore the nutrition of the fetus. If it is impossible to attach in the proper place, the embryo is introduced into the mucous membrane in the lower part of the uterus, close to the internal pharynx.

Maternal factors account for up to 90% of all causes of low placentation. Much less often, a decrease in the proteolytic properties of the ovum leads to this state, when the introduction into the loose mucous membrane of the bottom and body of the uterus becomes impossible. The embryo looks for a thinner place for itself - and finds it at the uterine pharynx. With an unfavorable outcome, such implantation can lead not only to a low location of the placenta, but also to atrophy of the chorionic villi, which threatens to terminate the pregnancy.

It is not always possible to find out the exact reason for the low location of the placenta. It is noticed that more often this pathology occurs in repeatedly pregnant women and extremely rarely - during the first pregnancy (without previous miscarriages, abortions, instrumental interventions in the uterine cavity).

Can the placenta migrate?

Low placenta previa is said to be if the fetal site is at a distance of 7 cm or less from the internal os of the uterus. Such a diagnosis is made at the second ultrasound screening at a period of 18-21 weeks, but during this period it does not have much significance. Normally, the low-lying placenta can migrate, and this happens in the II-III trimesters as the uterus grows and the lower uterine segment forms. The placenta "crawls" upward at a rate of 1-3 cm per month, and by 28-32 weeks usually reaches a normal level. With migration of the placenta, minor bleeding from the genital tract may appear.

After 28 weeks of gestation, the chances of the upward movement of the placenta are significantly reduced. If the fertile site remains in the lower part of the uterus at 32-36 weeks, the question of choosing a method of delivery is being decided.

Classification

In obstetric practice, it is customary to distinguish two options for low placentation:

• The placenta is located low along the back wall of the uterus. This is the most favorable option, since along with the growth of the genital organ, the fertile site will shift upward. As the gestation period increases, there will be room for the fetus in the lower segment of the uterus, and the birth is more likely to take place through the vaginal birth canal.
• The placenta, localized on the anterior wall, quite often goes down as the organ grows. Low placentation turns into true placenta previa - a much more serious condition, leaving almost no chance of natural childbirth.

Symptoms of the low location of the placenta

Low placentation in most cases does not manifest itself in any way and is detected by chance during an ultrasound scan. At the time of migration of the placenta, minor bleeding occurs, which does not pose a danger to the woman and the fetus. With a favorable outcome, a woman may not notice the problem at all, especially if the fertile site is located at the border of the norm, that is, at a distance of 5-6 cm from the internal pharynx.

Problems arise when the placenta is very low to the exit from the uterus or even obstructs it. Bloody discharge from the genital tract in this situation is repeated repeatedly. The intensity of this symptom can be different - from minor spotting to heavy bleeding. The severity of the manifestations of the disease depends on the localization of the placenta - the lower it is located, the higher the likelihood of an unfavorable outcome.

Complications

Low placenta previa threatens with the following complications:

Placental abruption

During the formation of the lower uterine segment, the myometrium contracts. And if normally this condition is not accompanied by any symptoms, then in the case of low placentation, detachment of the fetal site may occur. The placenta is not able to contract; it simply moves away from the wall of the uterus, exposing its vessels. The outflowing blood is maternal, bright scarlet. The bleeding may be profuse but not painful. Blood exits through the vagina without encountering obstacles and without forming hematomas, so the uterus remains painless to the touch and does not change its tone.

It can happen not only during pregnancy, but also during childbirth. The place of fetus departs from the wall of the uterus with the first contractions, unable to withstand the stress. After the rupture of the membranes and the outflow of amniotic fluid, bleeding may stop. A child moving along the genital tract can also press the placenta with the head and slow down blood loss.

The condition of the woman and the fetus with placental abruption will depend on the amount of blood loss. If help is provided on time, the best outcome will be maternal anemia and mild hypoxia of the child. Excessive bleeding can lead to the death of the woman and the fetus.

Iron-deficiency anemia

Frequent spotting in the II and III trimesters of pregnancy can lead to the development of anemia with the appearance of characteristic complaints: weakness, dizziness, pallor of the skin. The diagnosis is made by a general blood test. To correct anemia, iron supplements are prescribed, a change in diet is recommended.

Placental insufficiency

The location of the placenta in the lower part of the uterus is very unfavorable for the course of pregnancy. The mucous membrane here is poorly supplied with blood, and already from the second trimester, the baby experiences a lack of oxygen and nutrients. If the placenta does not migrate, in the long term this condition can lead to a delay in fetal development.

Consequences for the fetus

Low placentation interferes with the normal functioning of the fetal site and can lead to such undesirable consequences:

• chronic fetal hypoxia;
• developmental delay syndrome;
• entanglement with an umbilical cord, which threatens asphyxiation during childbirth;
• malposition.

All of these conditions impede the full development of the fetus and can place the birth of a child through the natural birth canal.

Diagnostics

Low placentation is detected during ultrasound. During the study, the doctor evaluates several parameters:

• Distance from the edge of the placenta to the internal os of the uterus.
• The state of the placenta, its thickness, the presence of calcifications.
• Correspondence of the degree of maturity of the placenta to the gestational age.
• The state of the chorionic villi in the endometrium.

Ultrasound examination is carried out in dynamics at 18-21 and 32-34 weeks, as well as before childbirth. With the development of bleeding, ultrasound is performed to assess the condition of the placenta and exclude its detachment.

Pregnancy management

In the absence of complaints and a satisfactory condition of the fetus, the woman is monitored. As practice shows, in 70-80% of cases, the low-lying placenta migrates upward, and further pregnancy proceeds without features.

Drug treatment is prescribed when blood flow in the placenta is disturbed, signs of fetal hypoxia appear. Means are used that improve microcirculation, preservation therapy is carried out with an increase in the tone of the uterus, and anemia is corrected. If the woman feels well and the risk of undesirable consequences for the fetus is low, treatment is carried out on an outpatient basis, in other situations - in an obstetric hospital.

With the development of bleeding and the onset of placental abruption, emergency hospitalization in the maternity hospital is indicated. Conservation and hemostatic therapy is carried out, the condition of the fetus is assessed using ultrasound and CTG. If the bleeding cannot be stopped, a caesarean section is indicated. When placental abruption occurs after 22 weeks, the child has a chance to survive with proper care. Up to 22 weeks, a miscarriage is recorded, and in this case it is not possible to save the fetus.

Delivery with low placenta previa

With the localization of the placenta at a distance of 5-6 cm from the internal pharynx, childbirth can be carried out through the natural birth canal. A prerequisite is a mature cervix and the correct position of the fetus: longitudinally, head down. During childbirth, the child's condition is monitored. Advance hospitalization and preparation for delivery is recommended.

When the placenta is located at a distance of 5 cm or less from the internal pharynx, the risk of bleeding during childbirth increases. In this situation, a cesarean section is shown in a planned manner.

If low placenta previa is detected, it is recommended:

• Avoid strenuous physical activity.
• Eliminate stress.
• Refuse long trips (especially in public transport).
• Limit sexual intercourse (with a very low location of the placenta, a ban on sex before childbirth is introduced).
• Monitor your well-being and vaginal discharge. If bleeding develops, consult a doctor.

Up to 70% of pregnancies with low placentation end favorably. In most women, the placenta migrates and by the middle of the third trimester takes its proper place. Regular ultrasound monitoring allows you to track the movement of the fetal site and develop the optimal tactics for managing the patient.

The placenta, despite its short-term existence, only a few months, plays a huge role in the life of the fetus. One of the most dangerous complications of pregnancy is placenta previa. This condition poses a threat not only to the life of the child, but also to the expectant mother. Therefore, the pathological location of the placenta requires careful monitoring and treatment of the pregnant woman.

What is placenta previa?

Location of the placenta Normally, the placenta (translated from Latin as a flat cake) is located in the bottom of the uterus or along the back wall. Such localization is due to the fact that in these places it is not at risk of injury. Less commonly, the placenta can be located on the anterior wall of the uterus, which is less favorable, since the anterior wall undergoes significant changes as the uterus grows due to pregnancy.

Placenta previa is an abnormal position where the placenta engulfs the internal os of the cervix (through which the fetus passes during birth). The frequency of this pathology is 0.1 - 1% of all pregnancies. Depending on how much the placenta overlaps the internal pharynx, several types of presentation are distinguished.

Types of placenta previa

• full or central presentation(the placenta completely overlaps the internal os of the cervix);
• partial presentation(the placenta partially captures the area of ​​the internal pharynx);
• low placentation(when the distance between the edge of the placenta is 5 cm or less, and 7 cm in the third trimester).

Partial placenta previa, in turn, is divided into regional and lateral... With marginal presentation, the placenta reaches the internal pharynx, but only the membranes protrude into the cervical canal. With lateral presentation, the placenta overlaps part of the cervical canal.

Among doctors, such a concept is widespread as "Migration" of the placenta, although it does not fully reflect the mechanism of movement of the placenta. They say about "migration" when, with the progression of pregnancy, the placenta shifts to a safe zone, to the bottom of the uterus. Most often, the "migration" of the placenta occurs with low placentation, especially when it is localized along the anterior wall. The mechanism of movement consists in the proliferation of the placenta in a more favorable direction, where the blood supply is better (the lower segment of the uterus is not sufficiently supplied with blood) and due to the displacement of the muscle layers of the uterus due to its growth.

Reasons for placenta previa

All the reasons that lead to an incorrect location of the placenta are divided into two groups:

• maternal factor(depends on the state of the woman's body);
• fruit factor(when the proteolytic functions of the fertilized egg are reduced, and it is not able to implant in the upper part of the uterus, but attaches to its wall when it has already gone down to the lower segment).

Predisposing factors of placenta previa are associated with changes in the structure of the uterine mucosa. These include:

• endometrial polyposis;
• numerous and curettage of the uterine cavity;
• uterine fibroids;
• operations on the uterus (removal of myomatous nodes);
• complicated labor with intrauterine intervention (manual control of the uterine cavity, manual separation of the placenta);
• multiple pregnancy;
• anomalies in the development of the uterus and its hypoplasia;
• smoking;
• multiple births;
• living in high mountain areas;
• chronic endocervicitis.

Clinical manifestations of pathology

The main sign of placenta previa is uterine bleeding. They are characterized by unpredictability and always start suddenly (usually at night, when a woman wakes up in a pool of blood). The amount of bleeding can vary, from spotting discharge to massive blood loss. As a rule, spotting appears after 24 weeks, which is associated with intense uterine growth, stretching of the lower segment and the appearance of uterine contractions. As a result, the placenta exfoliates from the wall of the uterus and, since it is unable to contract, begins to bleed. The bleeding may stop as suddenly as it started. The amount of blood lost depends on the type of presentation, the lower the placenta is deployed, the more bloody discharge (thus, it becomes clear that full presentation is the most formidable). Bleeding can be provoked by physical exertion, lifting weights, intercourse, harsh cough, going to a bath or sauna, vaginal examination, increased intra-abdominal pressure (constipation).

The second sign of placenta previa is fetal hypoxia. And although the baby does not lose his own blood during bleeding, placental abruption does not allow him to provide him with the necessary amount of oxygen.

Why is placenta previa dangerous?

The main complication of placenta previa is its detachment followed by bleeding. Massive bleeding can turn into profuse, which leads to the development of hemorrhagic shock, DIC (intravascular coagulation) and, as a result, fetal death. The risk of antenatal mortality also increases with the area of ​​the exfoliated area (with more than 1/3 detachment, the baby dies).

Placenta previa is constantly accompanied by a threat, which is manifested by an increased tone of the uterus, the occurrence of pain in the lower abdomen and in the lower back. In addition, this pathology is characterized by hypotension, manifested by weakness, and fainting. Constant bleeding leads to development.

Due to incorrect localization of the placenta, fetoplacental insufficiency develops, intrauterine fetal hypoxia and a delay in its growth and development. Also, with placenta previa, an incorrect position of the child (transverse, oblique,) is often observed, which is accompanied by characteristic complications.

Another complication of this pathology is the true increment of the placenta, which requires extirpation of the uterus. When bleeding occurs during childbirth, early rupture of the membranes is often observed.

Newborns are characterized by low weight, developmental abnormalities, physiological jaundice lasts longer, and underdevelopment of the respiratory system.

The placenta during the period of gestation of the baby facilitates the transport of oxygen and nutrients to the baby, and also with its help, the withdrawal of metabolic products is carried out. The tissue of the placenta produces hormones that are responsible for the normal course of pregnancy.

But there are situations when a woman develops such a pathology as central placenta previa, that is, the organ is fixed in the wrong place. Normally, the placenta should be placed at the bottom of the uterus in the area that is practically unchanged.

Reasons for the development of placenta previa

It is noted that the causes of such pathologies can be both problems with the mother's body and problems with the ovum. But the most common reason for this condition is the presence of dystrophic processes in the uterine mucosa. This leads to the fact that the endometrium is not able to descend to the bottom of the uterus and this causes the placenta to sink lower.

The predisposing factors for this kind of pathology are the following:

1. chronic inflammatory processes in the uterus;
2. numerous generic activities;
3. performing abortions or performing curettage of the uterus;
4. labor or turnover, the conduct of which led to such a complication as purulent-septic disease;
5. oncological processes of the uterus;
6. the presence of scars on the uterus resulting from surgical labor or removal of myomatous nodes;
7. congenital abnormalities in the development of the uterus;
8. endometriosis of the internal type;
9. sexual type of infantilism;
10. the presence of such a bad habit as smoking;
11. taking drugs;
12. the first labor activity at the age of 30 or more;
13. pathologies associated with the hormonal functioning of the ovaries;
14. carrying twins or twins.

All these factors lead to the fact that the endometrium simply does not have time to gain a foothold in the right place and placenta previa occurs.

It is worth noting that there is also such a manifestation as migration with central placenta previa - this is the movement of the placenta from the lower segment upwards and its gradual acceptance of a normal position. There is a high likelihood of migration if the placenta is placed on the anterior wall of the uterus.

Symptoms and possible complications

Central placenta previa during pregnancy is almost always accompanied by vaginal bleeding. As a rule, severe bleeding occurs as early as 4 months of pregnancy and can periodically occur until delivery.

In most cases, there are no painful sensations during bleeding - this is the main difference from the process of abortion, when cramping pains are also observed along with blood.

If there is a diagnosis of complete central placenta previa, then the following symptoms can also be expected:

• painful sensations in the lower abdomen and in the lumbar region;
• the uterus is constantly in good shape;
• hypotension is present.

Such manifestations lead to a significant decrease in pressure, which provokes the development of a feeling of weakness, depression, drowsiness, and dizziness can be observed.

In turn, the presence of bleeding and other symptoms can lead to a number of complications:

1. early complete abruption of the placenta is carried out;
2. the rupture of the fetal bladder is performed ahead of time;
3. there is a high probability that the fetus will be placed incorrectly - across, obliquely, in the pelvic region;
4. the placenta is accreted - the villi present in the placental tissue have grown very deep into the layer of the uterus, as a result of which during labor the placenta is not able to separate from the uterus on its own;
5. fetal hypoxia - the location of the child is such that he practically lies on the placenta and his slightest movement can provoke pressure on it, and leads to constriction of blood vessels and a deterioration in oxygen access.

Central placenta previa: consequences for the baby

If bleeding occurs periodically and is quite profuse, then it is possible that anemia will develop, which, according to numerous medical indications, leads to a decrease in the amount of hemoglobin, and this entails a number of serious complications.

If there is not enough oxygen in the mother's body, this will negatively affect the baby's condition. In most cases, there is a delay in the development of the fetus, the baby lags behind in growth. In addition, such a pathology will affect the already born child, with a probability of almost 90%, in the first year of his life he will suffer from anemia.

Diagnostic features

As doctors note, central placenta previa during pregnancy is a rather dangerous disease, which is characterized by a high level of secrecy. The first striking symptom is bleeding, therefore, before it appears, it is rather difficult to determine the presence of presentation, it, of course, can be suspected, but only professional doctors can confirm the diagnosis.

Initially, the doctor carries out an external examination, as a result of which the height of the uterine fundus is measured (with a central presentation, the height of the fundus is greater than it should be at the current gestational age) and an examination of the location of the fetus. It does not make sense to palpate, since precise sensations cannot be obtained due to the placenta.

If bleeding has already occurred, then the woman is hospitalized without fail and brought to the hospital, where an ultrasound scan is performed (it is advisable to use a vaginal sensor during this procedure). An examination is carried out in the mirrors to reveal exactly where the source of bleeding is located, most often it is the cervix or varicose veins located in the vagina.

The peculiarity of the examination procedure with mirrors is that these manipulations are carried out in the operating room and using heated mirrors. This must be done so that when bleeding increases, you can immediately start surgery.

Also, an ultrasound examination is mandatory, with the help of which it is possible to identify the presentation of the choreon, its type, as well as the area occupied by the placenta.

In the presence of such a pathology as central presentation, the timing of the ultrasound is slightly shifted, the procedure is performed at 16, 24 and 34 weeks of pregnancy.

Observation by a doctor for central placenta previa

As many doctors note, central placenta previa is a disease that requires constant monitoring of the expectant mother, it is imperative to think over the options for the implementation of labor in advance.

The frequency of visits to the gynecologist will completely depend on the gestational age, but only if the woman is not worried about anything.

Basically, the schedule of visits to antenatal clinics practically does not differ from the schedule of visits during the normal course of pregnancy:

• from the 3rd to the 5th month - once a month;
• starting from 6 months of pregnancy - twice a month.

The features of observation and treatment of a woman directly depend on which wall the placental presentation passes through - anterior or posterior.

Monitoring the condition of a woman will consist in regular examination of the condition of the placenta and regulation of bleeding.

As for the treatment itself, it includes the following elements:

1. transfusion of small doses of blood;
2. the use of drugs of the antispasmodic and tocolytic type;
3. to get rid of uteroplacental bleeding, increase blood clotting and strengthen the walls of blood vessels, doctors prescribe hormonal drugs for pregnant women;
4. the use of sedatives is recommended, vivid examples are motherwort and valerian tinctures;
5. preventive actions are taken to prevent the development of hypoxia and endometritis.

In the presence of such a diagnosis as central placenta previa, a particularly dangerous period is the first trimester, which lasts until the 12th week of pregnancy. If this time did not bring any symptoms and bleeding, then you still should not relax.

In situations where the detection of pathology occurs at 20-22 weeks of pregnancy, compliance with all the doctor's prescriptions can contribute to the movement of the placenta to the required place. If even the slightest bleeding appears during this period, an ambulance should be called immediately. When there is a re-excretion of blood, the woman is placed in a hospital for the period until the very birth of the baby. This is the only way to reduce the risk of placental abruption, severe blood loss and the development of all kinds of complications.

If the pathology of the location of the placenta is present before 36 weeks, then the patient is immediately hospitalized and the question of her delivery is considered. From the information received, it follows that if a woman has a central placenta previa at 38-39 weeks of pregnancy, then labor is performed only with the help of a cesarean section. Natural childbirth is strictly contraindicated, since there is a risk of severe complications.

Having a diagnosis of central placenta previa at 20 or more weeks of pregnancy is a 100% indication for a cesarean section, since the child will not be able to leave the uterus on its own due to the fact that its entrance is blocked by the placenta.

The greater the risks of complications and the stronger the bleeding, the more urgent is the appointment of a cesarean section, regardless of the gestational age.

If a woman refuses to go to the hospital and wants to be treated at home, then she needs to completely follow the doctor's instructions so that bleeding does not occur, and even more so the placenta is detached.

It was noted that even the most expensive drugs do not guarantee that the placenta will return to its proper place, especially if its fixation has occurred on the posterior wall. But to contribute to this, or at least prevent the development of complications, you can use the following actions:

• you need to spend more time in bed, giving up housework;
• food should be supplemented with foods fortified with a large amount of protein and iron;
• regular walks in the fresh air are necessary;
• you should give up sex for a while;
• stressful situations should be avoided;
• for a while, exclude any physical activity, even gymnastics for pregnant women.

Behavior during the postoperative period

According to reviews of young mothers who had a diagnosis of central placenta previa, there is no longer any risk after labor. Such opinions are erroneous. Even if the birth took place without any complications, then after their completion there is still a rather high risk of bleeding. The reason for this condition is the low ability to contract the body of the uterus in the area where the placenta was placed.

Taking into account the fact that a large number of young mothers after such a diagnosis suffer from anemia and hypotension, then at least a few months after giving birth, you still need to take care of yourself.

After being discharged from the maternity hospital, you do not need to immediately declare that everything is fine with you and start doing the housework that has accumulated over a long time, the woman needs peace, both physically and emotionally.

Ask your next of kin to help you with your baby, while you yourself pay more attention to sleep, rest and walking with your baby. Proper nutrition is especially important, which will contribute to the normalization of hemoglobin in the blood. At the same time, it is worth considering the fact that the quality of nutrition of her child also depends on the quality of the mother's nutrition.

Breastfeeding is recommended, it will have a positive effect on both the mother and her baby. In the process of feeding, the iron present in the woman's body will be transferred to the baby, and this is very important if the child suffers from such a disease as anemia. As for the mother, breastfeeding increases the intensity of uterine contraction, and this prevents the risk of bleeding again.

Preventive actions

Many women, even during the planning period of pregnancy, having heard about such a problem as central placenta previa, wonder whether it is possible to prevent the appearance of this pathology.

Prevention of the development of such a disease is following the correct lifestyle, avoiding abortion and other manipulations aimed at traumatizing the walls of the uterus. To fulfill such requirements during intercourse, you need to use contraceptives and strictly monitor your reproductive system. In addition, it is necessary to regularly visit a gynecologist in order to diagnose and treat diseases of the reproductive system in time.

Special control over their vital activity should be carried out by women in the age group over 35 years old, as well as women who have a second pregnancy and in the past they have already been diagnosed with central placenta previa.

In the presence of a variety of hormonal disorders, pregnancy planning should be carried out only after their complete elimination.

Unfortunately, even if a woman has made every effort to prevent the development of such a diagnosis, it is still possible for it to appear: this is due to an anomaly of the ovum. In this situation, the only thing that remains is to follow all the doctor's prescriptions, and then there is a possibility that by the 20th week of pregnancy the placenta will take its intended position.

As a result of the information received, it can be distinguished that if during the course of pregnancy the placenta did not return to its proper place, then the only way to save the life of the mother and the child is a cesarean section. Even if all your life you have dreamed of giving birth to a child on your own, then it is better to give up this dream than to lose your life or lose your baby.

Central placenta previa is a serious disease that requires constant monitoring, otherwise complications are likely to develop.

Thank you

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Placenta previa - definition

Presentation placenta(placenta praevia - lat.) is a term used in obstetrics, with the help of which various options for the location of an organ in the cervical region are indicated. This means that the placenta is located in the lower part of the uterus and blocks the birth canal. It is the location on the way of the nascent fetus that reflects the Latin designation for presentation - placenta praevia, where the word "praevia" consists of two: the first preposition "prae" and the second root "via". Prae means before, and via means path. Thus, the literal translation of the term placenta praevia means literally "the placenta located in the path of the fetus."

Placenta previa currently refers to the pathology of pregnancy, and at 37-40 weeks of gestation occurs in 0.2-3.0% of cases. At earlier stages of pregnancy, placenta previa is observed more often (up to 5-10% of cases), however, as the fetus grows and develops, the uterus stretches, and its child's place moves further from the cervical region. This process is called "placental migration" by obstetricians.

To understand the essence of the pathological location of the placenta, called presentation, it is necessary to imagine the structure of the uterus, which is conditionally subdivided into the body, fundus and cervix. The cervix is ​​located in the lower part of the organ, and its outer part is lowered into the vagina. The top of the uterus, which is the horizontal platform directly opposite the cervix, is called the bottom. And the side walls located between the bottom and the cervix are called the body of the uterus.

The cervix is ​​a kind of tightly compressed muscle tissue cylinder with an opening inside, which is called the cervical canal. If this cylinder is stretched in width, then the cervical canal will expand significantly, forming an opening with a diameter of 9 - 11 cm, through which the child can exit the uterus during labor. Outside of childbirth, the cervix is ​​tightly collapsed, and the opening in it is very narrow. To visualize the physiological role of the cervix, mentally draw a bag tied with a string. It is the part tied with a rope that is the very tightly compressed cervix that keeps the contents of the bag from falling out. Now turn this bag upside down so that the part pulled together by the string is facing the floor. In this form, the bag completely repeats the location of the parts of the uterus and reflects the role of the cervix. The uterus in a woman's abdomen is located exactly like this: the bottom is at the top, and the cervix is ​​at the bottom.

In childbirth, the cervix of the uterus opens (expands) under the action of contractions, as a result of which an opening is formed through which the child can pass. In relation to the image of a bag, the process of opening the cervix is ​​equivalent to simply untying a string that tightens its opening. As a result of this "opening" of the bag, everything that is in it will fall out of it. But if you untie the opening of the bag and at the same time put some kind of obstacle in front of it, then the contents will remain inside, because they simply cannot fall out. Likewise, a child will not be able to be born if there is an obstacle in his path, at the site of the opening of the cervix. It is such an obstacle that the placenta, located in the cervical region, is. And such an arrangement of it, which interferes with the normal course of the generic act, is called placenta previa.

With placenta previa, a high mortality rate of newborns is recorded, which ranges from 7 to 25% of cases, depending on the technical equipment of the maternity hospital. High infant mortality in placenta previa is due to the relatively high incidence of preterm birth, placental insufficiency and abnormal position of the fetus in the uterus. In addition to high infant mortality, placenta previa can cause a formidable complication - bleeding in a woman, from which about 3% of pregnant women die. It is because of the danger of child and maternal mortality that placenta previa is classified as a pathology of pregnancy.

Types of placenta previa and their characteristics

Depending on the specific features of the location of the placenta in the cervical region, there are several types of presentation. Currently, there are two main classifications of placenta previa. The first is based on determining its location during pregnancy using transvaginal ultrasound (ultrasound). The second classification is based on determining the position of the placenta during childbirth when the cervix is ​​dilated by 4 cm or more. It should be remembered that the degree and type of presentation may change with the growth of the uterus or with an increase in cervical dilatation.

Based on the data of transvaginal ultrasound performed during pregnancy, the following types of adherence of the placenta are distinguished:
1. Full presentation;
2. Incomplete presentation;
3. Low presentation (low position).

Complete placenta previa

Full placenta presentation (placenta praevia totalis - lat.). In this case, the placenta completely covers the inner opening of the cervix (internal os). This means that even if the cervix is ​​fully opened, the child will not be able to enter the birth canal, since the placenta will block his way, completely blocking the exit from the uterus. Strictly speaking, giving birth in a natural way with full placenta previa is impossible. The only delivery option in this situation is a cesarean section. This location of the placenta is noted in 20 - 30% of the total number of cases of presentation, and is the most dangerous and unfavorable in terms of the risk of complications, child and maternal mortality.

Incomplete (partial) placenta previa

With incomplete (partial) presentation (placenta praevia partialis), the placenta overlaps the internal opening of the cervix only partially, leaving a small area free from its total diameter. Partial placenta previa can be compared to a plug that covers part of the tube's diameter, preventing water from moving as fast as possible. Also, incomplete presentation includes the presence of the lower part of the placenta at the very edge of the cervical opening. That is, the lowest edge of the placenta and the wall of the inner opening of the cervix are at the same level.

With incomplete placenta previa in a narrow part of the cervical lumen, the head of the child, as a rule, cannot pass, therefore, in the vast majority of cases, childbirth in a natural way is impossible. The frequency of occurrence of this type of presentation is from 35 to 55% of cases.

Low (inferior) placenta previa

In this situation, the placenta is located at a distance of 7 centimeters or less from the perimeter of the entrance to the cervical canal, but does not reach it. That is, the area of ​​the internal os of the cervix (the entrance to the cervical canal) with low presentation is not captured and is not overlapped by a part of the placenta. Against the background of low placenta previa, natural childbirth is possible. This pathology option is the most favorable in terms of the risk of complications and pregnancy.

According to the results of ultrasound, more and more often in recent years, for clinical practice, obstetricians have resorted to determining not the type, but the degree of placenta previa during pregnancy, which are based on the amount of overlap of the internal opening of the cervix. Today, according to ultrasound, the following four degrees of placenta previa are distinguished:

• I degree- the placenta is located in the area of ​​the cervical opening, but its edge is at least 3 cm from the pharynx (conditionally corresponds to a low placenta previa);
• II degree- the lower part of the placenta is located literally at the edge of the entrance to the cervical canal, but does not overlap it (conditionally corresponds to incomplete placenta previa);
• III degree- the lower part of the placenta blocks the entrance to the cervical canal completely. In this case, most of the placenta is located on any one wall (front or back) of the uterus, and only a small area closes the entrance to the cervical canal (conditionally corresponds to full placenta presentation);
• IV degree- the placenta is completely located on the lower segment of the uterus and blocks the entrance to the cervical canal with its central part. At the same time, the same parts of the placenta are located on the anterior and posterior walls of the uterus (conditionally corresponding to full placenta presentation).

The listed classifications reflect the options for placenta previa during pregnancy, determined by the results of ultrasound.

In addition, the so-called clinical classification of placenta previa has been used for a long time, based on determining its location in the process of childbirth when the cervix is ​​dilated by 4 cm or more. On the basis of a vaginal examination during childbirth, the following types of placenta previa are distinguished:

• Central presentation of the placenta (placenta praevia centralis);
• Lateral presentation of the placenta (placenta praevia lateralis);
• Regional presentation of the placenta (placenta praevia marginalis).

Central placenta previa

In this case, the entrance to the cervical canal from the side of the uterus is completely blocked by the placenta, when feeling its surface with a finger inserted into the vagina, the doctor cannot determine the fetal membranes. Natural childbirth with central placenta previa is impossible, and the only way to give birth to a child in such a situation is by cesarean section. Relatively speaking, central placenta previa, determined during vaginal examination during labor, corresponds to complete, as well as grade III or IV according to the results of ultrasound.

Lateral placenta previa

In this case, during the vaginal examination, the doctor determines the part of the placenta that closes the entrance to the cervical canal, and the rough membranes next to it. Lateral placenta previa, determined by vaginal examination, corresponds to incomplete (partial) or II-III degree according to the results of ultrasound.

Regional presentation of the placenta

During the vaginal examination, the doctor determines only the rough membranes of the fetus protruding into the lumen of the cervical canal, and the placenta is located at the very edge of the internal pharynx. Regional presentation of the placenta, determined by vaginal examination, corresponds to incomplete (partial) or I-II degree according to the results of ultrasound.

Posterior placenta previa (placenta previa on the back wall)

This condition is a special case of incomplete or low presentation, in which the main part of the placenta is attached to the back of the uterus.

Anterior placenta previa (placenta previa along the anterior wall)

This condition is also a special case of incomplete or low presentation, in which the main part of the placenta is attached to the anterior wall of the uterus. The attachment of the placenta to the anterior wall of the uterus is not a pathology, but reflects a variant of the norm.

In most cases, the anterior and posterior presentation of the placenta is determined by the results of an ultrasound scan up to 26 - 27 weeks of pregnancy, which can migrate within 6 - 10 weeks and come to a normal position by the time of delivery.

Placenta previa - causes

The placenta is formed on the part of the uterus where the ovum is attached. Therefore, if the egg is attached to the lower wall of the uterus, then the placenta will form in this part of the organ. The place for attachment is "selected" by the ovum, and it is looking for such a site of the uterus, which has the most favorable conditions for its survival (good thick endometrium, absence of neoplasms and scars, etc.). If the best endometrium, for some reason, is in the lower segment of the uterus, then the ovum will attach there, and subsequently this will lead to placenta previa.

The reasons for the attachment of the ovum in the lower segment of the uterus and the subsequent formation of placenta previa are due to various factors, which, depending on the original nature, can be divided into two large groups:
1. Uterine factors (depending on the woman);
2. Fetal factors (depending on the characteristics of the ovum).

Uterine factors- these are various pathological changes in the mucous membrane of the uterus (endometrium), formed during inflammatory diseases (endometritis, etc.) or intrauterine manipulations (abortion, diagnostic curettage, cesarean section, etc.). Fetal factors are a decrease in the activity of enzymes in the membranes of the ovum, which allow it to be implanted into the lining of the uterus. Due to the lack of enzyme activity, the ovum "slips" past the bottom and walls of the uterus and is implanted only in its lower part.

Currently, the following conditions are attributed to the uterine causes of placenta previa:

• Any surgical interventions on the uterus in the past (abortion, cesarean section, removal of fibroids, etc.);
• Childbirth with complications;
• Abnormalities in the structure of the uterus;
• Underdevelopment of the uterus;
• Isthmic-cervical insufficiency;
• Multiple pregnancies (twins, triplets, etc.);
• Endocervicitis.

Due to the fact that most of the causes of placenta previa appear in women who have undergone any gynecological diseases, surgery or childbirth, this complication is observed in 2/3 of cases in re-pregnant women. That is, women who are pregnant for the first time account for only 1/3 of all cases of placenta previa.

For fruitful reasons placenta previa include the following factors:

• Inflammatory diseases of the genital organs (adnexitis, salpingitis, hydrosalpinx, etc.);

Given the listed possible causes of placenta previa, the following women are at risk for the development of this pathology:

• Burdened obstetric history (abortion, diagnostic curettage, difficult childbirth in the past);
• Any surgical interventions on the uterus transferred in the past;
• Neuro-endocrine dysregulation of menstrual function;
• Underdevelopment of the genitals;
• Inflammatory diseases of the genital organs;
• Myoma of the uterus;
• Endometriosis;
• Pathology of the cervix.

Diagnosis of placenta previa

Diagnosis of placenta previa can be based on characteristic clinical manifestations or on the results of objective studies (ultrasound and bimanual vaginal examination). Signs of placenta previa are as follows:

• Bloody discharge from the genital tract of a bright scarlet color with a completely painless and relaxed uterus;
• High standing of the fundus of the uterus (the indicator is more than that which is characteristic for a given gestational age);
• Abnormal position of the fetus in the uterus (breech presentation of the fetus or transverse position);
• The noise of blood flow through the vessels of the placenta, clearly distinguishable by the doctor during auscultation (listening) of the lower segment of the uterus.

If a woman has any of the listed symptoms, then the doctor suspects placenta previa. In such a situation, a vaginal examination is not performed, since it can provoke bleeding and premature birth. To confirm the preliminary diagnosis of placenta previa, the gynecologist sends a pregnant woman to an ultrasound scan. Transvaginal ultrasound allows you to accurately determine whether a given woman has placenta previa, as well as to assess the degree of occlusion of the uterine pharynx, which is important for determining the tactics of further pregnancy management and choosing the method of delivery. Currently, it is ultrasound that is the main method for diagnosing placenta previa, due to its high information content and safety.

If it is impossible to do an ultrasound, then to confirm the diagnosis of placenta previa, the doctor makes a very careful, accurate and careful vaginal examination. When placenta previa with fingertips, the gynecologist feels the spongy tissue of the placenta and rough membranes.

If a woman does not have any clinical manifestations of placenta previa, that is, the pathology is asymptomatic, then it is detected during screening ultrasound studies, performed without fail at 12, 20 and 30 weeks of pregnancy.

Based on the ultrasound data, the doctor decides whether it is possible to perform a vaginal examination in this woman in the future. If placenta previa is complete, then a standard two-handed gynecological examination cannot be performed under any circumstances. With other types of presentation, you can only very carefully examine the woman through the vagina.

Ultrasound diagnostics

Ultrasound diagnostics of placenta previa is currently the most informative and safe method for detecting this pathology. Ultrasound also allows you to clarify the type of presentation (full or partial), measure the area and thickness of the placenta, determine its structure and identify areas of detachment, if any. To determine the various characteristics of the placenta, including presentation, ultrasound should be performed with a moderate filling of the bladder.

If placenta previa is detected, then periodically, with an interval of 1 to 3 weeks, an ultrasound scan is performed in order to determine the speed of its migration (movement along the walls of the uterus above). To determine the position of the placenta and assess the possibility of conducting natural childbirth, it is recommended to perform an ultrasound scan at the following stages of pregnancy - at 16, 24 - 25 and 34 - 36 weeks. However, if there is an opportunity and desire, then an ultrasound scan can be done weekly.

Placenta previa - symptoms

The main symptom of placenta previa is recurrent painless bleeding from the genital tract.

Bleeding with placenta previa

Bleeding with placenta previa can develop at various stages of gestation - from 12 weeks to the very birth, but most often they are noted in the second half of pregnancy due to severe stretching of the walls of the uterus. With placenta previa, bleeding up to 30 weeks is noted in 30% of pregnant women, at 32 - 35 weeks also in 30%, and in the remaining 30% of women, they appear after 35 weeks or at the beginning of labor. In general, with placenta previa, bleeding during pregnancy is observed in 34% of women, and during childbirth - in 66%. During the last 3 to 4 weeks of pregnancy, when the uterus contracts particularly strongly, bleeding may worsen.

Bleeding during placenta previa is due to its partial detachment, which occurs as the wall of the uterus stretches. When a small area of ​​the placenta is detached, its vessels are exposed, from which bright scarlet blood flows.

Various factors can provoke bleeding during placenta previa, such as excessive physical exertion, severe cough, vaginal examination, sauna use, sexual intercourse, bowel movement with strong straining, etc.

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

• Sudden, profuse and painless bleeding, often occurring at night, when a woman literally wakes up in a pool of blood, is characteristic of complete placenta previa. Such bleeding may stop as suddenly as it began, or it will continue in the form of a scanty discharge.
• The onset of bleeding in the last days of pregnancy or in childbirth is characteristic of incomplete placenta previa.

The intensity of bleeding and the amount of blood loss does not depend on the degree of placenta previa. In addition, bleeding with placenta previa can be not only a symptom of pathology, but also become its complication, if it does not stop for a long time.

Given the repeated episodes of bleeding in placenta previa, pregnant women with this pathology almost always have severe anemia, a lack of circulating blood volume (BCC), and low blood pressure (hypotension). These nonspecific signs can also be considered symptoms of placenta previa.

Also, the following signs are considered indirect symptoms of placenta previa:

• Wrong presentation of the fetus (oblique, transverse, gluteal);
• High standing of the fundus of the uterus;
• Listening to the murmur of blood in the vessels at the level of the lower segment of the uterus.

What threatens placenta previa - possible complications

Placenta previa can threaten the development of the following complications:

• The threat of termination of pregnancy;
• Iron-deficiency anemia;
• Wrong position of the fetus in the uterus (oblique or transverse);
• Breech or foot presentation of the fetus;
• Chronic fetal hypoxia;
• Delayed fetal development;
• Placental insufficiency.

The threat of termination of pregnancy is due to periodically recurring episodes of detachment of the placenta, which provokes fetal hypoxia and bleeding. Full placenta previa most often ends in preterm labor.

Gestosis in placenta previa is due to the impossibility of a full-fledged second invasion of the trophoblast into the endometrium, since the mucous membrane in the lower segment of the uterus is not dense and thick enough for additional villi to enter it. That is, a violation of the normal growth of the placenta during its presentation provokes gestosis, which, in turn, increases the severity and increases the frequency of bleeding.

Fetoplacental insufficiency is due to the fact that the blood supply to the lower segment of the uterus is relatively low compared to the bottom or the body, as a result of which insufficient blood flows to the placenta. Poor blood flow results in insufficient oxygen and nutrients reaching the fetus and therefore not meeting its needs. Against the background of such a chronic deficiency of oxygen and nutrients, hypoxia and fetal growth retardation are formed.

Iron deficiency anemia is caused by recurring recurrent bleeding. Against the background of chronic blood loss in a woman, in addition to anemia, a deficiency of circulating blood volume (BCC) and coagulation factors is formed, which can lead to the development of disseminated intravascular coagulation syndrome and hypovolemic shock during childbirth.

The incorrect position of the child or his breech presentation is due to the fact that in the lower part of the uterus there is not enough free space to accommodate the head, since it was occupied by the placenta.

Placenta previa - principles of treatment

Unfortunately, there is currently no specific treatment that can change the place of attachment and the location of the placenta in the uterus. Therefore, therapy for placenta previa is aimed at stopping bleeding and maintaining pregnancy for as long as possible - ideally until the term of delivery.

With placenta previa throughout pregnancy, a woman must necessarily observe a protective regime aimed at eliminating various factors that can provoke bleeding. This means that a woman needs to limit physical activity, do not jump and drive on a shaky road, do not fly an airplane, do not have sex, avoid stress, do not lift weights, etc. In your free time, you should lie on your back, throwing your legs up, for example, on a wall, on a table, on the back of a sofa, etc. The "lying on your back with raised legs" position should be taken whenever possible, preferring to just sitting on a chair, in a chair, etc.

After 24 weeks, if bleeding is not abundant and stops spontaneously, a woman should receive conservative treatment aimed at maintaining pregnancy until 37 to 38 weeks. Placenta previa therapy consists of the following drugs:

• Tocolytic and antispasmodic drugs that improve the stretching of the lower segment of the uterus (for example, Ginipral, No-shpa, Papaverine, etc.);
• Iron preparations for the treatment of anemia (for example, Sorbifer Durules, Ferrum Lek, Tardiferon, Totema, etc.);
• Preparations to improve the blood supply to the fetus (Ascorutin, Curantil, Vitamin E, folic acid, Trental, etc.).

The most common conservative treatment for placenta previa against the background of non-abundant bleeding consists of a combination of the following drugs:

• Intramuscular injection of 20 - 25% magnesium, 10 ml;
• Magne B6 2 tablets twice a day;
• No-spa, 1 tablet three times a day;
• Partusisten 5 mg four times a day;
• Sorbifer or Tardiferon 1 tablet twice a day;
• Vitamin E and folic acid 1 tablet three times a day.

A woman will have to take these drugs throughout her pregnancy. If bleeding occurs, it is necessary to call an ambulance or independently get to the maternity hospital and be hospitalized in the department of pathology of pregnant women. In the hospital, No-shpu and Partusisten (or Ginipral) will be injected intravenously in large doses to achieve the effect of strong relaxation of the muscles of the uterus and good stretching of its lower segment. In the future, the woman will again be transferred to tablet forms, which are taken in lower, maintenance dosages.

For the treatment of placental insufficiency and the prevention of fetal hypoxia, the following means are used:

• Trental is given intravenously or taken in pill form;
• Kurantil take 25 mg 2 - 3 times a day one hour before meals;
• Vitamin E take 1 tablet per day;
• Vitamin C should be taken at 0.1 - 0.3 g three times a day;
• Cocarboxylase is injected intravenously at 0.1 g in glucose solution;
• Folic acid is taken orally at 400 mcg per day;
• Actovegin take 1 - 2 tablets per day;
• Glucose is given intravenously.

Therapy of fetoplacental insufficiency is carried out in courses throughout pregnancy. If the use of these means it is possible to prolong the pregnancy up to 36 weeks, then the woman is hospitalized in the antenatal department and the method of delivery (cesarean section or natural childbirth) is chosen.

If, with placenta previa, severe, persistent bleeding develops, which cannot be stopped within several hours, then an emergency caesarean section is performed, which is necessary to save the woman's life. In such a situation, they do not think about the interests of the fetus, since an attempt to maintain pregnancy against the background of heavy bleeding with placenta previa will lead to the death of both the child and the woman. An emergency caesarean section with placenta previa is performed for the following indications:

• Recurrent bleeding, in which the volume of blood lost is more than 200 ml;
• Regular meager blood loss against a background of severe anemia and low blood pressure;
• One-stage bleeding, in which the volume of lost blood is 250 ml or more;
• Bleeding with complete placenta previa.

Childbirth with placenta previa

With placenta previa, childbirth can be carried out both through natural routes and by cesarean section. The choice of delivery method is determined by the condition of the woman and the fetus, the presence of bleeding, and the type of placenta previa.

Caesarean section with placenta previa

Caesarean section with placenta previa is currently performed in 70 - 80% of cases. Indications for cesarean section with placenta previa are the following cases:
1. Complete placenta previa.
2. Incomplete placenta previa, combined with breech presentation or abnormal position of the fetus, a scar on the uterus, multiple pregnancy, polyhydramnios, a narrow pelvis, the age of a primiparous woman over 30 years old and a burdened obstetric history (abortion, curettage, miscarriage, pregnancy loss and uterine surgery );
3. Continuous bleeding with a blood loss of more than 250 ml with any type of placenta previa.

If the listed indications for cesarean section are absent, then with placenta previa, birth can be carried out through natural routes.

Natural birth

Vaginal birth with placenta previa can be performed in the following cases:

• The absence of bleeding or its stop after opening the fetal bladder;
• Cervix, ready for childbirth;
• Regular contractions of sufficient strength;
• Head presentation of the fetus.

At the same time, they wait for the independent onset of labor without the use of stimulating drugs. In childbirth, the fetal bladder is opened when the cervix is ​​opened by 1 - 2 cm. If, after opening the fetal bladder, bleeding develops or does not stop, then an emergency caesarean section is performed. If there is no bleeding, then labor continues in a natural way. But with the development of bleeding, an emergency caesarean section is always performed.

Sex and placenta previa

Unfortunately, sex with placenta previa is contraindicated, since frictional movements of the penis can provoke bleeding and placental abruption. However, with placenta previa, not only classic vaginal sex is contraindicated, but also oral and anal sex, and even masturbation, since sexual arousal and orgasm lead to a short-term, but very intense uterine contraction, which can also provoke bleeding, placental abruption or premature birth.

Any deviation from the norm heard by the expectant mother at the doctor's appointment or during the examination is alarming. Low placentation is no exception. How dangerous this condition is and how to prevent its negative consequences, we will consider in more detail.

Normal placement of the placenta and low placentation

When a fertilized egg finishes its path through the fallopian tube and enters the uterus, it attaches to one of its walls. Normally, the cell will be located closer to the fundus of the uterus, which is located in the upper part of this organ.
They talk about low placentation when the distance from the uterus to the uterine pharynx is no more than 6 centimeters

But it happens that the egg, for some reason, is attached to the lower part of the uterus, closer to the "exit". This condition is low placentation. It is important to remember that this diagnosis is made when the distance from the uterus to the uterine pharynx is 6 centimeters or less.

Low placentation and placenta previa

When the placenta drops so low that it blocks the entrance to the uterus, then it appears. It is important not to be confused: with low placentation, the uterine pharynx is open, with presentation - partially or completely closed.

Expectant mothers often combine these concepts into one, starting to panic. But, despite the similarity, there is one very important difference in these diagnoses: with low placentation, natural childbirth is quite possible, in contrast to presentation, in the presence of which there is a high probability of delivery by cesarean section.

Low placentation differs from presentation with an open entrance to the uterus, which makes natural delivery possible

Symptoms of low placentation

The further the distance from the placenta to the uterine pharynx, the less likely it is that any symptoms of low placentation will appear. When the baby's place drops low, right down to presentation, signs similar to those of a miscarriage appear:

• pulling abdominal pain;
• back pain;
• discharge of blood - red or brown.

If abdominal pain can be safe and indicate a sprain, then bleeding is a very dangerous symptom, which requires urgent advice from a specialist in charge of pregnancy or an emergency doctor.

Causes of the low location of the placenta

To date, medicine does not give an exact answer to the question of the causes of low placentation. Nobody knows why the egg is attached in one place or another in the uterus. But factors have been identified that affect the fact that the embryo will not be located in the usual place:

• previous inflammatory diseases;
• surgical interventions, in particular, a history of abortion;
• endometriosis;
• the presence of scars on the uterus;
• myoma;
• anatomical flaws in the structure of the uterus (bend, bicornuate uterus, etc.);
• vascular pathologies in the pelvic organs.

Risks and Impact of Low Placentation on Pregnancy

Low placentation can lead to placental abruption in severe cases

The condition of the low-lying placenta is not as obviously dangerous as presentation, but it also carries significant risks:

• As the growing fetus presses on the uterus, it begins to "oppress" the baby's place. And this is fraught with uterine bleeding and, in extreme cases, placental abruption.
• It is laid down by nature so that the blood supply at the bottom of the uterus is better than below. Thus, the fetus, attached to its lower part, runs the risk of receiving less vital nutrients and oxygen.

At the same time, it must be remembered that this diagnosis is not definitive. After all, a child's seat during pregnancy can repeatedly change its location. This process is called "placental migration".

Migration in most cases corrects the incorrect attachment of the fetus

Migration is a process that in most cases corrects a pathology such as low placentation. It is important to understand that the placenta itself does not actually move. The change in its location is the result of the proliferation of the myometrium - the muscular layer of the uterus. Simply put, the placenta migrates as the uterus grows. Migration of the placenta always occurs in only one direction - from the bottom up, from the internal os of the uterus to its bottom.

It is thanks to this phenomenon that doctors do not focus on the location of the placenta until the third trimester - it has been proven that in 95% of cases the placenta rises on its own, taking the correct position.

Diagnosis of low placentation

Ultrasound will reliably predict the fact of abnormalities in the location of the placenta

The location of the placenta is determined by ultrasound diagnostics. Also, based on the results of ultrasound and Doppler, the doctor will be able to determine whether there is a shortage of nutrients (by the size of the fetus and their age-appropriateness) and oxygen (by assessing blood flow during Doppler analysis).

That is why, if a low placentation is detected, it is necessary not to neglect the doctor's recommendations and attend consultations, as well as undergo examinations as often as recommended by the gynecologist leading the pregnancy.

Timing of establishing low placentation and placental migration

Typically, an ultrasound scan shows low placentation at 20–22 weeks, at the time of the second routine screening. From this moment on, a woman must adhere to a protective regime. Doctors wait up to 36 weeks to change the location of the placenta. Only after this period, the state of "low placentation" is taken into account by the doctor, who will take delivery in the future.

Treatment of low placentation and features of the protective regime

As soon as the expectant mother finds out about this diagnosis, the first questions she asks the doctor are whether it can be cured and whether it is necessary to change the regimen. Let's consider these aspects in more detail.

Low placentation treatment

To date, there are no drugs that can affect the change in the placenta of its location. Therefore, in the presence of this pathology, doctors always choose a waiting tactic. Or, if the placenta still does not take the desired position, the method of delivery is corrected as necessary. It is important to remember that low placentation itself is not an indication for cesarean section.

Guard mode

Due to the risk of uterine bleeding and placental abruption, doctors strongly recommend that a pregnant woman maintain a protective regimen. You may have to be careful until the very birth.

The protective regime includes the following measures:

1. Limit physical activity. Any sport must be canceled. Only walking at a brisk pace is allowed.
2. Do not make sudden movements. The placenta, which is already under pressure, may not withstand the jerk, and then detachment will begin.
3. Minimize travel, especially on public transport. Stress, shaking and sudden movements are highly undesirable with low placentation.
4. Raise your legs while sitting. A slight elevation of the legs will increase blood circulation and help prevent fetal hypoxia.
5. Strictly limit the weight of items taken in hand. Lifting weights is a very common cause of the onset of uterine bleeding. The maximum permitted weight is 2 kg.
6. Get up from a prone position without a jerk, with the help of your hands and without using, if possible, your abdominal muscles.

The author of this article was also diagnosed with low placentation during pregnancy. I, frightened after the ultrasound, "wool" the Internet and "tortured" the doctor - what to do, how to fix it. And the gynecologist gave me two very good, in my opinion, advice. The first of them consisted in the words "regime without fanaticism": yes, it is necessary to limit the load, not to make sudden movements. But this does not mean that you need to "hibernate" like a bear in winter. Because with constant lying in bed, the blood supply in the pelvic organs deteriorates, and this is dangerous for the baby, who, due to improper location, risks receiving less of the substances necessary for life. In addition, no ventilation of an apartment or house can be compared to a walk in the fresh air. Only oxygenated blood is able to sufficiently transfer this oxygen to a growing baby.

The second piece of advice my doctor gave me was about the universal static exercise, the knee-elbow position. It is universal in that it will be useful both with an increased tone of the uterus, and with pathology of the location of the placenta, and even in the case of an incorrect position of the fetus.

This exercise is unique for several reasons:

• reduces pressure on the uterine pharynx and the low-lying placenta;
• improves blood flow;
• changes the direction of gravity.

I did this exercise 3-4 times a day for 15 minutes. After that, it was necessary to lie for 30-40 minutes.

As a result, following these tips, by the next screening I heard that the placenta had risen markedly - to a normal level. It is impossible to say for sure what exactly influenced her migration and whether anything at all. But one thing I can say for sure - it didn't get any worse, and I did everything I could to change the situation.

Photo gallery: features of the security mode

With a low placenta, it is necessary to rise without sudden movements from the “on the side” position, helping with your hands. While sitting on a chair or in a chair, the legs must be lifted to improve blood flow in the pelvic organs. Physical activity with low placentation should be limited to leisurely walks

Sex with low placentation

As a rule, the doctor categorically excludes sex with a low placenta.

But since there are several types of sex, pregnant women often have a question - whether all types of intimate contact should be limited or vaginal sex itself.

With low placentation, it is necessary to exclude any type of sex that:

• causes excitement, leading to a rush of blood in the pelvic organs;
• produces a direct physical effect on the vagina or rectum.

Childbirth with a low placenta

If by the end of pregnancy the placenta has not changed its place and the diagnosis of "low placentation" remains, the doctor will carefully consider the accompanying factors:

• whether there is fetal hypoxia;
• whether the child is positioned correctly;
• is there an umbilical cord entanglement;
• whether the distance to the entrance to the uterus is less than 2 cm.

In the presence of these conditions, the doctor will probably decide on a caesarean section.