Can the chorion change its position? Echographic signs of a low location of the chorion. Chorionic presentation - causes, symptoms, treatment

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 of the fertilized egg is observed 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 look fine on the outside, there is a huge risk of 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

To get an answer to this question, you must first define the term. Doctors call chorion the placenta in the first weeks immediately after conception. What is the placenta and how is it formed? After conception, the fertilized egg in the usual way moves into the uterine cavity. In the process of this advancement, it gradually turns into a multicellular embryo (or ovum), densely covered with delicate fibers.

Thanks to them, the embryo finds its place on the mucous membrane of the uterus. At this very place, the villi are already growing luxuriantly. It is from these that the so-called baby's place, or placenta, is formed, which is connected to the fetus through the umbilical cord. Presentation (a word understandable to any woman) of the chorion can be detected already at the end of the third month of pregnancy, when the first ultrasound is performed. Chorion is vital, here in the literal sense of the word, necessary for the development of both pregnancy and the embryo itself. It is through the chorion that the fetus communicates with the parent’s body. Through it the baby already breathes and receives his nutrition. The chorion produces hormones in a special way and is considered an endocrine organ.

What is low chorion presentation, what dangers does it pose?

This is said when the baby's place is less than six centimeters from the internal os of the uterus. This can have several consequences: firstly, detachments (resulting in bleeding), secondly, pelvic or so-called oblique presentation of the embryo, which can lead to a cesarean section, as well as a miscarriage. Very heavy bleeding leads to fatal outcome in case it is not stopped immediately. Complete chorion presentation carries the risk of placental abruption over a large area, and this is dangerous for bleeding for a pregnant woman. At this time, the fetus may experience acute hypoxia, which can cause it to die in literally a matter of minutes.

What are the causes of low chorion presentation, how can it be avoided using preventive measures?

Certainly, the best prevention Regular visits to the doctor, early detection and treatment are considered similar disease. The causes of this pathology are various inflammatory diseases, usually as a result of curettage and abortion. Usually in such cases, the uterine tissue is damaged, as a result of which the egg is not able to implant in the most suitable place for it (this is the back or front wall of the uterus). In addition, disorders can occur due to various neoplasms in the uterine cavity (for example, multiple fibroids), due to various kinds polyps. Therefore, all expectant mothers with fibroids need to talk to a gynecologist about the existing tumors before pregnancy.

Increased risk of this low presentation chorionic villus usually occurs in women over 35 years of age and those who intend to give birth again.

The main thing in such a situation is a healthy, full-blooded lifestyle during pregnancy, correct behavior and compliance with safety precautions. It is recommended to stop sexual relations with your spouse, to reduce to a certain level physical activity, be sure to regularly visit your doctor and do ultrasound examinations in a timely manner.

The first weeks of pregnancy for the expectant mother are probably one of the most difficult periods throughout the entire period of bearing a child. At this time there are several “critical periods” in the life of the future little man; his mother is mentally and physically rebuilt for a successful pregnancy. Unfortunately, this period does not always pass without complications and problems, so routine ultrasound examinations should be carried out. A woman’s first ultrasound is scheduled for the end of the first trimester, and it is at this time that this pathology is most often detected.

How dangerous is chorionic presentation at 12 weeks, and how to prevent complications?

Chorionic presentation during pregnancy - what does it mean?:

The chorion is a special organ that provides communication between the body of the mother and her unborn child. Essentially this is early stage development of the placenta, therefore the term “chorion” is used only during the first three months of gestation, after which the word “placenta” is used. One surface of the chorion faces the fetus, and the other is attached to the wall of the uterus. And it is precisely when the location of the chorion is atypical that various disorders can occur.

As you know, the uterus communicates with the vagina and external genitalia through the cervix, inside which there is a special cervical canal. The internal opening of this canal, which breaks off into the uterus, is called the os of the cervical canal. The chorion or placenta is normally attached to the bottom or lateral surfaces of the uterus and does not overlap the pharynx in any way. But in some cases they can partially or completely cover internal hole cervical canal - it is in such a situation that a disorder called "Chorion presentation"

Types of presentation:

The closure of the cervical canal by the chorion does not have to be complete, therefore there are several types of presentation that characterize the complexity of this condition:

Partial chorion presentation. In such a situation, the developing placenta covers at least two-thirds of the lumen of the cervical canal.

Regional chorionic presentation . This is a variety and, one might say, more easy option partial presentation, since only one third of the lumen of the pharynx is covered.

Central chorion presentation. In this case, the lumen of the pharynx of the cervical canal is completely closed by the future placenta, which significantly complicates the course of pregnancy and poses a threat to both the unborn child and the life of the mother.

Low location of the chorion . The forming placenta can be located next to the opening of the cervix, but does not block it. If it is attached near the edge of the pharynx closer than three centimeters, then it is said to be low. This is not dangerous, but poses a potential threat to pregnancy.

Chorionic presentation at week 12 can be in any of these forms.

As pregnancy progresses, the growing uterus can pull back the placenta, so central presentation can turn into partial and marginal, and then disappear completely. According to obstetricians, more than 90% of cases of one or another chorionic presentation completely disappear over time, so if you were diagnosed with it in the first weeks of pregnancy, this is not a reason to panic. But you will have to monitor your condition and not neglect examinations by a specialist.

Causes of presentation:

Why exactly the developing placenta is attached in such dangerous proximity to the pharynx of the cervical canal is completely unknown. However, several main factors have been noted that contribute to a greater likelihood of developing this pregnancy complication. Especially often various options Chorionic presentation develops in women who have had in the past or currently have the following diseases and conditions:

Inflammatory lesions of the uterus, abortions, especially using the curettage method, surgical interventions for fibroids or cesarean section. All these factors are united by one consequence - after this, inner surface The uterus may leave scars and adhesions, which make it difficult for the chorion to attach to the “right” place.

Diseases of the liver, kidneys or heart. It would seem, how can these conditions affect the position of the fetus and its placenta in the uterus? But with pathologies of these organs, blood stagnation may occur in the pelvic area, which contributes to lower attachment of the chorion.

Multiple births in the past. If you are pregnant not for the first time, then your chances of improper attachment of the chorion significantly increase. Most physiologists see the reasons for this phenomenon in the fact that after each pregnancy, in the area of ​​the uterus where the placenta was attached, the structure of the endometrium changes. Therefore, when next conception The chorion can no longer attach there. Over time, such places on the inner surface of the uterus become less and less, which leads to the attachment of the placenta in the danger zone.

Uterine deformities, acquired (for example, after surgical interventions) or congenital in nature, can also lead to chorionic presentation.

Is chorionic presentation dangerous?:

Most pregnant women are frightened by such a conclusion from the first ultrasound examination. Although in fact, chorionic presentation during pregnancy of 10-13 weeks is observed in approximately 5% of cases, that is, in every twentieth woman. In more later this condition is becoming increasingly rare, occurring before birth in no more than 0.5% of women in labor. main reason This lies in the fact that the growing uterus is able to “pull” the point of attachment of the chorion from the pharynx of the cervical canal to a safer zone. Therefore, according to pediatricians, chorion presentation during the first trimester can be regarded as a feature of the course of pregnancy, but not a complication.

Difficulties begin if the presentation continues to persist after the third month of pregnancy. Being dangerously close to the pharynx of the cervical canal, the placenta can be easily injured, which leads to bleeding varying degrees expressiveness. In case of marginal or partial presentation, the first bloody issues appear closer to the sixth month. They are practically painless, and blood may be released in thin streaks in the discharge, or give the impression of menstruation. Central presentation can manifest itself with such symptoms as early as the second or third month. In fact, this is the main consequence and danger of chorion presentation, which entails a number of disruptions to the course of pregnancy and the health of the mother and her unborn child:

The constant loss of small amounts of blood leads to anemia in a pregnant woman. You may experience weakness, dizziness, skin become pale. When heavy bleeding Blood pressure may decrease, vision may become dark, and you may even lose consciousness.

Disruption of connections between the uterus and placenta also leads to malnutrition of the unborn baby. Its development slows down, and against the background of reduced oxygen delivery (due to a damaged placenta and anemia in the mother), intrauterine fetal hypoxia occurs.

If the mother’s blood loss reaches significant levels, this can lead to miscarriage, intrauterine fetal death and a number of other terrible consequences.

In addition to the problems described, presentation is often complicated by incorrect positioning of the fetus, which leads to difficulties during the birth process. Therefore, if such a condition is diagnosed in you in the sixth month or later, then you need to mentally prepare yourself for the fact that you may have to have a caesarean section rather than give birth on your own.

Treatment of chorionic presentation:

Unfortunately, at the moment, doctors do not yet know how to correct such a condition as chorionic presentation, so all treatment comes down to preventing complications and eliminating their consequences. As a rule, if there is a central presentation in the fourth month, they prefer to place the girl in the position in a hospital for preservation. The same is done with partial forms of presentation, if they are complicated by bleeding, hypertonicity of the uterus and other factors that may threaten termination of pregnancy. In a hospital setting you will be provided with the following treatment:

To begin with, strict bed rest and limiting physical activity, which is one of the the most important factors prevention of bleeding with placenta previa. In addition, you will need to avoid emotional stress, as this can also lead to negative consequences.

Regular examination by a doctor and diagnostic ultrasound examinations. Being under 24-hour medical supervision, you greatly reduce the risk of sudden complications, since they will be identified and corrected as quickly as possible. short term. Most deplorable and even tragic situations with chorion presentation are caused by delayed medical intervention.

Maintenance treatment, which includes all the vitamins necessary for the pregnant body.

Proper and regular nutrition, which helps normalize work gastrointestinal tract. If you have diarrhea or constipation, you may strain your abdominal muscles, which increases pressure in the pelvis and can trigger bleeding.

If you develop anemia due to bleeding, it can be treated in a hospital setting by taking iron supplements, including those given by injection.

Treatment is also prescribed to eliminate other factors, threatening the flow pregnancy - for example, antispasmodics with uterine hypertonicity.

In case of partial chorionic presentation, which does not manifest itself with severe symptoms, you do not have to go to the hospital for preservation, but you need to follow certain precautions for prevention possible complications. These primarily include:

Exercise stress. Leisurely walks and walking around the house is the maximum for a girl in such a situation. Lifting heavy objects, walking up stairs, and running are strictly contraindicated.

It is necessary to completely avoid sexual contact. During pregnancy, in principle, sexual intercourse is not prohibited at almost any stage, but during presentation it can cause severe bleeding.

Mental stress or stress affects the pregnant body no better than lifting weights. Therefore, they also need to be excluded, and even with sedentary and predominantly mental work, it will be time for you to go on maternity leave.

Also, as with preservation, it is necessary to eat properly so as not to cause changes in stool and at the same time provide the body with all the necessary nutrients. You also need to agree with your doctor on the choice of a vitamin complex, which will be very useful in such a situation.

And most importantly, if you have been diagnosed with chorion previa and at some point you notice the release of even a small amount of blood in the absence of pain, weakness and other symptoms, then you need to urgently consult a doctor. And if the bleeding is accompanied by pain in the lower back and lower abdomen, palpitations, weakness or fainting, then you need to call “ Ambulance"as soon as possible, as you risk losing your child.

During the mandatory ultrasound after 12 weeks, the location of the chorion is assessed, among other things. Sometimes an ultrasound specialist diagnoses chorionic presentation. What does this mean and how dangerous is it?

What is chorionic presentation and why does it occur?

Until the placenta is formed, the embryo is surrounded by a villous membrane, which grows into the lining of the uterus. Until the 16th week of gestation, this is the chorion (from the 17th week - the placenta), which performs the following main functions:

• Nutrition of the embryo;
• Respiration - delivery of oxygen and removal of carbon dioxide;
• Isolation of metabolic products;
• Embryo protection.

During the normal course of pregnancy, the chorion attaches to the fundus of the uterus and grows along the anterior, posterior and lateral walls, but this does not always happen.

Chorion presentation is its incorrect location, in which there is complete or partial overlap of the internal os of the cervical canal.

Why this condition occurs is not completely clear. But a connection has been established with some factors:

• chronic inflammation of the uterus;
• previous operations;
• abnormal development of the uterus;
• a large number of pregnancies and births;
• low attachment of the placenta in the previous pregnancy.

Types of chorion location

Based on the attachment of the chorion relative to the internal os, presentation occurs:

• Complete - a condition in which the chorion completely covers the internal os. This will subsequently develop into placenta previa.
• Incomplete - characterized by overlap of part of the uterine os. If the villous membrane comes out up to a third, then this is called marginal presentation.
• Low - the chorion is located at a distance of 3 cm or less from the pharynx, but does not overlap it.

Chorionic presentation at 12 weeks is not the final verdict. As the uterus and fetus grow, migration may occur, and the condition will return to normal. A more favorable prognosis is noted for the posterior location of the chorion and presentation along the anterior wall.

Complete covering of the uterine pharynx by the chorion - dangerous look pathology, which threatens massive bleeding.

How is chorionic presentation manifested?

Most often, pathology is detected during ultrasound.

Bloody discharge can also be caused by breech presentation, especially if it occurred shortly before hot bath, sauna, sexual intercourse. In this case, you need to urgently consult a doctor.

Complications

The pathology is dangerous:

• premature miscarriage;
• uterine bleeding;
• intrauterine death of a child.

Chronic blood loss leads to the development of anemia and fetal hypoxia. While maintaining complete closure of the pharynx, childbirth naturally impossible.

Treatment of chorionic presentation

Partial chorionic presentation without bleeding does not require hospitalization. Isolation of any amount of blood is an indication for treatment in the hospital.

It is impossible to artificially change the location of the villous membrane, so the main task facing doctors is maintaining pregnancy. A protective treatment regime is created in the hospital:

• The woman is in a calm environment, on bed rest;
• Limited physical exercise;
• Provided balanced diet with the exception of products that strengthen or relax the stool.

Drug treatment is as follows:

• Suppositories with Papaverine, Drotaverine tablets to relieve uterine tone;
• Iron preparations, for example, Totema, Maltofer - for the prevention or treatment of anemia.

In the presence of bleeding, the hemostatic drug sodium etamsylate is additionally used. At the beginning of therapy, it is administered intravenously or intramuscularly. Then you can switch to tablets.

Massive bleeding that cannot be treated conservative ways, is an indication for termination of pregnancy.

After discharge from the hospital, at home it is necessary to adhere to a measured lifestyle, eliminate stress and increased workload. It is forbidden to have sex, because this may cause new bleeding and miscarriage.

What is the prognosis for the pathology?

Chorionic presentation at 8-14 weeks can transform into a normal location of the placenta or persist in the form of low placentation.

If the presentation does not disappear, but turns into an anomaly in the location of the placenta, then by the time of birth the baby may be transverse in the uterus or with the buttocks down. In such cases, to reduce the risk, it is recommended to deliver the baby through.

Prevention

Women should take care of their reproductive health as soon as possible:

• Hypothermia should be avoided and inflammatory diseases of the genital area should be treated promptly.
• Do not resort to abortion, this is not a method of family planning.
• It is important to eat properly and nutritiously and lead a measured lifestyle.

If you follow these simple rules, you won’t have to become familiar with pathologies from personal experience.

Yulia Shevchenko, obstetrician-gynecologist, especially for the site

Useful video

The placenta is the organ of primary importance when it comes to pregnancy. Medical specialists pay close attention to her during the examination procedure. The placenta is attached to the uterus and grows parallel to the baby. In appearance, it resembles a kind of flat cake, pierced blood vessels. If the placenta is attached incorrectly or in the wrong place, then such a pathology threatens great difficulties for both the fetus and the expectant mother. The phenomenon can be caused by many factors.

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. The membrane covering the fertilized egg 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. Procedures are carried out in the hospital and preventive actions, 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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