Low-set placenta. Low placentation in pregnant women, placenta previa, treatment

15.08.202227.05.2017

O44 Placenta previa

Epidemiology

The epidemiology of pregnancy complications with low placentation is such that only 15% of cases can be complicated by bleeding or threat. In most women, this problem is asymptomatic and childbirth goes well. Among the etiological factors of low placentation, surgical interventions and frequent abortions are in first place in terms of prevalence, which must be taken into account and identified as risk groups for this pathology.

Causes of low placentation during pregnancy

To understand the main reasons for the development of this pathology, it is necessary to understand how placentation occurs under normal conditions. The placenta is the place where the baby “lives” and develops all the time. In its structure, the placenta is connective tissue that contains many vessels. This is necessary for good fetal blood circulation and adequate nutrition, since all nutritious foods enter the bloodstream and then to the child. One of the main functions of the placenta is protection from external factors, since it is a very serious barrier to viruses, bacteria, toxins, and drugs. Therefore, in order for the placenta to perform all its functions normally, its correct location is necessary. Under normal conditions, the placenta is attached to the fundus of the uterus or to its posterior wall. This ensures normal blood flow, the vessels are not pinched and the child receives all the nutrients. The fundus of the uterus and the back wall have a very dense layer of endometrium, and when the placenta is attached in this place, it is very tightly fixed right up to the moment of birth. There is no risk of placental abruption or other complications. In any case, the placenta should attach so much that it is 7 centimeters above the internal os. Then we are talking about the normal attachment of the placenta. If the placenta is below seven centimeters, but does not at all overlap the pharynx, then we are talking about low placentation. Sometimes the placenta covers the internal os partially or completely, then placenta previa is a more complex case.

The reasons for this abnormal location of the placenta may be different. Inflammatory diseases of the internal genital organs of women can be considered in first place in terms of prevalence.

Other reasons for low placentation include congenital uterine defects, which disrupt the entire organ area and prevent normal placentation. Very often, girls are born with congenital defects in the structure of the uterus, which are not critical and the girl can become pregnant and carry to term healthy child. Such defects include a bicornuate uterus, a unicornuate uterus, and uterine hypoplasia. In this case, the normal structure of the uterus is disrupted and the fertilized egg cannot be implanted in one horn, since blood circulation will be impaired as the fetus grows. Therefore, implantation occurs a little lower, where the placenta will later form, which is the reason for low placentation.

Surgical interventions on the uterus also often change the topic of the organ. In certain cases, surgery for fibroids with partial resection of the myometrium may be performed. This leads to the fact that the placenta cannot attach normally to the fundus. Sometimes a simple suture on the uterus after caesarean section may cause low placentation.

Uterine fibroids may be another cause of low placentation. This disease is characterized by the formation of a benign compaction in the thickness of the myometrium or the formation of a node. Such nodes can form in one horn, which directly interferes with normal placentation.

A woman’s age directly affects development normal pregnancy. If a woman’s first pregnancy is after 35 years, then only this can cause low placentation. After all, with age, normal blood circulation in the uterus is disrupted and this interferes with normal placentation.

Risk factors

Based on these reasons, we can identify the main risk factors for the development of low placentation in women during pregnancy, which must be taken into account for the timely prevention of complications. Such risk factors include:

chronic inflammatory diseases of the internal genital organs;
surgical interventions on the uterus;
uterine fibroids;
congenital uterine defects;
first pregnancy at an advanced age;
frequent abortions or miscarriages in history;
hard physical work of the mother before pregnancy or in the early stages.

Such risk factors may not lead to low placentation, but if they exist, then such mothers must undergo thorough examinations and prevent these problems.

Pathogenesis

The pathogenesis of the development of such a problem in such diseases lies in the disruption of the structure of the endometrium under the influence of prolonged inflammation. If we are talking about chronic infections or acute endometritis, then inflammatory cells constantly support the pathological focus. In response to such intervention, the synthesis of connective tissue may be activated, which can cause disruption of the structure of the endometrium. As a result, the fertilized egg cannot implant in the fundus area, since the connective tissue does not allow it to penetrate deep into the endometrium. Therefore, the embryo looks for a place where blood circulation is a little better and can implant lower, where the placenta will later develop. Thus, inflammatory processes in the uterus contribute to low placentation.

Symptoms of low placentation during pregnancy

The first signs of low placentation may appear only in the third trimester, when the size of the fetus is such that the placenta may peel off slightly. Then there may only be symptoms, or there may not be any changes until the birth itself.

Low placentation in the early stages of pregnancy does not appear if the woman does not have any heavy loads. At the same time, the child develops normally, he has sufficient blood circulation and nutrition. As a child's weight increases, his needs also increase. It can move more actively, and if a woman makes some sudden movement or lifts something, this can disrupt the connection between the placenta and the endometrium. Then the first symptoms may appear.

Manifestations of low placentation are often blood discharge from the vagina. This can happen at any stage, but more often in the second half of pregnancy. Such spotting appears after active walking or physical activity. The discharge is not accompanied by increased uterine tone or pain in the lower abdomen. Apart from such minor discharge, a woman may not be bothered by anything else. Blood appears due to the fact that if the placenta is located low, then under a certain load it can peel off and blood is released. Its quantity may be small, as well as small area detachment, so the discharge may stop on its own. But even in this case, you need to see a doctor.

If the detachment is significant, then severe bleeding occurs. This may cause dizziness, fatigue, headache, or fainting. This is due to severe blood loss.

Low placentation during pregnancy along the posterior wall is more dangerous, since complications occur more often. In this case, the bleeding may be internal and there may be no external signs. Blood may accumulate outside the area of placental abruption and may not be released due to compression by the fetus. Therefore, there may not be any bleeding. But due to the accumulation of blood, there may be a feeling of pressure in the lower abdomen or slight pain. It is not expressed, but is constant and intensifies over time.

Symptoms of low placentation during pregnancy may not appear at all until the period of childbirth. Already during childbirth, during contractions, there may be a slight detachment of the placenta, since it is located low and the fetus can move under the influence of contractions. Then minor bleeding may occur, which requires immediate response from doctors.

Complications and consequences

Low placentation during pregnancy with twins is common, since both placentas cannot attach correctly, they simply do not have enough space. In this case, complications occur less frequently, since compression of the uterus on all sides by two fetuses does not allow the placenta to detach. Only during childbirth can the first symptoms appear, when one fetus has already come out and pulled the other placenta.

Bleeding with low placentation during pregnancy is the most common symptom, so you should pay attention to this regardless of the period.

Complications that can develop against the background of low placentation and which are the most threatening are placental abruption. As a child grows, its size also increases. Such a fetus can actively move and with sudden movements, especially against the background of a short umbilical cord, the placenta may detach, since in this place it is not tightly attached to the endometrium. This is accompanied by bleeding, which threatens termination of pregnancy. Sometimes there may be no external bleeding, and then the blood accumulates behind the uterine cavity. This leads to the formation of a hematoma and before our eyes the woman’s condition worsens, and the cause is difficult to determine. The consequence of such a hematoma may be the formation of a Kuveler uterus, when blood seeps into all layers of the uterus and such myometrium can no longer contract. This risks major bleeding, so the only treatment is to remove the uterus.

Diagnosis of low placentation during pregnancy

Diagnosis of low placentation during pregnancy can be final only in the second trimester, when the formation of the placenta is completely completed. At the same time, it is important to know about the concept of the significance of this pathology. A woman can have low placentation throughout her entire pregnancy, but it does not cause any symptoms and the birth goes well. And vice versa - low placentation can cause bleeding already in the first half of pregnancy, then this is considered a significant diagnosis. Therefore, if such a pathology is established in the first half, then you just need to know that it exists and prevent complications. After all, there may be no symptoms until the end of pregnancy. And if the diagnosis is established already when bleeding or other symptoms appear, then we need to talk about treatment. Therefore, the timing of diagnosis is not as important as the symptoms of the pathology.

Anyway, routine examinations pregnant woman can detect pathology in time. Therefore, if you do not deviate from the normal management of pregnancy, then no special examinations are required.

If a woman has complaints in the form of bloody discharge, then you need to carefully examine the woman on a chair or couch. Under normal conditions, palpation fails to reach the edge of the placenta through the internal os. If upon palpation a small part of the placenta is detected, then low placentation or presentation can already be suspected. With low placentation, the tone of the uterus is not increased and there is no pain on palpation.

The tests that need to be performed are not specific. Since the placenta is located low, there is a risk of infection. Therefore, it is important to conduct a study of vaginal secretions with the exception of the inflammatory process of the vagina or uterus.

Differential diagnosis

Instrumental diagnosis of pathology is also very important for the purpose of differential diagnosis. The main method for diagnosing this pathology is ultrasound. This method allows you to clarify how the placenta is located, what is the distance from the internal os, and whether there is a presentation. Ultrasound can also be used to study blood circulation in the placenta. If there is a suspicion of a retroplacental hematoma, then an ultrasound will visualize a focus of increased echogenicity in the area of placental abruption.

After the thirtieth week, for a more accurate diagnosis of the fetal condition, cardiotocography should be performed. This is a method that allows you to diagnose fetal movements, heart rate, and uterine tone. This allows you to exclude premature birth as the cause of bleeding.

Differential diagnosis of low placentation on early should be carried out primarily with the threat of termination of pregnancy. These pathologies are accompanied by identical blood discharge from the vagina. But unlike low placentation, the threat is also accompanied by nagging pain in the lower abdomen and increased tone of the uterus. This occurs because the uterus contracts in an attempt to expel the fetus. With low placentation, both uterine tone and pain are not expressed. At a later stage and directly during childbirth, low placentation should be differentiated from complete or partial placenta previa. During palpation with complete presentation, the internal os will be completely covered by the placenta, while low placentation is accompanied by only slight palpation of the placental tissue. The most accurate way to differentiate these pathologies is with ultrasound.

Diagnosis of low placentation should be using ultrasound, and not when symptoms appear. Only in this case can complications be avoided by warning the woman and prevention.

Treatment of low placentation during pregnancy

Active treatment of such a pathology can be used if symptoms are severe or there is evidence of bleeding. Then they use medications that are aimed at stopping bleeding, improving uteroplacental circulation and maintaining pregnancy. Women with this diagnosis definitely need a gentle regime, it is necessary to avoid exertion and long walks.

Sometimes low placentation later can cause placental abruption, then the tone of the uterus may increase and this requires the use of tocolytic drugs in the acute period. Further, when the condition normalizes, women are prescribed drugs that improve the rheological properties of the blood and normalize uterine circulation. But it should be taken into account that such active tactics can be used only with severe symptoms; if clinically low placentation does not manifest itself, then external intervention is not required.

Ipradol is a drug from the group of selective sympathomimetics, which acts by binding to uterine receptors and leads to relaxation of muscle fibers. Therefore, the drug is used for low placentation, which is complicated by the threat of miscarriage and is accompanied by increased uterine tone and rhythmic contractions. The method of administration of the drug is intravenous, which allows you to quickly achieve the effect. Dosage – 10 micrograms of the drug should be administered slowly, and then switch to infusion use. Side effects- palpitations, heart rhythm disturbances, headache, feeling of heat, increased blood pressure, tremor, diarrhea. Precautions - the medicine should not be used during pregnancy earlier than 22 weeks.

Against the background of active tocolytic therapy, hemostatic therapy can be carried out in parallel if bleeding is severe.

Tranexamic acid is a drug for systemic hemostasis that acts by inhibiting fibrinolysis and is widely used in gynecology. The drug can be used to treat complications with low placentation, including the formation of retroplacental hematoma. The method of administration of the drug is intravenous drip. Dosage of 100 milliliters of solution during the first hour, and then under the control of the condition and blood test. Side effects of tranexamic acid are heart rhythm disturbances, headache, tinnitus, thrombosis, nasal congestion, dizziness, convulsions. Precautions - if there is bleeding in the urine, use the drug with caution, as this may cause further anuria.

If a woman with low placentation has had minor bleeding, but the tone of the uterus and the condition of the child are not disturbed, then a small hematoma may form, which will resolve over time. But it can be a source of infection, since blood is a good breeding ground for pathogenic microorganisms. Therefore, after this, the majority is inclined to take an antibacterial agent, which is not dangerous to the fetus. This not only prevents infection, but also acts on microorganisms that can multiply during this period of the disease. The group of cephalosporin antibiotics is considered the most suitable for use by pregnant women.

Ceftibuten– beta-lactam antibiotic of the 3rd generation, especially effective against gram-positive and gram-negative flora. The drug has a bactericidal effect on possible anaerobic pathogens of infection, therefore it can be used with for preventive purposes in gynecology. The dosage of the drug is 200 milligrams twice a day, taking into account prophylactic administration, for at least five days. Side effects are possible if they affect the stomach - colitis or dysbacteriosis develops, which is manifested by bloating and stool disturbances. Precautionary measures - do not use the drug if you are allergic to penicillin antibiotics, as well as with congenital enzymopathies.

Usage vitamin products in the treatment of low placentation is very important, since in this case there is often a violation of blood flow in the umbilical cord and placenta. Therefore, the use of vitamins that contain magnesium and ascorbic acid helps improve blood circulation in the uterus and placenta, which reduces the effect of insufficient oxygen on the child’s brain.

Actovegin– a drug that is most often used for the prevention and treatment of uteroplacental insufficiency. This drug is a derivative of various amino acids, which in human tissues normalize cellular respiration and improve oxygen absorption. The drug is used in ampoules. For the administration and complex treatment of placentation anomalies, a dosage of 10 milliliters per day is recommended. The method of application is intramuscular. Side effects can occur in the form of severe allergic reactions to a foreign protein. Precautions - the drug for injection can only be dissolved in saline or glucose; the drug is not used with other solvents. It is imperative to conduct a sensitivity test before using the medicine, as it is allergenic.

The use of other medications may only be symptomatic. There is no etiological therapy for low placentation, since the drugs cannot affect the location of the placenta itself.

Physiotherapeutic treatment, given pregnancy, is also not recommended, since it is difficult to predict the reaction of the child and placenta to such intervention. Therefore, in the acute period, thermal and radiation procedures are not used.

Alternative treatment for low placentation

Traditional methods of treating low placentation can be used very widely. Such methods can be used even if there are no manifestations of the diagnosis to prevent complications. For this purpose, you can use herbs and infusions that improve uteroplacental blood circulation, because often the child may lack nutrients. In order to prevent detachment and the threat of premature birth, agents are used that reduce tone and sympathetic activity. Therefore, you can drink herbal infusions and be treated with folk remedies throughout pregnancy right up to childbirth.

Juice from carrots, apples and beets is very useful to take with low placentation to normalize the structure of the vascular walls and improve blood circulation, unless of course there are allergies. To prepare juice you need to squeeze out half a liter apple juice, add one glass of grated carrot juice and a glass of beet juice, mix everything thoroughly and add honey before use. Dosage – half a glass of juice is taken in the morning and evening.
Tea made from ginger, lemon juice and raspberry branches is very useful for improving uterine trophism and preventing infectious complications. It tones the body of a pregnant woman well, has a calming effect and invigorates in the morning. You can take about two liters per day, of course, if there is no edema or hypertension. To do this, you need to brew tea from raspberry branches, boiling them for several minutes, and then pour the tea into a cup and add ten grams of ginger and the juice of a quarter of a lemon. You should drink this tea instead of plain water several times a day, then you can lie down for a while with your legs raised on a hill to improve blood flow to the uterus.
To prevent ascending infection, it is very good to use a herbal solution for washing. To do this, you need to take oak bark and string grass, steam it, and wash it with warm grass every day.

Herbal treatment is used very often, since many herbs have a good effect on the tone of the uterus, local blood circulation and the condition of the fetus, while they also have a systemic effect with sedation of the body.

St. John's wort is a plant that normalizes the vascular tone of the placenta and improves blood circulation in the uterus, regulating nerve conduction. To prepare medicinal tea, you need to take 50 grams of St. John's wort herb, boil it over low heat for five to ten minutes and then strain. You need to drink this tea three times a day, a teaspoon at a time, until the thirty-seventh week.
Infusions of stinging nettle are especially effective in preventing complications of low placentation and the appearance of exfoliation. To prepare medicinal tea, you need to take ten grams of the herb, add half a liter of water, and then after it has steeped for twenty minutes, strain and drink. Dosage – about a liter of tea should be drunk per day, monitoring other liquids in case of swelling.
Calendula tincture is an excellent tocolytic agent, and in addition it also has properties to reduce the activity of bleeding in the presence of retroplacental hematoma. To prepare medicinal tea, you need to take the flowers and fruits of calendula, add half a liter of water, and then after it has steeped for twenty minutes, strain and drink. In the acute period, you can drink up to half a liter of tincture per day, and then you can drink a prophylactic dose of a tablespoon twice a day.
You need to take 100 grams of dry dandelion and plantain herbs, make tea from a liter of water and drink a tablespoon three times a day. The course of treatment is four weeks. This is an excellent tool for normalizing fetal trophism, as it dilates blood vessels and activates the supply of oxygen and nutrients to the fetus.

Homeopathy is used to treat low placentation as widely as traditional methods treatment. And the main advantage of such methods is the possibility of their long-term use.

Arnica is homeopathic remedies o, which consists of herbal preparations that are more effective in patients with low placentation, which is manifested by bleeding after a mechanical shock. The method of using the drug is one drop every two hours on the first and second days after the onset of symptoms, and then one drop three times a day, under control of the heartbeat - if tachycardia appears, the dose can be reduced. No side effects were identified. Precautionary measures - do not take if you are allergic to linden pollen.
Zincum valerianicum is an inorganic homeopathic medicine. Used to treat low placentation, which is accompanied by nagging pain in the lower abdomen. This drug may prevent detachment if it is started before any symptoms appear at initial diagnosis. The method of use of the drug depends on the form. The dosage when taking drops is one drop per ten kilograms of body weight, and when taking capsules - two capsules three times a day. Side effects are possible in the form of hyperemia of the skin of the hands and feet, as well as a feeling of heat. Precautions - do not use simultaneously with antispasmodics.
Hamamellis is the number one remedy for low placentation or placenta previa. This is a homeopathic medicine that improves blood circulation specifically in the area of the placenta and strengthens the connection in this place, which prevents detachment. It is available in the form of drops and is used in a dosage of eight drops per dose. Directions for use: the solution should be dripped into 100 milliliters of boiled water and drunk half an hour before meals. The course of treatment can be started with a dosage of three drops twice a day, and then after a month you can increase the dose to five drops, as the duration of pregnancy increases. Side effects are rare, allergic skin reactions are possible.
Hydrastis is a homeopathic remedy based on the goldenseal plant, which is very effective in maintaining pregnancy due to its action, which is similar to the natural hormone progesterone. The drug normalizes blood circulation, which even with low placentation helps to improve the trophism of the placenta. The drug is especially effective in the later stages of pregnancy with twins or anemia in the mother. The drug is available in granules and is dosed at six granules every six hours. Taking the drug before pregnancy is not recommended.

Surgical treatment of low placentation is not used, since it is impossible to change the natural placenta attachment even with any physical exercise. As for surgical intervention for low placentation, something must be said about the period of childbirth. Often, low placentation during active labor can cause minor detachment. Then, upon palpation, doctors identify a whole fetal bladder, which requires intervention. If an amniotomy is performed, the fetus descends lower along the birth canal and even with a slight detachment, compression occurs - this can stop bleeding and the formation of a hematoma. In this way, an intervention is performed - amniotomy, which can be considered a kind of invasive intervention for low placentation. In the afterbirth period, low placentation can cause complications of retained membranes, which also requires surgical intervention in the form of manual separation of the placenta.

Prevention

When talking about preventing low placentation, you must first prepare for pregnancy. If possible, the first child should be born before the age of 35, because in the future the risk of developing such a pathology increases. Any surgical intervention on the uterus can cause abnormal placentation, so pregnancy should be planned in such a way that after the operation the time necessary for the regeneration of the uterus passes. If the diagnosis has already been established, then complications need to be prevented. It is very important to lie down more, not lift weights, not lead an active lifestyle, eliminate stress and eat normally. After all, any violation of the regime can lead to detachment.

Forecast

Gestation forecast normal child with low placentation is very good, since the problem is not so great and with the right actions complications can be avoided.

Low placentation during pregnancy is not as terrible a diagnosis as it seems at first glance. This is a pathology in which the placenta is attached in an uncharacteristic place. There is a risk of circulatory disorders and fetal hypoxia, or a risk of complications during childbirth. But often the pathology does not manifest itself throughout the pregnancy and everything ends well. If there are symptoms of such a pathology, then only in this case treatment measures are applied.

Know your childhood place.
After ultrasound examination The doctor said the phrase: “The placenta is fine so far.” And now you are at a loss: “What does this mean and what could change as the baby’s due date approaches?”

Whatever you call it - the cold medical term “placenta” or more in a simple word“children’s place”, the meaning will be the same.
However, for most expectant mothers, the placenta remains a mystery – where is it located? why is it needed? and why do doctors attach such importance to it? Unfortunately, it is not always possible to ask the doctor all these questions during an appointment.

What is it?
The placenta begins to form simultaneously with the development of the fetus, and in early pregnancy it is called the chorion. The chorion (or villous membrane of the embryo) is a special outgrowth - villi, covering the entire fertilized egg. With their help, the fetus is immersed in the mucous membrane of the uterus and is fixed in it. Inside the villi there are small vessels in which the fetal blood flows; on the outside the villi are washed with the mother’s blood. This is how metabolism occurs: oxygen, nutrients and other substances necessary for the growth and development of the fetus penetrate from the mother’s blood into the blood of the fetus, and carbon dioxide and metabolic products enter the mother’s blood, which must be removed from the baby’s body. By the second month of pregnancy, the placenta is formed. It consists of a modified uterine mucosa and greatly expanded chorionic villi. As the fetus grows, the number of villi increases, which increases the contact surface between the maternal and fetal bloodstreams. This means more intensive exchange between them. During full-term pregnancy, this surface exceeds the surface of the adult human body. The surface area of all villi during full-term pregnancy is about 14 square meters. m, and the length of the fibers, if folded longitudinally, reaches as much as 50 km. By appearance the placenta looks like a round, thick, soft cake with a diameter of 15-18 cm and a weight of 500-600 grams. It has two surfaces: the fetal surface is smooth, covered with an aqueous membrane, under which there are vessels diverging from the place of attachment of the umbilical cord to the periphery of the placenta, the maternal surface is adjacent to the wall of the uterus, divided into lobules in which blood vessels pass.

What is it for?
The placenta is a real laboratory. It processes nutrients coming from the mother’s blood: it builds fetal proteins, synthesizes and breaks down fats and carbohydrates necessary for the baby’s life, and removes carbon dioxide and other metabolic products from the baby’s body. Being also a powerful endocrine organ, the placenta performs the function of various endocrine glands; it synthesizes hormones that support the course of pregnancy and ensure the development of the fetus. So the role of the placenta is very important; in fact, this organ performs the functions of the lungs, digestive organs, kidneys, and skin.

Important location.
Typically, the baby's place is formed in the body of the uterus and occupies the anterior or posterior wall of the uterus closer to its bottom. Here are the most favorable conditions for fixation of the placenta and the formation of uteroplacental blood flow. Sometimes, and this is associated with previous abortions, inflammatory diseases of the uterus, underdevelopment of the genital organs, the placenta forms in the area of the internal opening of the cervical canal, blocking it, which is called placenta previa. The most serious complication encountered with this pathology is bleeding. Uterine contractions occur not only during childbirth, but also occur throughout pregnancy; they are simply weak and the woman does not feel them. The placenta does not have the ability to contract, so the walls of the uterus and placenta shift relative to each other. The placental villi are separated from the walls of the uterus, the integrity of the blood vessels is disrupted, and bleeding begins. It can stop on its own (if the detachment was small and the contractions stop), but there can also be massive bleeding that threatens the life of the mother and fetus. This complication most often develops in the third trimester of pregnancy or childbirth, but can also occur in the early stages. Therefore, if you have been diagnosed with placenta previa, be prepared that a few weeks before giving birth you will be hospitalized in the pregnancy pathology department of the maternity hospital. Unfortunately, childbirth naturally are impossible, since dilatation of the cervix will cause total placental abruption. Therefore, at a time close to childbirth, a caesarean section is performed. If the placenta is located at the junction of the uterine body and its cervix (isthmus or lower segment of the uterus), then they speak of low placentation. In this case, the baby's place does not cover the internal pharynx, but is simply located very close to it (5 cm in the second trimester and below 7 cm in the third). During uterine contractions or during childbirth, when the cervix dilates, placental abruption can also occur. In addition, the isthmus region is physiologically completely unsuitable for securing the placenta there. Fewer blood vessels pass through here and, accordingly, a full utero-fetal circulation cannot be formed. As a result, the fetus suffers, it develops hypoxia and developmental delay syndrome may occur.

Rise!
Fortunately, the placenta has the ability to “rise.” The growing uterus pulls the placenta along with it, so in most cases low placentation “corrects” by the end of pregnancy. If everything is in order, then the rate of movement of the placenta is approximately 2-4 cm per month. However, if, according to research results, this figure is higher, then this is an alarming sign indicating a threat of interruption. If you have a previa or low placenta, then you better:

– somewhat reduce your physical activity (however, you should not go to bed for the entire duration of pregnancy and carry yourself around like a crystal vase; a long absence of average physical activity leads to delayed fetal development);
– during rest and sleep, place your feet on an elevation - this position helps to raise the placenta.

If the slightest alarming signs appear (pain in the lower abdomen, bleeding from the genital tract), consult a doctor immediately. If this happens in the evening or at night, call an ambulance. You may have to go to the hospital, do not refuse - in the maternity hospital they will create the most optimal regime and conditions for monitoring your health, prescribe medications that stop bleeding, relieve uterine tone and normalize placental blood flow. In general, in such a situation it is better to play it safe.
Sometimes detachment of a normally located placenta also occurs. It occurs with increased permeability and fragility of blood vessels, which occurs with toxicosis of the first and second half of pregnancy, increased blood pressure, hormonal imbalance, and diseases of internal organs. If the area of detachment is insignificant, then this does not in any way affect the well-being of the expectant mother. The diagnosis is made only after childbirth, when, when examining the separated placenta, doctors discover an area of hemorrhage.
With more severe abruption, you may feel minor pain in the abdomen, mainly on the side where the placenta was detached. Bloody discharge does not always occur; this symptom depends on the size and location of the detachment: if it is on the edge, there will be bloody discharge, but if only in the center, then even with a large area of damage there may not be bloody discharge. At the slightest suspicion of placental abruption, urgent hospitalization is necessary, since this condition is dangerous for both the life of the mother and the fetus.

Mature or not?
The placenta begins to form simultaneously with the development of the fetus. And just like it, it grows and develops - it increases in size, its villi and vessels grow, and lobules form. Each stage of pregnancy corresponds to a certain structure, which is called the degree of maturity of the placenta. This parameter is assessed based on ultrasound results.
There are four degrees of placental maturity (0, I, II, III, IV). If the examination reveals that the degree of maturity of the placenta is older than the gestational age, then they speak of premature aging of the placenta. The appearance of degree P maturity before 32 weeks of pregnancy and stage III maturity before 36 weeks is considered premature. If you have been diagnosed with this, this does not mean that complications may arise; you just need to check the condition of the uteroplacental blood flow. As a rule, the doctor receives reliable information after performing Doppler sonography (an option for ultrasound).
Poor circulation leads to the development of degenerative changes in the placenta, which entails its premature aging. In this case, the fetus experiences hypoxia and developmental delay syndrome. Typically, this pathology occurs with toxicosis in the second half of pregnancy, as well as chronic diseases of the mother. Of course, it will not be possible to rejuvenate the placenta with the help of drug correction, but it is possible to restore normal blood circulation, stop the aging process and minimize the baby’s suffering.
In case of severe toxicosis in the second half of pregnancy, a pronounced disturbance of blood circulation in the placenta occurs, up to the death of the villi, which leads to the development of placental infarctions. Sometimes heart attacks reach significant sizes and penetrate the entire thickness of the placenta. Small heart attacks do not have a significant effect on the growth and development of the fetus, but large ones can lead to serious complications. Such changes in the placenta can be excluded or, conversely, confirmed using a conventional ultrasound examination.
In case of Rh-conflict pregnancy, diabetes mellitus in the mother, intrauterine infection, the size and weight of the placenta significantly exceed normal indicators due to swelling of its structures, premature aging and a slowdown in the speed of blood flow in the placental vessels are noted.

Tricky slices.
Sometimes additional lobules are found in the placenta. They are located at some distance from it and are connected to the placenta by vessels. The presence of additional lobules does not affect the condition of the fetus in any way. But during childbirth, they may not separate along with the placenta, but linger in the uterus and cause bleeding. In order to prevent this situation, after the separation of the baby's place, doctors carefully examine it and, if a defect in the placenta is detected, they perform a manual examination of the walls of the uterus to remove the insidious lobule. The condition of the placenta is assessed using ultrasound results. If everything is in order, then the study is usually carried out at 14, 24, 36 weeks (of course, the dates are approximate) and on the eve of birth. If any deviation is detected, the ultrasound is repeated after 1-2 weeks.
So, now it has become clear why the placenta is needed, what important role it plays and why doctors are so worried if deviations in its work are detected.

The placenta is considered the main organ for the fetus from the moment of conception to birth. She grows with the baby, performing the most important functions for development and life. The proper nutrition of the fetus and the success of future births depend on the location of this organ during gestation.

What does low placenta mean?

What does low location of the embryonic organ mean? The placenta begins to form in the early stages of pregnancy, completing its formation by 12-16 weeks of gestation.

When the baby's place takes the correct position - high on the anterior or posterior uterine wall, it does not interfere with the normal movement of the baby along the birth canal at birth. If it is fixed at the bottom, approaching the cervix, and the distance between the pharynx and the embryonic organ is less than 6 cm, unpleasant consequences may develop.

During pregnancy expectant mother must do an ultrasound procedure three times:

From 11 to 14-15 weeks of gestation.
In the second trimester from 18 to 21-22 weeks.
At 30-34 weeks of term.

With the help of the study, the location of the embryonic organ is determined and it is decided whether the woman herself can give birth to a child. When diagnosed with low-lying placenta, do not panic.

The baby's place is able to move upward, away from the internal os due to the enlargement of the uterus. The main migration period is considered to be up to 24 weeks. Closer to childbirth, in most pregnant women, low placentation changes to a high location - 5-6 cm from the cervix. Only 5% of patients remain diagnosed after 32 weeks of gestation.

Causes of pathology

The location of the child's place largely depends on the internal factors of the expectant mother. If a pregnant woman has any diseases or abnormalities of the reproductive system, low placentation is a common occurrence in such women.

Let us consider in detail what exactly the causes of the disease are:

Surgical intervention on the uterus. Previous operations on the organ (curettage, cesarean section, removal of fibroids with partial resection of the myometrium) are the main cause of the disease. They lead to the fact that it is impossible to attach a child’s place to the damaged mucosa of the upper segment of the organ.
Inflammatory diseases internal genital organs of a pregnant woman.
Congenital anomalies of the uterus: bicornuate or unicornuate uterus, hypoplasia. Such defects do not allow the fertilized egg to attach correctly, so it is implanted below normal. This is where the children's place is formed.
Gynecological pathology. Uterine fibroids develop as a node in the thickness of the myometrium, preventing the fertilized egg from implanting in this place. With endometritis, the internal functional membrane is damaged, which disrupts normal placentation. The embryo has to penetrate too low into the endometrium, where a baby's place is formed.
Woman's age. When expectant mother becomes pregnant for the first time after 35 years, uterine circulation is disrupted, which prevents normal placentation.
Leading an incorrect lifestyle. Alcohol abuse, active smoking, poor nutrition also contribute to the deterioration of uterine blood flow, which is why the baby's place is not fixed in the fundus of the uterus, remaining below, at the internal os.
Multiple pregnancy.

Possible consequences

Low placentation is by no means a harmless condition. Under certain conditions, it can lead to serious complications, including the death of a baby or woman.

Threats to the mother

The most unfavorable consequence is placental abruption. The disease threatens a pregnant woman in several ways.

A small separation of a child's place: the pathological process may be without pain, but with the appearance of bleeding. When blood accumulates inside the uterine cavity, the woman has no spotting. Severations of a child's place are prone to recurrence: their number increases with the formation of a threat to the development of the fetus. A pregnant woman develops anemia, accompanied by a feeling of fatigue, headache, and a feeling of lack of air.

Peeling off of a large fragment of an embryonic organ entails heavy bleeding in the expectant mother, which can lead to death if treatment is not provided in time. medical care. Blood begins to accumulate inside the uterine cavity, its layers become saturated with contents that penetrate the peritoneum. This pathology is called Couveler's uterus. Due to the serious threat to the life of the expectant mother, a cesarean section must be immediately performed to remove this organ.

Threats to the baby

At a period of 19-20 weeks, a low location of the placenta threatens the baby with the development of oxygen starvation. The fetus grows, increases in size, and its pressure on the uterine cavity increases, compressing the blood vessels of the placenta and disrupting blood flow. The cervix is anatomically poorly supplied with blood compared to the fundus.

Incorrect position of the child's seat leads to hypoxia in a child with intrauterine growth retardation. In addition, when the baby makes active movements, damage to the child's place is possible. Low placentation threatens complications during childbirth: this position prevents the baby from leaving the womb.

When implantation of the embryo is disrupted, a concomitant disease appears, such as the marginal location of the placenta. With this pathology, the embryonic organ is localized less than 2 cm from the internal os. This can lead to complications during childbirth with the death of the child.

Detachment of an embryonic organ threatens disruption of intrauterine development or even death of the fetus. This is due to the fact that the separated placenta does not take part in the nutrition and protection of the child. At an early stage, the consequences are minimal, but with total detachment, acute hypoxia occurs, followed by the death of the baby.

Features of childbirth with a low placenta

How exactly a woman with such a disease will give birth is decided by the attending physician. At 37-38 weeks of gestation, the pregnant woman is hospitalized in the pathology department so that she is under constant supervision.

Before it starts labor activity, the child's seat can rise to the permissible distance. In this case, natural childbirth is possible. If this does not happen, low placentation leads to overstrain of the blood vessels with their subsequent rupture with premature placental abruption. That is why its low position at 38 weeks is an indication for a cesarean section.

The doctor may choose to puncture the membranes so that the placenta is secured by the baby's head. Specialists perform this delivery in the operating room so that, if necessary, a caesarean section is performed.

How to cure the disease

Having learned the diagnosis, you should not worry and try to figure out the question on your own: “What to do with a low-lying placenta?” If pathology is detected at 13 weeks, the doctor recommends following simple steps that help normalize the condition and prevent the development of complications.

What needs to be done - let's figure it out:

Be sure to wear a bandage.
Refuse any physical activity. Replace them with slow walks in the fresh air.
Try not to climb stairs.
Do not carry heavy objects under any circumstances.
Eat nutritiously and regularly.
Avoid sexual intercourse for a while.
Minimize travel on public transport.
Avoid any sudden movements.
Do not sit cross-legged.
Try to avoid stressful situations.
Place a bolster or pillow under your feet so that your limbs are positioned higher than your body. This stimulates the placenta to move to its normal position.
Do not perform any intravaginal procedures (for example, douching).
If your doctor recommends hospitalization, be sure to follow the instructions.

Any deviation from the norm heard by the expectant mother at a doctor’s appointment or during an examination causes alarm. Low placentation is no exception. How dangerous is this condition and how to prevent it? negative consequences, let's take a closer look.

Normal location of the placenta and low placentation

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

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

Low placentation and placenta previa

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

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

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

Symptoms of low placentation

The greater the distance from the placenta to the uterine os, the less likely it is that any symptoms of low placentation will appear. When the baby's place drops low, even to the point of presentation, signs similar to the symptoms of miscarriage appear:

pulling pain in the abdomen;
lower back pain;
blood discharge is red or brown.

If abdominal pain can be safe and indicate a sprain, then bleeding is a very dangerous symptom, which requires immediate consultation with a specialist managing the pregnancy or an emergency doctor.

Causes of low placenta

Today, medicine does not give an exact answer to the question about the causes of low placentation. No one knows why an egg implants in a particular place in the uterus. But factors have been identified that influence the fact that the embryo will not be located in its usual place:

inflammatory diseases suffered previously;
surgical interventions, in particular a history of abortion;
endometriosis;
presence of scars on the uterus;
myoma;
anatomical defects in the structure of the uterus (curved, bicornuate uterus, etc.);
vascular pathologies in the pelvic organs.

Risks and impact of low placentation on pregnancy

Low placentation can lead to placental abruption in severe cases.

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

Since the growing fetus puts pressure on the uterus, it begins to “oppress” the baby’s place. And this is fraught with uterine bleeding and, in extreme cases, placental abruption.
Nature has designed it so that the blood supply to the bottom of the uterus is better than from below. Thus, the fetus, attached to its lower part, risks not receiving vital nutrients and oxygen.

At the same time, it must be remembered that this diagnosis is not final. After all, a baby’s place can change its location several times during pregnancy. This process is called “placental migration”.

Migration in most cases corrects improper attachment of the fetus

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

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

Diagnosis of low placentation

Ultrasound will reliably reveal the fact of anomalies in the location of the placenta

The location of the placenta is determined by ultrasound diagnostics. Also, based on the results of ultrasound and Doppler, the doctor will be able to determine whether there is a shortage useful substances(according to the size of the fetus and its correspondence to age) and oxygen (according to the assessment of blood flow during Dopplerometry).

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

Timing for the establishment of low placentation and placental migration

As a rule, ultrasound shows low placentation at 20–22 weeks, during the second routine screening. From this moment on, the woman must adhere to a protective regime. Doctors wait until the 36th week to change the location of the placenta. Only after this period is the condition of “low placentation” taken into account by the doctor who will deliver the baby in the future.

Treatment of low placentation and features of the protective regime

As soon as the expectant mother learns about this diagnosis, the first questions she asks the doctor are whether it can be cured and whether the regimen needs to be changed. Let us consider these aspects in more detail.

Treatment of low placentation

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

Security mode

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

The protective regime includes the following measures:

Limit physical activity. It is necessary to cancel all sports activities. Only slow walking is allowed.
Do not make sudden movements. The placenta, which is already under pressure, may not withstand the jerk, and then detachment will begin.
Minimize travel, especially on public transport. Stress, shocks and sudden movements are something that is extremely undesirable with low placentation.
Raise your legs while sitting. A slight elevation of the legs will increase blood circulation and help prevent fetal hypoxia.
Strictly limit the weight of items picked up. Lifting weights is a very common cause of uterine bleeding. The maximum permitted weight is 2 kg.
Rise from a lying position without jerking, using your arms and, if possible, not using your abdominal muscles.

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

The second advice the doctor gave me concerned the universal static exercise - the knee-elbow pose. It is universal in that it will be useful both in case of increased tone of the uterus, and in case of pathology of the location of the placenta, and even in the case of abnormal position of the fetus.

Unique this exercise for several reasons:

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

I performed this exercise 3-4 times a day for 15 minutes. After this, I had to lie down for 30–40 minutes.

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

Photo gallery: features of the protective regime

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

Sex with low placentation

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

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

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

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

Childbirth with a low-lying placenta

If by the end of pregnancy the placenta still has not changed location and the diagnosis of “low placentation” remains, the doctor will carefully consider the associated factors.

Low placentation: what threatens it, preventive measures, delivery

The placenta is low-lying - this diagnosis is heard in hundreds of women in the second trimester. This pathology can be very dangerous in some cases, but in others it goes away without any treatment and does not cause problems. Let's figure out what the placenta is, what its normal and pathological location is, what the pathology threatens and how to avoid problems.

The placenta is a temporary organ with the help of which the mother’s body transfers to the child’s body the substances necessary for life, removes everything unnecessary and provides oxygen. In addition, the placenta produces hormones necessary for the progression of pregnancy and protects against infections. Normally, the placenta begins to develop at a distance of at least 6 cm from the internal os of the uterus (inner part of the cervix), otherwise doctors diagnose “low placentation”, and this threatens a number of problems during gestation, such as bleeding and malpresentation of the fetus, which often lead to surgical delivery, and in severe cases, even to the death of mother and child.

Why does low placenta previa occur in a pregnant woman? This pathology is more typical for women over the age of 30 who have repeatedly given birth and had abortions. Repeated inflammatory processes and neoplasms of the uterus lead to tissue degradation, and the fertilized egg has no choice but to look for the most favorable place for development, and this may just be the internal os. The low position of the placenta has numerous causes, and every woman who cares about her health and wants to have children in the future should understand that any gynecological disease, any intervention in the uterus, can lead to such dangerous consequences in the future.

But not everything is so bad, the placenta is often low until the third trimester, but by 32 weeks it rises on its own, this is due to the growth of the uterus. According to statistics, only 5 percent of women have this pathology until childbirth. In addition, not every low location of the placenta during pregnancy, even one that persists into the last trimester, is very dangerous for the woman and child and serves as an absolute indication for cesarean section. The baby's place may not completely cover the internal pharynx, but only touch it with the edge; in such cases, an experienced doctor will be able to undertake a natural birth from a woman.

Management of pregnancy with low placentation is always very careful. The woman will have to undergo ultrasound many times, limit physical activity and stop having sex. Over a long period of time, increased uterine tone can provoke abruption of an incorrectly located placenta, resulting in bleeding, and possible fetal death as a result of acute hypoxia, if the placental abruption is large. Even a gynecological examination of the cervix can provoke bleeding, which is why doctors try not to conduct examinations on a chair without any particular reason.

Listen to your doctors and hope for the best. Many women give birth on their own or by caesarean section to healthy babies with low placenta previa.