Chorion presentation: low, central, incomplete location. Chorionic presentation: is it worth worrying about?
The term "chorion" is used by gynecologists to refer to the placenta in the first trimester of pregnancy. Many patients have early stages, the entry “chorion presentation” appears on the card. Like everything unknown, this definition, coupled with the word diagnosis, can seriously frighten the expectant mother.
Let's try to explain clearly what chorion presentation is. This diagnosis means that the placenta is located incorrectly. When, instead of attaching to the body of the uterus, it can capture the lower uterine segment.
Sometimes partial or complete overlap occurs internal pharynx cervical canal leading from the uterus. This diagnosis is most relevant for the first trimester of pregnancy. Basically, as the fetus develops, the chorion rises. But there are times when this does not happen.
Types of chorion presentation
At low presentation chorion attachment is observed ovum a couple of centimeters below the cervix. This occurs in only 5% of pregnant women. Such a diagnosis can only be made during an ultrasound. Low attachment is most common in the first two trimesters. In 90% of cases, the chorion rises safely to the desired position as the fetus grows. This is due to the fact that the tissues of the uterus are pulled upward and pull the placenta along with it. Thus, everything is done without drug treatment.
There are presentations on the back or front wall uterus. The first option is the most common and is considered the norm. In this case, the placenta can also move to the side walls of the uterus. Nothing wrong with that. In the case of the chorion along the anterior wall, there is also no cause for concern. In this option, placenta migration occurs even faster.
It happens that the placenta has not risen, but there is no overlap of the internal os. In this case, the pregnant woman is recommended to rest completely and be constantly monitored by a gynecologist.
At partial presentation the placenta can cover up to two-thirds of the cervix. A variety of this type is called marginal presentation , in which the overlap of the uterine opening does not exceed one third. These options are worse, but also not hopeless. Although the risk of miscarriage increases and bleeding may occur, hospital treatment does not apply.
The most dangerous is complete or central placenta previa . In this case, there is a complete overlap of the internal os of the cervical canal. With this form of presentation, starting from 4 months, hospitalization is indicated. Although everything may seem fine on the outside, there is a huge risk heavy bleeding. They can develop without visible reasons, even in a state of complete rest. Therefore, in order not to risk the life of a pregnant woman, doctors observe her in a hospital.
However, in any case, you should not panic. Although in full presentation it is indicated C-section, there is a real chance to save the pregnancy. A successful outcome is observed in 95% of cases.
The main causes of chorion presentation
The main reason for this violation is considered pathology of the internal walls of the uterus , due to which the embryo cannot attach to them. Often, these pathologies arise as a result of abortion or due to sexually transmitted infections. Presentation can also develop with uterine deformation, which occurs as a result of myomectomy.
Women suffering severe forms diseases heart, kidney or liver are included in the group increased risk. This is due to congestion in the uterine cavity. Chorionic presentation often affects second-bearing women , especially over 35 years old.
This deviation may be due to pathology of the ovum , as a result of which it is impossible to fully attach the latter. It also happens that the placenta is attached too tightly and cannot separate on its own during childbirth.
It would be appropriate to note that chorionic presentation, excluding the central variant, can only be definitively diagnosed at the end of pregnancy, since the position of the placenta can always change.
Consequences of chorionic presentation
The most common complication of presentation, as well as a symptom, is bleeding . Its character depends on the degree of presentation. During complete presentation, bleeding is observed already at 2-3 months. The lateral form involves bleeding after 6 months and during childbirth. The intensity of hemorrhages is also determined by the degree of presentation. It is noticed that 20% of cases occur during the second trimester.
Bloody discharge with this pathology is of a special nature.
The advantage is that the effusion always occurs outward, and avoids the formation of hematomas between the uterus and the chorion. However, this does not reduce the danger for the expectant mother and child.
A distinctive feature of these bleedings is suddenness. At the same time, the pregnant woman does not experience any pain or discomfort. This makes it possible not to confuse them with spontaneous abortion, which is always accompanied by painful spasms.
Having appeared once, bleeding tends to recur at different intervals. It is impossible to predict its intensity and abundance.
The main threat of placenta previa is miscarriage . The tone of the uterus can signal danger, nagging pain in the stomach and lower back. Often permanent accompanying symptom is
The chorion is the villous membrane of the fertilized egg that ensures its growth and development. During the normal course of pregnancy, it is implanted into the inner lining of the uterine fundus, and then onto the front, back and side 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 blocking of the internal os of the cervical canal coming from the uterus. This diagnosis is most dangerous in the early stages of pregnancy. Usually, as the fetus grows, the placenta moves up, but in some cases this does not happen.When does presentation occur?
The reasons for the development of this pathological condition are not fully understood. 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.During the period of gestation female body undergoes numerous changes. They start with the shift hormonal levels. Further changes occur in the reproductive organ itself. During this period, the woman is not even aware of her new position. In this article we will talk about the term “chorion”. You will learn about what it is and where it is located this education. You will also be able to get acquainted with the problems that may arise with the chorion.
Conception process
To begin with, it is worth saying a few words about fertilization. U healthy woman Once a month the follicle ruptures. At this moment, the female gamete is released, ready for fertilization.
If sexual intercourse takes place at this moment, then male cells will be able to freely meet with the egg. When two gametes merge, continuous cell division and movement begins. When education reaches reproductive organ, the fertilized egg is attached. It grows tightly into the inner lining of the uterus and remains there for a long time.
Chorion - what is it?
The chorion is the outer membrane of the embryo. It is worth noting that it consists of two important components: amnion and chorion.
The outer part (chorion) is the most important part. It is she who borders inner shell uterus. The localization of the chorion can be different. You will learn about the most popular of them below.
Chorion is a component normal pregnancy. Without it, the fetus will not be able to develop normally and will simply die. This membrane appears approximately one week after fertilization and remains until the placenta is formed. Many doctors say that the chorion is the placenta. To some extent this statement is true. It is at the junction of the upper membrane of the fetus with the endometrium that the placenta is formed.
Diagnosis of chorion
This formation cannot be detected during a vaginal examination. The chorion is a formation that can only be seen with ultrasound examination. In the ultrasound protocol, the specialist always describes the condition of this structure, its location and features.
Types of chorion
Medicine knows several varieties of the upper membrane of the fertilized egg. It is worth noting that they all depend on and can change greatly over time. The type of chorion can only be determined by
Gestation period up to 6 weeks from conception
On at this stage During the development of the fertilized egg, a ring-shaped chorion can be detected. What it is?
During examination, a fertilized egg can be detected. It is worth noting that the embryo is not yet visible at this stage. Upper shell the fertilized egg is attached to the endometrium over its entire area. It is in this case that we can say that there is a ring-shaped chorion.
Gestation period up to 8 weeks from conception
Often on record ultrasound examination women discover the entry: “Chorion circular.” What does it mean?
This condition of the upper membrane is characteristic of early pregnancy. This type of formation is transformed approximately at 8 weeks from the moment of fertilization.
Villous chorion
This type of shell is absolutely normal. Many women ask their gynecologist: “Villous chorion: what is it?”
The shell got its name because it has so-called villi. It is with their help that it is attached to the inner wall of the reproductive organ. Villous chorion is always described in the ultrasound report. Its location is also noted.
Localization of the chorion
There are several common options for attaching this structure. Doctors still do not know why the fertilized egg chooses this or that place. Let's look at each possible option.
Posterior localization
This condition is the most common. In most cases, in the first trimester of pregnancy, chorion is detected along the posterior wall of the reproductive organ. In this case, it is necessary to take into account the structural features of this shell.
Front location
If your chorion is not located along the back wall, then it is attached to the front of the uterus. This condition is also normal, but it is necessary to observe special measures caution.
With anterior localization, there is a risk of detachment of the fetal membranes. If you follow all the doctor’s instructions, you will most likely be able to avoid such complications. There is no need to panic when receiving such information. The chorion is capable of moving and migrating.
Lateral position
The chorion may be on the side during pregnancy. This position is always reduced to anterior or posterior. In this case, it is indicated that the chorion is located, for example, in the front and to the right.
Chorionic presentation
Many pregnant women have to deal with this diagnosis. First, it’s worth finding out what “presentation” means.
If the fertilized egg is attached low in the reproductive organ, then the resulting chorion will overlap or simply be located very close to the exit from the uterus. This condition is a pathology, but no treatment has yet been invented for it.
You should not be upset about this location of the chorion. He can migrate. The resulting placenta may also move upward or sideways. Thus, placenta previa, which was detected during the second screening, often disappears during the third examination with an ultrasound probe.
What can be the danger of chorion presentation?
This condition goes away on its own in most cases. However, there is a category of women in whom the chorion and placenta remain in place and do not move anywhere. What does this mean?
With this outcome, doctors may choose a non-standard delivery. If the placenta completely blocks the entrance to the uterus, then the chorion test is performed when the doctor takes into account the distance between the cervical canal and the edge of the membrane. If the gap between the cervix and the placenta is more than five centimeters, then the woman is allowed to give birth on her own. In other cases, a planned additional ultrasound is performed several days before birth and, if necessary, a caesarean section is prescribed.
Chorionic presentation: precautions
If you have been diagnosed with this, your doctor will give you several recommendations. It is worth listening to advice and following all precautions. Otherwise, spontaneous bleeding may occur, which leads to the most unexpected consequences.
Maintaining physical rest
When chorion presentation occurs, complete physical rest is always prescribed. A woman needs to give up physical education and sports exercises. It is also forbidden to lift heavy objects and make sudden movements.
In some cases, it is even forbidden to sneeze, since a sharp contraction of the uterus can lead to partial detachment of the chorion.
Sexual rest
In addition to physical rest, sexual rest is also necessary. It is worth abandoning all contacts until the chorion rises to a safe distance from the cervical canal. Otherwise, involuntary contractions of the reproductive organ can cause bleeding.
Taking medications
For chorionic presentation, the doctor may prescribe some medications. They relax the uterine muscle and prevent it from contracting. In the early stages of pregnancy, these can be Duphaston tablets, Papaverine rectal suppositories, No-Shpa tablets. For more later For embryo development, other means may be prescribed: Ginepral injections or tablets, Magnelis B6 vitamins.
It is worth noting that such medications should be taken only on the recommendation of a doctor. In some cases, you can do without them altogether. The doctor may also recommend wearing a bandage. This device will support your stomach and make it easier general state pregnant woman.
Summarizing
While expecting a baby, women go through various studies. Including ultrasound. During such an examination, the doctor always examines the chorion and notes its location. This takes into account the size of the shell, the presence of detachments and other problems.
If you have chorionic presentation, always follow your doctor's advice. Only in this case will the pregnancy end with a successful delivery.
During pregnancy and examination, women may encounter the expression chorion along the posterior wall.” What does this mean, when does it occur during pregnancy, is this condition dangerous and what can be done about it, what does marginal presentation mean, we will tell you in this article.
What is chorion?
Chorion is one of the membranes that makes up the baby’s placenta during pregnancy. There are 3 shells in total - allanotis, aminion and chorion. During pregnancy and the formation of an embryo, a placenta is created, which attaches to the wall of the uterus. It turns out that the chorion along the back wall of the uterus is a type of attachment.
In its normal state, the placenta is attached to the fundus of the uterus or its body at the posterior wall, adjacent to the sides. There are varieties when the placenta is attached low, either to the anterior wall of the uterus, or to its lower segment, when the pharynx partially or completely covers cervical canal.
Reasons for location on the rear wall
It turns out that chorion along the posterior wall is a common situation that does not cause concern. This term is one of the types of placenta attachment, which will be indicated to you on your card after the ultrasound.
The chorion attached to the back affects the size of the tummy - it will be small compared to the front wall - the belly will be large and noticeable even in the first trimester. The chorion tends to migrate inside the body of the uterus, so that in one trimester it can be attached to the back wall, and at 12-13 weeks - already to the front. Anterior or posterior localization is detected by a doctor using ultrasound at 12-13 weeks.
But you should know that the norm for the location of the chorion is if it is located above the internal pharynx by more than 3 cm, it should not be low. Another scenario is considered a deviation - it could be a marginal presentation, incomplete, central.
Placenta previa
Simultaneously with the diagnosis of chorion on the posterior or anterior wall, pregnant women at 12-13 weeks have the opportunity to see chorion or placenta previa in their chart. This term means: the placenta is located non-standardly - it is attached not to the uterus itself, but to its lower segment.
The first trimester may also be marked by the fact that you can also encounter complete or partial closure of the pharynx of the cervical canal, but as the baby grows at 12-13 weeks, the chorion moves and the pharynx becomes open again. But this may not happen in every case.
Low
Low presentation means that the fertilized egg has attached below the cervix. This happens very rarely - in about 5 cases out of 100, and is determined by ultrasound. The first and second trimester may be characterized by this position, but almost always subsequently the chorion assumes a normal position due to the growth of the uterus and the extension of the placenta.
Along the back and front wall
Posterior presentation is considered the most common option and is not considered abnormal. This is not an advantage dangerous pathology. The placenta in this embodiment can capture the walls from the side. Anterior presentation is considered less rare, without going beyond the norm. Anterior presentation is characterized by the fact that the placenta migrates more quickly to its normal state.
When the placenta does not rise at 12-13 weeks, but the localization of the pharynx is not blocked, then pregnant women are prescribed timely examinations and complete rest without stress.
Partial
Partial presentation during pregnancy is characterized by overlap of the cervix up to 60 percent. One of the cases of this option at 12-13 weeks is marginal presentation, when the percentage of overlap is no more than 30. Such presentation is dangerous due to the threat of miscarriage, bleeding and fetal hypoxia. To treat this deviation, complete rest and sedatives, treatment is carried out at home, examinations are regularly carried out in the hospital.
Complete
Complete presentation during pregnancy is otherwise called central, when the pharynx is completely blocked. Having discovered such a pathology, already at 12-13 weeks the pregnant woman will be put on preservation due to the risk of bleeding and loss of the child. There is even a threat to the mother's life, so hospitalization is mandatory. With this scenario, a cesarean section is most often indicated, and adverse outcomes occur in only 5 cases out of 100.
Why does presentation occur?
Causes of breech presentation during pregnancy may include:
- deviation from the norm in the condition of the internal walls of the uterus and the inability of the embryo to attach to them;
- previous abortions or infectious diseases;
- uterine deformation due to myomectomy;
- diseases of the cardiac system, liver and kidneys that cause stagnation;
- second birth of a woman after 35 years;
- predominant anomaly of the ovum;
- the placenta is too dense.
Despite all the threats, all of the above pathologies can be successfully treated with careful examination and monitoring by doctors. Therefore, when you see a diagnosis of anterior or posterior placenta, whose localization confuses the doctor, do not be alarmed, trust the doctors, and you can give birth to a healthy child!
According to statistics, up to 45% of pregnant women face such a diagnosis as marginal chorionic presentation in the early stages of pregnancy. Should I be afraid of such a medical verdict, and what to do? we'll talk in this article.
What it is?
The chorion is a temporary organ that performs the functions of a pharmacist. It is formed from the moment of implantation of the fertilized egg from fallopian tube, where the meeting of the egg and sperm took place, into the uterine cavity. As soon as the blastocyst (which is what the fertilized egg turns into by 8-9 days after ovulation) reaches the uterine cavity, it strives to gain a foothold in it. It is this process that is called implantation.
At the site of attachment of the blastocyst membrane, they are isolated special enzymes, which make the mucous membranes of the uterus more pliable and allow the fertilized egg to “grow.” A chorion is formed at the site of attachment. It is necessary to supply the fertilized egg with useful substances from the mother’s blood. A little later, the placenta appears in its place. But until 12-13 weeks we're talking about specifically about the chorion, since the placenta is still forming and does not function.
If implantation is successful, the fertilized egg is fixed in the fundus of the uterus (this is its top part). If for some reason pathological reasons The blastocyst failed to implant in the upper or middle part of the uterus; it may descend into the lower uterine segment. And then the chorion will form low.
Chorionic presentation is its location relative to the cervical canal - a thin passage inside the cervix connecting the uterine cavity and vagina. There is no talk of presentation only if the chorion has formed in the area of the fundus of the uterus or in its middle part (in the body of the uterus).
If the chorion is low, there are several types of presentation.
Classification
Depending on the degree of occlusion of the cervical canal, through which the fetus will then pass during childbirth, There are also types of pathology.
- Regional chorionic presentation- the chorion is located low, its edge slightly touches the area of the cervical canal with one edge. This presentation is considered the most favorable, in terms of prognosis, for further pregnancy and childbirth.
- Incomplete presentation- the chorion is located low and covers the entrance to the cervical canal by about two-thirds. The forecasts are less optimistic, since this position of the chorion in the uterus increases the likelihood of miscarriage or bleeding due to chorion detachment.
- Full presentation- the chorion has formed low and completely covers the entrance to the cervical canal. This is a rather dangerous pathology, the prognosis for which is very unfavorable.
Any chorion presentation, but especially complete and incomplete, poses a threat of miscarriage and chorion detachment. In its place, the placenta will form, a network will develop blood vessels, and this is dangerous if the vessels grow into the lower part of the uterus, which, according to the laws of nature, should open and release the baby out when the due date comes.
Often chorion presentation can change into another pathological condition- placenta previa, and then independent childbirth naturally, most likely, will be contraindicated. The woman will have a caesarean section. Carry the child to due date It will also not be easy, since the low-lying placenta and adjacent to the exit from the uterus will create a risk of spontaneous bleeding at any time.
A baby who is breech will receive less oxygen and useful substances, and this is fraught with malnutrition and hypoxia.
Causes and symptoms
The main reason for marginal presentation is internal conditions that prevented the fertilized egg from implanting normally and in a more suitable fundus of the uterus. Such prerequisites include disorders of the endometrium of the uterus. It is usually observed in women who have had several abortions or have undergone diagnostic curettage.
Miscarriages and a history of frozen pregnancies also increase the likelihood of abnormal placement of the fertilized egg. An obstacle to full implantation may be a scar or several scars on the uterus from previous operations or a cesarean section.
Women who have given birth a lot cannot boast of being strong and elastic. muscle tissue reproductive organ, they also have an increased likelihood that a subsequent pregnancy may occur against the background of low placentation.
The presence of fibroids, fibroids and other formations in the upper part of the uterus also creates obstacles for the attachment of the blastocyst, and it is forced to descend in search of “shelter” in the lower uterine segment. The reason may also be congenital anomaly structure of the uterus - bicornuate or saddle uterus. A certain sequence of such pathologies has also been noticed - if in a previous pregnancy a woman had low placentation, it is highly likely that the attachment of the fetus and the development of the chorion during a subsequent pregnancy will also be low.
There may be no symptoms of marginal chorionic presentation in the early stages, but small short-term bleeding may appear. Usually they are always assessed correctly by a woman - as a threat to the preservation of the child.
If the chorion, and subsequently the placenta, does not migrate, such bleeding, associated with the rupture of small blood vessels due to stretching of the uterine walls, can recur frequently, in some cases until the very birth. Because of them, a woman begins to suffer from anemia, she chronically lacks iron, and her blood contains a small amount of hemoglobin. Be that as it may, if bloody discharge appears from the genital tract of a pregnant woman, you should immediately call an ambulance.
With timely hospitalization using conservative treatment It is possible to save up to 90% of all babies who grow in the mother's womb against the background of marginal presentation of the chorion, placenta and even the umbilical cord.
What to do?
As already mentioned, marginal chorionic presentation is diagnosed in approximately 4-5 women out of ten pregnant women up to 12 weeks. However, not all of them immediately fall into the risk group and are listed as patients for planned cesarean section. The prognosis is favorable, and in 90% of cases the chorion, and then the placenta, which forms in its place, migrates higher along with the growth of the uterus.
The baby in the mother's womb is growing rapidly. To meet his needs for comfort, the uterine wall and ligamentous apparatus forced to stretch. Together with them, the placenta, which at the beginning of pregnancy was in a marginal presentation, will “crawl” upward. The placenta will migrate along the anterior or posterior wall of the uterus - it does not matter. It is important that in most cases it actually rises, and all the threats and risks associated with low placentation remain a thing of the past.
Medicine cannot influence the migration process, speed it up or stimulate it. A woman diagnosed with marginal chorionic presentation must follow all the recommendations of her attending physician, exclude physical activity, heavy lifting, jumping, sudden movements, and squats. She will have to visit her doctor more often and have an ultrasound done to monitor the process of chorion (placenta) migration. Sex during marginal presentation is prohibited, since orgasm associated with contraction of the uterine muscles can contribute to rapid traumatic detachment of the chorion and the occurrence of heavy bleeding, in which the child may die in utero, and the woman may lose a lot of blood and die from this.
The process of placental migration is usually completed by 18-20 weeks of pregnancy. By this time or a little later (by 35-28 weeks), the true state of affairs becomes clear - if the placenta has risen, the restrictions will be lifted, if not, the pregnant woman will be classified as a risk group for premature birth and will continue to lead with increased attention and trepidation.
Treatment
It is impossible to speed up migration, but treatment for a woman with marginal presentation chorion sampling will most likely be prescribed. Only it will not be aimed at the chorion itself, but at relaxing the muscles of the uterus, so as to prevent its tone and not provoke new detachments and bleeding. Depending on the degree of presentation, treatment may be carried out in a hospital, or they may be allowed to take necessary medications at home. The doctor leaves this question at his own discretion.
