home All hormones Echographic signs of a low location of the chorion. Chorionic presentation - causes, symptoms, treatment. Regional placenta previa: how to avoid complications

Echographic signs of a low location of the chorion. Chorionic presentation - causes, symptoms, treatment. Regional placenta previa: how to avoid complications

The chorion is the villous membrane of the fertilized egg that ensures its growth and development. During normal pregnancy, it is implanted in inner shell the bottom of the uterus, and then - to the anterior, posterior and lateral walls. Chorionic presentation implies its incorrect location. It is not attached to the body of the uterus, but captures its lower segment. Sometimes there is complete or partial overlap of the internal pharynx cervical canal coming from the uterus. This diagnosis is most dangerous in early stages pregnancy. Usually, as the fetus grows, the placenta moves up, but in some cases this does not happen.

When does presentation occur?

Reasons for the development of this pathological condition have not been fully studied. However, several factors have been identified that contribute to the incorrect location of the chorion. Among them are chronic inflammatory diseases uterus, postoperative scars, fibroids, uterine developmental anomalies and a large number of history of childbirth.

Symptoms of improper placement of the chorion

Usually, this pathology diagnosed during a routine ultrasound in the absence of any complaints from the woman. There are cases when presentation is accompanied by bleeding from the genital tract against the background of complete well-being. Usually their development is facilitated by such external factors such as excessive exercise, sexual intercourse and taking a hot bath.

Possible complications

Chorionic presentation is one of the most serious obstetric problems that can lead to a number of complications for the fetus and mother. These include termination of pregnancy, intrauterine growth retardation and fetal death, severe anemia in a woman with frequently recurring bleeding.

Treatment of chorionic presentation

There is no specific treatment for this pathology. Therapeutic measures are aimed at preventing miscarriage and treatment possible complications. When diagnosing chorionic presentation during an ultrasound, a woman is offered a set of therapeutic measures in a hospital setting. She is advised to be strict bed rest, ultrasound monitoring, taking medications to reduce uterine tone and vitamins for pregnant women. When discharged home, a pregnant woman should exclude physical exercise, stressful situations and sexual intercourse. Appearance bloody discharge is a reason for emergency treatment V gynecological department and the prescription of hemostatic drugs. In case of massive bleeding, threatening condition women undergoing pregnancy termination.

"- similar diagnosis can be found in medical card pregnant quite often. In the first half of pregnancy, the “embryo” and “chorion” are medical terms, personifying the child and the placenta, respectively. Chorionic presentation indicates the site of attachment of the future placenta to the uterine wall, which may suggest further development of the fetus in the uterine cavity. In order to accurately consider the issue, such medical terms should be analyzed in detail.

Internal position of the chorion

The chorion is a continuation of the umbilical vein of the embryo. It attaches to the wall of the uterus, as a result of which the embryo, and later the child, will receive all the necessary and beneficial nutrients that directly affect the development of the fetus.
The chorion attachment is formed in three places:

to the fundus of the uterus;
to the side walls;
in the cervical area, where central, marginal, and incomplete chorion presentation are distinguished.

Normal attachment of the chorion is its attachment to the bottom or sides of the uterus. In 10-12% of cases, the chorion is attached to the cervix. This position is called presentation. Depending on the location of attachment, there are also several varieties of the presented diagnosis.

Chorionic presentation at 12 and 13 weeks

At the end of the first semester, the pregnant woman is assigned the first. Here you can find a similar diagnosis of the attachment of the future placenta. It is necessary to consider the presented medical terms in more detail.

Chorionic presentation at 12 or 13 weeks

It should be noted that chorion presentation at 12 weeks does not mean its permanent location until birth. Very often a kind of migration occurs. Similar processes are carried out until week 20. Sometimes you can observe migration at quite later- almost before the birth itself.

Chorionic presentation at 13 weeks indicates the place of attachment in the cervical cavity. Such features of the development of pregnancy have practically no effect on the development of the fetus, however, one should not deviate from general rules maintaining pregnancy. Typically, chorionic presentation at 13 weeks prohibits sexual intercourse for pregnant women, as well as any heavy lifting. You should not expose yourself to stress and physical activity.

Otherwise, the woman faces heavy bleeding during detachment. placental tissue. Therefore, a woman should take care of herself and her child, because heavy bleeding can provoke hemorrhagic shock, from which the expectant mother can die. Even the slightest bleeding threatens the child with the loss of the required amount of oxygen and nutritional components.

Regional chorionic presentation at 13 weeks

As already described above, chorion presentation has several varieties. They, in turn, influence the further development of the fetus, as well as the result of the form of delivery - natural or C-section. Regional presentation of the chorion at 12 weeks is the most favorable outcome that can develop with the presented pathology. This type of pathology can “eliminate on its own” as a result of migration within a few days or weeks.

Regional presentation of the chorion is characterized by partial overlap of the cervix. The presented species is divided into two subspecies. Thus, they distinguish between marginal presentation of the chorion at the 13th week, where the future placenta covers no more than 1/3 of the cervix, and incomplete attachment, which entails more dangers and difficulties, since this diagnosis is made in the case of overlap of 2/3 of the cervix. Both subspecies have the ability to migrate, so the expectant mother should not worry. Most women give birth on their own, even if they were once diagnosed with marginal chorionic presentation at 12 or 13 weeks.

Normal location of the placenta

The chorion transforms into the placenta only at the 12th week, but its final maturation occurs only at the sixteenth. Afterwards, the development of the placenta continues until the 36th week. This organ is designed to provide the baby with oxygen, all necessary substances and microelements. However, ideal conditions for normal development of the placenta are not always created.

Interesting fact: according to statistics, about 15% of women experience pathological placental attachment.

All types of placenta previa are pathological and require constant monitoring by a doctor.

Physiological norm A condition is considered when the placenta is attached to the fundus of the uterus or in areas close to its lower part: the front or back wall. If deviations exist, the organ may join the pharynx.

The pharynx is an opening in the uterus that connects it to the vagina. It protects the uterine area from infection.

Based on the location of the placenta, they can diagnose the following types presentation:

complete (the placenta completely covers the uterine os);
low (the placenta is in close proximity to the pharynx, the approximate distance is 4–5 centimeters);
lateral (the uterine os is partially covered by the placenta);
marginal (the placenta touches the pharynx only at the edge).

Interesting fact: there is a theory that gravity plays a significant role in choosing a place for attachment of the fertilized egg. If future mom prefers to sleep on the right side, then it is attached with right side uterus and vice versa.

What is marginal placenta previa and marginal presentation along the posterior wall?

Marginal placenta previa is a pathology that occurs when the upper segment of the uterus turns out to be unsuitable for the implantation of the fertilized egg for a number of reasons, and it attaches lower. However, the embryonic organ can “migrate” during gestation. A change in the location of the placenta occurs due to a change in the structure of the lower segment of the uterus and due to the lengthening of the upper uterine segment. Typically, the “migration” process begins in the 6th week and is completed by the 34th week of pregnancy. In this case, it is not the placenta itself that moves, but the underlying myometrium (the submucosal layer of the middle muscular layer of the uterine wall) shifts. “Migration” of the embryonic organ occurs from bottom to top. If after the 34th week the edge of the placenta still touches the internal os of the uterus, then we can talk about the marginal attachment of the placenta.

Interesting fact: marginal placenta previa after the 32nd week is typical for only 5% of pregnant women. However, they still belong to the risk group, since the percentage of perinatal mortality increases in this case by 25%.

Marginal presentation of the placenta along the posterior wall is an indicator that the organ will not leave the internal os in most cases. This position will contribute to the successful completion of the cesarean section, since the placenta is not injured during the incision. The posterior wall is not elastic and is little subject to change, so the likelihood of “migration” of the embryonic organ is low. Regional presentation along the anterior wall is more dangerous, since the organ in this case is subjected to serious stress, and there is a risk of mechanical disruption of the integrity of the placenta. In this case, there is a high probability that in the later stages of gestation the placenta will take a normal position.

Placenta previa often leads to persistent bleeding. The latter are more expected in later stages of pregnancy. This is due to the active formation of the lower segment of the uterus. The placenta is capable of correctly performing the task assigned to it only when it is located normally.

Important: during pregnancy, it is imperative to monitor the location of the placenta, its thickness and structure using ultrasound. It is advisable to carry out the first no later than the 13th week. The thickness of the organ can only be determined at the twentieth.

Complications with marginal placenta previa

The placenta may return to its normal position closer to the third trimester. This does not happen in only 5% of women in labor. In this case, the following complications are possible:

premature labor activity or the need for emergency termination of pregnancy;
severe iron deficiency anemia;
developmental defects and prolonged fetal hypoxia;
placental abruption (marginal or central);
rupture of the uterine body due to fusion of its walls with the placenta;
perinatal fetal death;
embolism (blocking of lumens) of blood vessels;
heavy bleeding at the end of labor.

Video: placenta previa

Causes of the pathological location of the placenta

Placenta previa can be caused by the most for various reasons and factors. The fertilized egg may differ in some features. The state of health of the mother and the processes occurring directly in the uterus play a major role. It is not possible to influence the place where the placenta is implanted by medical means; the process is uncontrollable. However, a woman is quite capable of minimizing potential risks.

Abnormalities of the ovum

Trophoblast (outer cell mass of the embryo), which is formed during the cell's journey through the female reproductive organs- This chief assistant at the stage of attachment of the fertilized egg to the wall of the uterus. In the future, it is he who helps the fetus form the placenta. Membrane covering ovum, may be too dense. In this case, successful implantation will not occur, even if the fertilized cell (zygote) is strong.

If you believe the statistics, then only healthy embryos, without genetic abnormalities, are able to properly implant into the uterine cavity. Embryos with congenital pathologies or do not undergo natural selection female body(the latter provokes a miscarriage), or are attached incorrectly.

Correct implantation of the fertilized egg can only occur with good tubal patency, absence of abnormalities in the embryo and favorable uterine mucosa

In addition, the fertilized egg may not be active enough. If it does not promptly release a sufficient amount of enzymes that destroy the mucous membrane, then abnormal placentation may occur. While the egg is in the upper segments of the uterus, it does not have time to mature for implantation, and when the process is completed, it no longer has a choice and has to be attached lower.

Reasons related to maternal health

Once in the uterus, the fertilized egg begins to actively look for a place for implantation. Normally, it is attached to the upper layers of the uterus (most often the posterior wall or fundus is involved). However, this does not happen if the organ mucosa is damaged. Then the fertilized egg descends and implants into the lower segments of the uterus. There are many provoking reasons for this phenomenon, their list is as follows:

bad habits;
inflammatory processes occurring in the uterus;
frequent births or a significant number of them;
carrying out a curettage procedure or abortive intervention during pregnancy, as well as infection that may result from them;
tumor development in the uterus;
an abundance of scars on the body of the uterus;
various anomalies of the uterine organ;
endometriosis (a disease associated with the growth of internal cells of the uterus beyond the organ);
too late first birth;
hormonal disruptions and disorders;
multiple pregnancy;
accompanying illnesses internal organs. For pathologies of cardio-vascular system or circulatory disorders, congestion may form in the pelvic organs, as a result of which the fertilized egg cannot attach normally.

All the factors described above can negatively affect the course of pregnancy and fetal development.

Symptoms of marginal placenta previa

Regional placenta previa can be characterized by two types of symptoms: silent and severe. The first does not involve changes, so the woman is unable to respond to the ongoing process in a timely and correct manner. Violations can only be detected by ultrasound diagnostics.
If the location is abnormal, the placenta can tear away from the walls of the uterus and cause bleeding

At expressed form Symptoms: incorrect location of the embryonic organ is most often manifested by external bleeding. In addition, false contractions may appear at any time. It is the latter that lead to stretching of the uterus, separation of the placenta from its walls and rupture of blood vessels. Bleeding can also occur at a time when the organ opens much later than the uterine segment. The placenta exfoliates, which leads to disastrous consequences.

Important: bleeding tends to occur at the most unexpected moment; the process cannot be predicted. It can form even during a night's rest. Its strength and duration cannot be predicted either.

Regional placenta previa can manifest itself in different ways. It all depends on individual characteristics body. At the first sign of discomfort, consultation with a doctor is required.

Diagnosis of pathological locations of the placenta

The anomaly is detected when ultrasound examination. Using ultrasound, you can accurately determine the presence of pathology, the specific position of the placenta body and the location of its edges. Computer diagnostics gives an idea of the thickness of the organ and its size. An ultrasound can also record the distance from the lower edge of the placenta to the internal os of the uterus. This parameter is very important because it can tell you about potential risks and complications.

Bimanual examination of the vagina (assessment of the condition of the uterus, ovaries and pelvic tissues on a gynecological chair) is not advisable in order to prevent bleeding, which may ultimately cause premature birth. In a situation where it is impossible to perform an ultrasound, the doctor must carefully carry out the examination and draw conclusions.

Treatment

It is impossible to cure marginal placenta previa in the truest sense of the word. There is only an opportunity to promote the “migration” of the embryonic organ or to prevent the situation from getting worse. In order to reduce pressure on the vaginal vessels and the lower edge of the placenta, a woman is recommended to use a special bandage. For a pregnant woman in such a situation, physical activity and stress, which can lead to jumps, are contraindicated. blood pressure. Sexual contact should also be avoided.
If a pregnant woman is diagnosed with placenta previa, it is recommended to wear a bandage

An exercise will help reduce pressure on the lower edge of the placenta: a woman is recommended to stand on both hands and feet on the floor 3-4 times a day. You need to stay in this position for several minutes. In this way, it will be possible to somewhat stretch the anterior wall of the uterus and achieve some upward movement of the placenta. The exercise may be especially effective in the second trimester.
In order to reduce pressure on the lower edge of the placenta, a woman is recommended to stand on all fours for a few minutes 3-4 times a day.

Drug treatment may include vitamin therapy, taking antiaggregation agents (suppressing the adhesion of blood cells) and vascular drugs in doses that are safe for the health of the mother and fetus.

Most often, women diagnosed with marginal placenta previa are hospitalized at 24 weeks. The hospital carries out procedures and preventive measures, such as:

tocolytic therapy. A pregnant woman is prescribed medications to reduce the number of uterine contractions. This effect is possessed by: Ginipral and Partusisten. They are administered to the expectant mother by drip or intramuscular injection;
prevention of fetoplacental insufficiency. A pregnant woman is prescribed vitamin complexes and drugs designed to improve blood circulation: Curantil, Trental or Actovegin;
prevention of anemia. A woman is prescribed drugs that increase the level of hemoglobin in the blood;
taking antispasmodics. Women are prescribed suppositories with papaverine, Magne-B6, No-shpa or magnesium sulfate. Therapy is aimed at reducing the tone of the uterine organ;
prevention of premature birth. If there are risks due to placental abruption, additional treatment is carried out with corticosteroids: Dexamethasone and Hydrocortisone. This is necessary to prevent breathing disorders in the baby.

Childbirth with marginal presentation

In a situation where special exercises did not help, and the bandage did not give the desired effect, doctors decide on the most in a safe way delivery. This usually occurs at 36–38 weeks of gestation. If the ultrasound still indicates marginal placenta previa, the obstetrician-gynecologist may recommend early hospitalization.

If bleeding is mild or absent, then natural delivery is possible. In this case, when the cervix is dilated into 3 fingers, a prophylactic amniotomy is performed (opening the membranes amniotic sac).
If the cervix is dilated to 3 fingers and a diagnosis of marginal presentation is made, a woman is recommended to have a prophylactic amniotomy

Some obstetricians and gynecologists allow women to give birth on their own, even if there is bleeding. If the cervix is smooth and soft, then an amniotomy is performed before contractions, as a result of which the baby descends and is closely pressed against the entrance to the pelvic area, thereby retaining the detached lobules of the placenta. This will stop the bleeding. The woman is also prescribed the drug Oxytocin. It reduces the amount of blood loss during childbirth and speeds up the process, causing strong and frequent contractions.

When amniotomy is not effective, then a woman with heavy bleeding a caesarean section is prescribed. In some cases, early surgical delivery (when the period is less than 36 weeks) is acceptable. In this case, not only the woman, but also the child is prepared for premature intervention by administering drugs that accelerate the formation of alveoli in the lungs. Ultrasound examination will help assess the maturity of the fetus and its readiness for childbirth.

Important: bleeding limits or completely eliminates the use of antiplatelet agents that help improve blood flow. Anemia can lead to poor maternal health or fetal hypoxia (lack of oxygen).

Photo gallery: childbirth with a diagnosis of placenta previa

If bleeding during placenta previa is weak or absent, then natural delivery is possible. If there is heavy bleeding and a diagnosis of placenta previa, the doctor may decide to perform an early surgical delivery. When amniotomy is not effective, a woman with heavy bleeding and a diagnosis of marginal presentation is prescribed a cesarean section.

Video: when a caesarean section is inevitable

Regional placenta previa is a diagnosis that is becoming more common. It did not bypass the author of the article either. The gynecologist advised eliminating physical activity, resting more, monitoring blood pressure(there were problems with him), to hold off on sexual intercourse and recommended wearing a special bandage. Initially, I followed the doctor’s advice, but I didn’t have enough patience for long. I walked a lot to work, carried heavy bags and reassured myself that there was no need to worry about trifles. I put the bandage aside almost immediately, since wearing it caused discomfort. When removed, the child became more active, as if he was grateful for the “expansion of free space.” At 23 weeks, slight bleeding appeared. I got scared, called a taxi and went to the hospital. The doctor admitted me to the hospital, but for a week it did not recur. Calm has come. I began to take more care of myself, but at the 38th week the doctor insisted on hospitalization, and for good reason. At 39 weeks I woke up bleeding heavily. Since the uterus had already begun to open, the obstetrician-gynecologist opened the membrane of the amniotic sac, and they began to prepare me for childbirth. Oxytocin was prescribed to speed up the process and reduce blood loss. I gave birth on my own, and everything went relatively well. There was a lot of blood, I suffered a lot of fear, but the main thing is that the child was born healthy. Conclusion: you must always listen to your doctor’s recommendations and strictly follow them. Self-indulgence and careless attitude can lead to harmful consequences. When a child’s life is at stake, there is no point in taking risks.

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Before pregnancy, many women did not even know about the existence of chorion, its significance, and even more so about chorion presentation. So, first, let's find out what chorion is. The chorion is the outer embryonic membrane, which, having passed through the early stage individual development The fetus turns into the placenta, which is secured by a “large sucker” with the help of numerous villi into the inner lining of the uterus.

Note that the villous membrane - the chorion - performs early stages During pregnancy there are several vital functions for the fetus:

respiratory - provides excretion carbon dioxide, and the supply of oxygen from mother to fetus;
trophic – ensures delivery nutrients from mother;
excretory – with the help of the chorion, metabolic products are removed; protective - protects the fetus from external influences.

What does chorion presentation mean?

In order to understand why a low position of the chorion is dangerous, let’s define what a presentation is. So, chorion presentation is a pathology of pregnancy in which it is located in the lower part of the uterus. In this case, the chorion partially or completely covers the internal os.

Chorionic presentation - causes

The reasons for chorionic villus presentation are not clear, but some factors are known that influence chorionic villus presentation: uterine fibroids, uterine developmental abnormalities, postoperative scars on the uterus, chronic inflammation uterus, chorionic presentation in previous pregnancies, frequent abortions. Chorionic presentation along the anterior wall or previa can also occur due to polyps or multiple fibroids. That's why frequent visit gynecologist for preventive examinations and healthy image life will help to avoid problems associated with possible presentation and its consequences during pregnancy.

Why is chorion presentation dangerous?

This classification of chorion presentation is accepted. Complete chorion presentation is dangerous due to the complete occlusion of the internal os of the cervix. It is also called central chorionic presentation. This arrangement is dangerous heavy bleeding due to placental abruption, and hypoxia is dangerous for the child at this time, due to which he can die in a matter of minutes.

Partial chorion presentation means that only part of the internal os is blocked. Low chorion presentation means that the chorion does not cover the internal os, but is located at a distance of less than 3 cm from it.

During pregnancy, the placenta migrates all the time, so even complete placenta previa may become normal before delivery. Chorionic presentation is an indication for caesarean section, natural childbirth in this case excluded.

Chorionic presentation - treatment

There is no cure for breech presentation as such, the main thing is to stick to it. preventive measures. The best prevention- a healthy lifestyle and regular visits to the doctor, identifying and monitoring the appearance of fibroids and polyps before onset of pregnancy. If, however, chorionic villi previa was detected during pregnancy, it is necessary to stop sexual relations, reduce physical activity to a minimum, eliminate stressful situations and limit mental stress, take a complex and medications to reduce the tone of the uterus, as well as iron supplements to prevent anemia.

Regular ultrasound examinations will help to qualitatively control the current situation, and maybe in the third trimester the placenta will migrate safely and settle in a safe place, which will lead to a natural birth.