Low location of the placenta during pregnancy, what is it? Types of abnormal placement of the placenta

– a complication of pregnancy, which is characterized by the localization of the baby’s place in the lower segment of the uterus, closer than 6 cm from its internal os. The danger is that the anomaly does not manifest itself in any way. Define low position placenta can only be obtained during an ultrasound scan or when complications develop - damage, organ detachment, accompanied by pathological signs. Treatment is carried out on an outpatient basis; a protective regime and drug therapy are indicated. In most cases, with a low-lying placenta, delivery is carried out by cesarean section.

As a rule, a low location of the placenta is detected during ultrasound screening of the first trimester, but closer to the 20th week, in approximately 70% of cases, migration of the child's place occurs, and the diagnosis is removed. By the end of pregnancy, this pathology persists in only 5% of patients. If a low location of the placenta is detected in the third trimester, the likelihood of it moving is extremely low.

Causes

Scientists have still not been able to definitively establish the reasons for the low location of the placenta. However, based on numerous studies, it has been suggested that abnormal attachment of the child’s place occurs against the background of diffuse hyperplasia of the chorionic villi and marginal death of individual elements of the decidua. Thinning of the myometrium, which has developed as a result of numerous abortions, curettage and other gynecological manipulations, can cause such changes and lead to a low location of the placenta. The risk of obstetric anomalies increases against the background of previous miscarriages, inflammatory and infectious diseases reproductive organs.

A low-lying placenta is often diagnosed after a cesarean section as a result of scar formation on the uterus. Pathology is more likely to develop during multiple pregnancies, if a woman has a history of 3 or more births, against the background of benign diseases, for example, fibroids. Congenital anomalies of the uterus, in particular, a bicornuate or saddle-shaped uterus, the presence of septa in the organ cavity, also increase the possibility of a low-lying placenta. The high-risk group includes patients prone to bad habits those exposed to stress and performing heavy physical work.

Classification

In obstetrics, two types of low placenta are diagnosed depending on the location of the embryonic organ in relation to the uterus itself. Based on this criterion, the pregnancy prognosis can also be different. The following forms of anomaly are distinguished:

Low location of the placenta back wall uterus. This is a more favorable option for the development of pathology. As the uterus increases in size, migration of the baby's place often occurs. Accordingly, space is freed up for the child, and childbirth is highly likely to occur through natural means.
Low location of the placenta on the anterior wall of the uterus. It is diagnosed quite rarely, but has an unfavorable prognosis. If, when the baby's place is localized on the back wall, it tends to move upward, then in this case, as the uterus enlarges, the placenta will “move” downward. In this case, there is a threat of partial or complete blocking of the uterine os. The anterior low location of the placenta often causes umbilical cord entanglement, fetal hypoxia, and premature placental abruption.

Symptoms of low placenta

Clinically, a low location of the placenta in most cases does not manifest itself. Typically, women feel well, and it is possible to detect abnormal attachment of the child’s place during a planned obstetric ultrasound. Low position of the placenta may be accompanied by pathological symptoms, if complications begin to develop against its background. With premature detachment, possible nagging pain in the abdomen, sacrum, bleeding. It is extremely rare that this diagnosis contributes to the development of late toxicosis. In addition, a low location of the placenta in late gestation can lead to fetal hypoxia. Oxygen deficiency is manifested by a decrease motor activity baby, fast or slow heartbeat.

Diagnosis and treatment

It is possible to identify a low location of the placenta during ultrasound screening of the 1st, 2nd or 3rd trimester of pregnancy, which is routinely prescribed by an obstetrician-gynecologist to all patients at 12, 20 and 30 weeks of pregnancy, respectively. Determining the abnormal attachment of the baby's place in the early stages is not critical, since closer to the middle of gestation it migrates and takes the correct position without risk to the health of the woman or the fetus. Ultrasound at a low location shows not only its exact location, but also its thickness, the level of blood flow in the vessels, and the condition of the fetus. Evaluation of these parameters allows us to suspect more serious complications, in particular, hypoxia, entanglement, and incipient detachment.

Treatment for low placenta depends on the gestational age, as well as the general condition of the woman and fetus. Detecting an anomaly in the first trimester does not require complementary therapy, it is enough to limit physical activity. It is highly likely that the baby's place migrates as the uterus increases in volume. Hospitalization for low-lying placenta is indicated when there is a threat of premature abruption, severe fetal hypoxia, or closer to birth in the period of 35-36 weeks to examine the patient and determine the delivery plan.

The low location of the placenta requires correction of the daily routine. The patient should rest as much as possible. It is important to completely exclude psycho-emotional and physical stress, sexual contact, as all this can provoke complications in the form of detachment. If the placenta is low, you should walk less and avoid traveling to public transport. It is recommended to rest in a lying position, while raising the leg end to increase blood flow to the pelvic organs, in particular to the uterus and placenta.

Drug treatment for low-lying placenta is not prescribed. Management of pregnancy in this case requires more careful monitoring; most likely, consultation with an obstetrician-gynecologist will be prescribed more often than usual. Correction of the condition of the patient or fetus is carried out only if there is a threat or development of complications against the background of abnormal attachment. When placental abruption begins, the use of drugs that improve blood flow in the vessels of the umbilical cord is indicated, vitamin complexes. If uterine hypertonicity is present against the background of a low placenta, tocolytics are used.

With a low location of the placenta, delivery is possible both through the vaginal genital tract and by cesarean section. The first option is possible if the baby seat is placed no lower than 5-6 cm from the internal os of the uterus, as well as good condition of the mother and fetus, sufficient maturity of the cervix and active labor activity. A planned cesarean section is performed when a low location of the placenta is accompanied by the threat of premature detachment, with severe fetal hypoxia.

Prognosis and prevention

The vast majority of pregnancies occurring with a low-lying placenta have a favorable outcome. In 70% of patients with this diagnosis, closer to childbirth, the baby's place is occupied. correct position along the anterior or posterior wall of the uterus. In other cases, timely diagnosis and prescription of a protective regime make it possible to avoid complications, carry the pregnancy to 38 weeks and give birth absolutely healthy child. In 40% of women with a low-lying placenta, birth is carried out by caesarean section. In other cases, children are born through the natural birth canal. Sometimes the fetus shows signs of intrauterine hypoxia.

Prevention of low placenta consists of early diagnosis and treatment of gynecological abnormalities that contribute to the thinning of the uterine mucosa. Women should also avoid abortions and register their pregnancy with an obstetrician-gynecologist in a timely manner. Eliminating stress will help reduce the likelihood of developing a low-lying placenta. physical activity after conception. You should also avoid working on hazardous enterprises, give up bad habits, get plenty of rest and ensure a sufficient supply of nutrients to the body of the expectant mother. Walking outside has a positive effect on the health of the woman and the fetus. fresh air. Each patient must follow all recommendations of the obstetrician-gynecologist, take necessary tests and conduct screening studies to detect a low-lying placenta as early as possible and begin therapy.

Collapse

The placenta is a temporary organ that is formed on early stages pregnancy. This is an embryonic structure that supplies the embryo with oxygen and nutrients, as well as excretory function. It also plays a protective role, protecting the fetus from infections. Most often, the baby's place is fixed in the posterior and lateral areas, but it is not uncommon for the placenta to be located along the anterior wall of the uterus. If there are no other pathological abnormalities, this situation is not dangerous for the woman and does not require additional treatment.

What does this mean?

Localization of the chorion along the anterior wall of the uterus is not a pathological deviation, but the woman requires careful medical supervision. The baby's place develops on the 7th day in the area of the uterus where the implantation of the fertilized egg occurred - in the anterior, posterior and lateral areas. However, fixation of the placenta to the posterior wall near the fundus of the uterus is considered more favorable for the woman.

With intensive growth of the fetus, the walls of the reproductive organ gradually stretch, but this process occurs unevenly. It is the anterior wall of the uterus that is subjected to the greatest load. When the muscle layer is stretched, it becomes thinner, while the density and thickness of the posterior sections change little. In addition, the anterior part is more quickly injured by impacts and movements of the child, therefore creating the threat of damage and premature detachment of the placenta.

Unlike the muscular layer of the uterus, the placenta does not have the ability to stretch, so its fixation on the dense posterior wall near the fundus of the uterus is the best option for woman.

However, there is also good news. If the chorion is attached to the anterior uterine segment, it migrates upward faster than with other fixation options.

If the placenta is 6 cm or more above the internal os of the uterus, this is considered normal and the woman should not worry. Most often, pregnancy proceeds without abnormalities, and delivery occurs safely.

Reasons for this attachment

Not all processes during pregnancy proceed smoothly; for some reason, the embryo attaches to the side or front of the reproductive organ. The mechanism of the phenomenon has not been studied in detail, but there are predisposing factors:

Injuries to the walls of the organ;
Presence of scars and adhesions;
Endometriosis;
The presence of myomatous nodes;
Delayed development of the fertilized egg.

Most often, the placenta is located along the anterior wall of the uterus when the integrity of its internal walls is violated. This happens after numerous curettages, abortions, and caesarean sections. The structure of the endometrium is influenced by inflammatory processes and endometriosis.

Such attachment of the chorion is rarely detected in primiparous women; most often it is found during subsequent pregnancies. This is explained by changes in the internal walls of the reproductive organ during childbirth.

Sometimes the fertilized egg develops more slowly than necessary. Because of this, the embryo does not have time to penetrate the wall of the uterus in time and is attached to the front or lower part of it.

The localization of the embryo in one or another part of the uterus means that at the time of implantation of the embryo there was the best mucous membrane. That is, in this segment there was good blood supply and sufficient thickness.

How does localization affect bearing a child?

Many doctors consider the location of the placenta to be along the anterior wall of the uterus normal occurrence. For the course of pregnancy and childbirth, it does not matter whether the baby’s place is located on the front or back wall. Another parameter is much more important - the height of the child’s seat from the os of the uterus. Low fastening is dangerous due to the development of presentation and spontaneous miscarriage fetus

Possible complications of the anterior attachment of the placenta to the uterus

During a screening examination of pregnant women, the location of the placenta must be determined. This allows you to take into account all the risks and prevent pathology in time. Despite the fact that the fetus is attached to the anterior wall of the uterus, this does not necessarily affect the course of pregnancy. It can proceed without complications and end in a successful delivery. However, certain dangers still exist.

The risk of placental abruption increases. The growing fetus puts pressure on the uterine wall and pushes intensely, and the force of the movements increases in proportion to the duration of pregnancy. Closer to childbirth, so-called training contractions occur, during which the uterus contracts. The baby's place cannot follow its contractions, so the danger of detachment increases. If the placenta is attached high, the uterine wall has no scars, then the woman is not in danger.
Fetal hypoxia. The location along the anterior uterine wall can impede the supply of nutrients to the baby, this is dangerous for development placental insufficiency and gestosis. Pathology develops with low placentation, when the grown fetus compresses the blood vessels. As a result, blood circulation and metabolism between mother and child are disrupted.
Placenta previa. The most favorable situation is to place the chorion at the back, since as the uterus grows it moves upward. Anterior fixation creates certain problems. If for some reason the embryo is attached too close to the internal os, then as the size of the uterus increases, the baby's place may slide down. At the same time, it completely or partially closes the exit of the uterus. In the case of complete presentation, the birth of the child cannot proceed naturally, there is a risk of bleeding and miscarriage.
The risk of tight attachment and ingrowth of the embryonic structure increases. Existing scars interfere with normal fixation of the chorion. However, the pathology is quite rare and for its development there must be certain conditions:

The afterbirth is located in front;
There are cicatricial changes in the lining of the uterus;
Low mounting of the child seat.

Placenta accretion to the uterine wall is possible in the presence of all 3 factors.

Presentation is dangerous due to placental abruption, bleeding and miscarriage.

How is the location of the placenta determined?

The location of the baby's place is determined during a routine ultrasound. In the absence of any pregnancy pathologies, characteristic symptoms are not observed, and the woman’s well-being does not suffer.

There are some things to consider during pregnancy:

Fetal movement is felt weaker, sometimes later due date;
When listening to the baby's heartbeat, the sound will be duller and more distant;
The size of the abdomen is slightly increased;
Squeezing the abdomen and any injuries to it create a greater danger than when the placenta is located behind.

If there is an anterior presentation, it is determined by the doctor during a gynecological examination.

The anterior position of the child's seat is not a pathological deviation; many doctors consider the situation to be completely normal. If a woman does not have gynecological diseases(fibroids, cysts on the uterus) and cicatricial changes in the myometrium, then pregnancy proceeds without pathology and ends in term birth. Since the situation is accompanied by certain risks, the woman needs careful medical supervision.

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The placenta is one of several temporary organs that develop in a woman's body during pregnancy. The importance of the placenta in the development of the fetus is difficult to overestimate: it is an intermediary between the child and his mother, transfers nutrients and oxygen from the mother’s blood to the baby, removes toxins and waste products from the fetus, filters the mother’s blood from harmful substances and infections, thereby protecting the baby, whose immunity is not yet able to withstand the effects of the external environment.

Considering all this, it is easy to understand why doctors monitor the condition of the placenta, its location, and so on so closely.

The placenta is formed only by the 4th month of pregnancy. Before this, its functions are distributed among other temporary organs: the fetal membrane and yellow body, formed at the site of a burst follicle. For the development of the baby, it is very important that the placenta is formed correctly, and even its location is of great importance for the proper course of pregnancy.

What are the features of the location of the placenta, and how does it affect the course of pregnancy?

The most ideal option The location of the placenta in the uterine cavity is its attachment along the posterior wall in the upper part of the uterus, closer to the bottom. The fact is that the walls of the uterus are designed in such a way that as the fetus grows, they stretch very much. However, they do not stretch evenly.

The uterus is designed in such a way that stretching occurs mostly along anterior wall. It becomes thinner and more extensible, while the back wall remains dense and is much less susceptible to stretching.

That is why nature prescribes the attachment of the fertilized egg to the posterior wall, because the placenta, unlike muscle tissue, does not have the ability to stretch. Thus, the placenta, fixed to the posterior wall, experiences significantly less stress, which is not at all beneficial for it.

So it turns out that the back wall is an ideal option for the attachment of the fetus, and then the development of the placenta.

Placenta location options

By virtue of various reasons the fertilized egg can attach not only to the upper part of the posterior wall of the uterus, but also to other parts of it. Quite often there is a side mount: to the right or left of the back wall. In some, also not very in rare cases, the placenta is attached to the anterior wall of the uterus.

All of these options for the location of the placenta are not considered a pathology, although in such cases there is a deviation from the ideal location intended by nature. Women with a lateral placenta, as well as with a placenta attached to the anterior wall, most often carry and give birth to children naturally without complications. Of course, among them there are also those who are faced with various pathologies, but, as a rule, they have other reasons for complications.

Certainly, placenta located on the anterior wall is exposed to somewhat greater loads due to constant stretching of the walls of the uterus, fetal movements, and maternal actions. To some extent, this increases the risk of damage to the placenta, premature detachment, and so on. The direction of placental migration may also change.

Due to the constant stretching of the muscles of the uterus, the placenta can gradually descend too close to the os of the uterus, and sometimes even block the exit from the uterus to the birth canal. If there is 6 centimeters or less between the edge of the placenta and the cervical os, they say, but if the placenta partially or completely blocks the exit from the uterus, this pathology is called placenta previa.

However, low placentation and placenta previa can be caused by a number of other reasons, which will be discussed later. Presentation on the posterior wall occurs much less frequently than along the anterior wall. We have already discussed above why this happens.

Causes of anterior placenta previa

What are the causes of placenta previa along the anterior wall? Unfortunately, these reasons are not fully understood. However, some of them have already been reliably established. In particular, these include various endometrial damage- inner layer of the uterus. These may be inflammatory processes, scars from operations, for example, cesarean section, consequences of curettage after miscarriages or abortions.

Uterine fibroids, as well as its other pathologies, can cause placenta previa along the anterior wall. It has been noted that in women giving birth for the first time, this pathology occurs much less frequently than in second and subsequent pregnancies. This is most likely also due to the condition of the uterine mucosa.

However, reasons for this pathology may arise not only from the mother’s side. In some cases they lie in underdevelopment fertilized egg. Because of this lag, the fertilized egg does not have time to implant into the endometrium in time. Implantation occurs in this case in the lower part of the uterus.

It also happens that the fertilized egg attaches to the anterior wall in the upper part of the uterus, but subsequently the placenta migrates as a result of stretching of the uterus to the lower part.

Degrees of anterior presentation

There are complete and partial presentation. It's not hard to understand that full presentation This is a situation where the placenta completely covers the cervical os.

Partial presentation also divisible by 2 different types: lateral and marginal. Marginal - when the placenta passes along the very edge of the uterine os. Lateral presentation is when the placenta still blocks the exit from the uterus, although not completely.

Symptoms of anterior presentation and why it is dangerous

Unfortunately, very often anterior placenta previa proceeds completely asymptomatic. Of course, this does not mean that it will be impossible to diagnose pathology. We are talking about ways to identify the problem will come later. The main thing in the absence of symptoms is that it is not always possible to diagnose presentation on time.

In some cases, placenta previa makes itself felt bleeding. This means that it has arisen. Actually, this is precisely the main danger of presentation, although not the only one.

As you remember, the placenta supplies the fetus with nutrients and oxygen. When the placenta is located low, and even more so blocks the exit from the uterus, it turns out that the child presses on it with all his weight. It can compress blood vessels in the placenta. This, in turn, can cause oxygen starvation - hypoxia.

As the fetus grows, the pressure on the placenta increases, in addition, the baby’s movements become more active, he touches the placenta. As a result, premature placental abruption. In this case, the consequences can be disastrous not only for the child, but also for the mother. Especially if she has problems with blood clotting.

Bleeding during presentation can occur as early as the second trimester, immediately after the formation of the placenta has completed. However, most often it occurs at a later stage, sometimes just before childbirth, or even during childbirth.

Therefore, if a symptom of placenta previa becomes vaginal bleeding, you must immediately consult a doctor to determine the cause and begin treatment.

We should also talk about breech birth. Complete presentation, a condition when the placenta blocks the exit from the uterus, completely excludes the possibility of natural childbirth.

The placental tissue simply will not release the fetus into the birth canal. But in the case of partial presentation, natural childbirth is, in principle, possible. The main thing is that doctors delivering babies closely monitor the woman in labor. If bleeding occurs, it still makes sense to perform an emergency caesarean section.

Diagnosis of anterior presentation

Placenta previa can be diagnosed in several ways. Including when gynecological examination. Complete and partial presentation are felt differently by palpation. At full presentation to the touch it is felt that the cervix of the uterus is completely blocked by the placenta.

With partial presentation, both placental tissue and membranes. By the way, when viewed from the side and marginal presentation are perceived equally. So a gynecologist without additional devices will not be able to determine what type of partial presentation we are talking about.

If a woman was initially diagnosed with low placentation, for example, during the first routine ultrasound, then she will subsequently be regularly examined, including with ultrasound. Then, in the event of placenta migration and the development of presentation, this will be promptly identified during the next study. An ultrasound will show the presence of pathology even if it is asymptomatic. That is why women are recommended to attend all routine examinations and ultrasound examinations.

Treatment of women with anterior presentation

Unfortunately, modern medicine is not able to influence the location of the placenta. Treatment of placenta previa comes down to constant monitoring by doctors and timely examinations. In this case, not only the condition of the fetus and placenta is monitored, but also the condition of the pregnant woman. Blood tests must be done regularly. The level of hemoglobin and the ability of the blood to clot are checked. The fact is that anemia or acute blood incoagulability can play a bad joke on the expectant mother in the event of bleeding.

If a woman diagnosed with anterior placenta previa begins to have vaginal bleeding beyond 24 weeks, no matter how severe, the woman will be hospitalized. And be sure to go to the hospital where there is a special intensive care unit. In case of extensive blood loss. The main and first prescription for all women with bleeding during pregnancy is absolute peace.

Regardless of how quickly the bleeding can be stopped, the pregnant woman remains in the hospital until labor begins. A woman needs to be constantly examined. In addition, rarely do any women take seriously the recommendation to remain calm. Well, is it really a violation of the regime to cook dinner for your husband? A violation, like jogging with a broom or mop. In the hospital for compliance bed rest Doctors will take special care.

Further treatment is prescribed depending on the condition of the fetus, woman, severity of bleeding, and so on. If the fetus is premature and the mother feels well and the bleeding is not severe, every effort to maintain pregnancy. If a threat to the mother’s life is detected, the pregnancy will be terminated.

However, such cases are extremely rare. It is usually possible to prolong pregnancy at least until the baby's life can be saved. Of course, this is also not the most the best option, however premature babies, as a rule, grow up absolutely normal. Most often, women carry the child to an acceptable term.

We hope you now know what placenta previa is. Finally, I would still like to say that, in general, it does not matter at all to which wall the placenta is attached: to the back or the front. This circumstance It doesn't make the situation any easier or worse. However, during the examination it is still customary to indicate to which wall of the uterus the placenta is attached. Ultimately, a woman can use this information.

So, if you have an anterior presentation, you know for sure that it is especially important for you to take care of your stomach, and it makes sense to minimize even light impacts on it. So, you shouldn’t allow everyone to touch your stomach. Especially in the later stages, as this can cause training contractions. Sudden contractions of the uterine muscles can cause detachment and bleeding.

Replies

The placenta is a unique embryonic organ that forms in the early stages of the gestational period and by about the middle of pregnancy begins to serve as a source of nutrients for the fetus. For the successful bearing of the baby and bringing it into the world in the most optimal time the specific location of the placenta is extremely important: the norm for different periods pregnancy is somewhat different here.

The norms for the location of the placenta will tell unprepared patients little - they are, rather, established for obstetricians-gynecologists and other specialists managing pregnancy and choosing the optimal delivery tactics for each case when the time comes. Of course, specific and final decisions in this regard should be made directly during the act of childbirth, but a qualified doctor can make some predictions in this regard even in the middle or late stages of his patient’s gestational period. Not least of all, this choice will be affected by the location and height of the placenta: these two indicators will mainly affect how natural the birth will be for any pregnant woman - or whether the child will have to be removed from her womb by cesarean section.

The most successful for a pregnant woman - as well as her future baby - is considered to be the location of the placenta along the posterior uterine wall, and the closer to the bottom of the main female organ it is located, the better. In such a case, the chance for it to rise higher as the uterus grows is very high - and this entails a reduction in the risk of damage to the placental, and its abruption and other pathologies. Such relative stability of the course of pregnancy is created in terms of the development of the placenta due to the fact that its tissues in such a presentation are provided with stability sufficient for their normal functioning. Accordingly, the baby will receive normal nutrition, necessary for its growth, development and preparation for extrauterine existence, which will come just a few months later.

It is unlikely that even a single doctor will undertake to predict where exactly the placenta will be located in each individual woman, since the mechanism of this phenomenon has not yet been fully studied; but it is known that its attachment usually does not occur in places of damage to the endometrium - the inner uterine layer.

The location of the placenta on the other wall of the uterus - the anterior one - is more risky in terms of avoiding premature birth and other similar variants of pathologies of pregnant women. In this case, it is highly desirable that the placenta initially attaches as close as possible to the uterine fundus, since, according to experts, there is a chance that as the fetus grows, this embryonic organ will even slide down (with posterior wall implantation, this is excluded).

However, the most critical from the point of view normal course the gestational period in the later stages and the choice of medical tactics during childbirth will be not so much the localization as the height of the placenta. It is determined as a result ultrasound examination, and according to several ultrasounds performed on various stages pregnancy, doctors monitor dynamics this indicator. At a later date - i.e. in the third trimester, already about 29-32 weeks - any location of the lower edge of the placenta at a distance of less than 7 centimeters from the edge of the internal os of the cervix is considered low. When these indicators are generally measured by a couple of centimeters, we can talk about partial placenta previa, and if closer to the 35-37 week period it does not shift higher, this will serve as a signal for doctors that this pregnant woman should not be allowed to natural childbirth. Then the “pregnant” woman will have to come to terms with a planned cesarean section, because when the pregnancy is considered to be actually full-term, immediately before birth, the placenta no longer rises, and the operation becomes the only chance for a successful delivery of the baby into the world.

A low location of the placenta, and especially the situation when it partially or completely covers the cervix, is dangerous during childbirth because it causes bleeding, as well as hypoxia of the baby being born: after all, when the placental tissue is detached, it will be deprived of oxygen.

Thus, in the later stages, and specifically in the third trimester, of the gestational period, the norms for the location of the placenta are such that any position below 7 cm relative to the cervical os is considered low and requires close monitoring by doctors.

The placenta (baby place) is a unique embryonic formation that appears in the uterus during pregnancy. Correct localization of this amazing organ is the key to successful pregnancy and easy childbirth. That is why the location of the placenta during pregnancy is of paramount importance for doctors, and for the expectant mother herself. If the placenta is positioned correctly, no problems arise, but its presentation calls into question the very existence and development of the baby. We propose to discuss the features of the location of the placenta during gestation.

Location of the placenta during pregnancy. The importance of the placenta for the pregnant woman and the fetus

The formation of placental tissue begins with the appearance of the embryo in the uterus, and the final maturation of the organ occurs by 16 weeks. This formation consists of special villi, “stuffed” with blood vessels. As the gestation period increases, the placenta framework also grows - the vascular network, which is so necessary for the baby.

The importance of the placenta for the formation strong union mother and child cannot be overestimated. Here are just some of the functions of a child's place, thanks to which the baby can comfortably grow and develop in the mother's womb:

carries out continuous transportation of energy substances to the baby;
provides the fetus with hemoglobin, delivering it from the mother’s blood;
cleanses the internal environment where the baby lives from toxins and other dangerous products metabolic metabolism;
constantly filters the mother's blood, which provides the baby with high degree protection against various infections and pathogenic organisms.

The baby comes into contact with the placenta through a special cord - the umbilical cord. One of its edges is attached to the umbilical zone on the fetal body, and the other is fused with the tissue of the placenta. The cord contains 2 arteries and 1 vein, through which blood circulates between the baby and the placenta. Blood enriched with oxygen and useful elements moves through the vein to the baby, while the arteries carry away carbon dioxide and the products of the final breakdown of substances.

The normal location of the placenta during pregnancy - what is it?

The development of the placenta is considered most appropriate when it fuses with the posterior wall of the uterus, closer to its bottom. These conditions are optimal for successful embryo maturation. Scientists are still arguing about what the location of the placenta during pregnancy depends on.

It seems to many experts that the most rational assumption is that gravitational forces play a major role in the mechanism of placentation: for example, if a woman most often sleeps on her right side, then the egg is attached to the right side of the uterus. But this theory is not yet sufficiently substantiated. At the same time, doctors are absolutely sure that the embryo will never develop in a dangerous place - where myomatous nodes or damaged areas of the mucous membrane are located due to curettage in the past.

It is quite logical that the baby will develop normally only if the placenta is positioned correctly during pregnancy. This type of placentation does not harm the baby in any way. On the contrary, the continuously growing placenta gradually moves to the lateral areas of the uterus, which fully supply it with blood.

There are other ways to attach the placenta, making noticeable adjustments to the overall course of pregnancy. Let's talk about each option separately.

Anterior location of the placenta during pregnancy

The placenta is most often attached to the anterior wall of the uterus in women who have become pregnant not for the first time. The main danger of this arrangement is that as the fetus grows, the muscle fibers of the anterior uterine wall stretch the most. Particularly strong stretching is observed in the lower part of the muscular organ. In such conditions, there is a possibility of placental abruption. However, there is no cause for concern if the doctor has diagnosed a high location of the placenta along the anterior wall during pregnancy.

With this type of placentation, the mother will feel the first movements of the baby later than with placentation on the back wall of the uterus, and, most likely, they will be quite weak. Additional analyzes and diagnostic examinations are not prescribed for such placentation.

Patients whose placenta is attached below normal are subject to closer observation. Then they talk about either the low location of the placenta or its presentation.

Low location of the placenta during pregnancy

This variant of localization of the child's place is said to be when the maximum distance from the lower edge of the placenta to the internal os of the cervix is only 6 cm. This is detected physiological feature during the next ultrasound procedure. This state of affairs, if the circumstances are unfortunate, can result in a number of problems for the expectant mother:

damage to the placental membrane if the fetus, which is constantly gaining weight, is too active;
development of hypoxia in the child due to insufficient blood supply to the cervix;
difficulty moving the baby along the birth canal during childbirth.

However, with such a specific localization of the child's place, they are in no hurry to sound the alarm. The gynecologist will certainly reassure the worried patient and clearly explain to her what a low placenta means during pregnancy: this pathology is detected in the second trimester of pregnancy 15 times more often than before childbirth. That is, a disorder that appears in the middle of pregnancy can easily disappear by the end of pregnancy. late dates. This is explained by the so-called migration of the placenta: the strong and easily extensible muscles of the lower part of the uterus, as the duration of pregnancy increases, begin to stretch upward, carrying the placenta with them. When the lower edge of the blood organ rises higher, its location becomes normal for the further course of pregnancy.

What to do if the placenta is low during pregnancy

Of course, there is always a certain risk that a low-lying placenta will never move from its place. That's why doctors always give the expectant mother useful recommendations, by performing which you can avoid various complications:

Keep calm. Often the placenta moves up just before birth, so 90% of cases of lower placenta during pregnancy end in the successful birth of healthy babies.
Postpone sex life for the future (when the child is born).
Completely eliminate any physical activity.
Do not lift heavy objects.
Don't walk for a long time.
If possible, avoid traveling on public transport - jolts while driving are especially dangerous.
When resting, always place your feet on a pillow, thus raising them above body level.
If the doctor deems it necessary, immediately go into storage.

Prevention of low placenta during pregnancy

You can try to exclude the possibility of inferior attachment of the placenta at the stage of pregnancy planning. The main cause of the disorder is considered to be damage to the uterine mucosa. This means that a woman needs to keep her healthy. Here's how to achieve it:

approach sexual health issues with full responsibility, prevent infection of the intimate area and promptly treat all inflammatory processes;
stop smoking, do not abuse alcohol;
maintain immunity at a high level;
avoid abortion;
treat yourself extremely carefully during pregnancy so as not to provoke a miscarriage;
give consent to a caesarean section only for absolute medical reasons;
All surgical operations related to the treatment of the genital organs should be trusted only to a qualified doctor in a good clinic.

Fortunately, modern medicine does not consider low-lying placenta as a disease. This is a special situation, nothing more. Therefore, the corrective action program does not include medications or therapeutic procedures. If future mom will not ignore the advice of the gynecologist and will follow everything exactly medical recommendations, pregnancy will pass satisfactorily.

Placenta previa or location during pregnancy

More dangerous in terms of successful labor and safe birth of the child is the diagnosis of placenta previa. There are several types of pathology, but in each case, the baby’s place will somehow prevent the baby from passing through the internal os of the cervix.

Location of the placenta during pregnancy. Variants of placenta previa

Complete - the baby's place is shifted down the uterus and completely blocks the exit from it.
Partial - the internal pharynx is not completely blocked. The disorder is divided into lateral and marginal location of the placenta during pregnancy. Lateral attachment is diagnosed when more than half of the internal pharynx is covered by the tissue of the child's seat. With marginal placentation, only 1/3 of the uterine opening is closed.

Location of the placenta during pregnancy. Causes of placenta previa during pregnancy

An explanation of the pathology must be sought in initial stage pregnancy. The main factor provoking an abnormal localization of the placenta is considered to be a greatly altered inner wall of the uterus, which prevents the normal implantation of a fertilized egg. Let us list all the opinions that doctors put forward when talking about the reasons for the development of this pathology:

acute or chronic inflammation in the uterus due to surgical curettage or an infectious disease;
various congenital and acquired anomalies of the uterus (for example, the presence of a tumor);
serious liver, kidney and heart pathologies in a woman, which provoked the development of congestive processes in the pelvic organs;
placenta previa is most often found in multiparous women, which is explained by the extensive complex of diseases that they acquired by the time of the second birth;
certain physiological disturbances in the fertilized egg itself, which prevents it from attaching to the upper uterine segment.

Location of the placenta during pregnancy. Symptoms of placenta previa during pregnancy

The main indicator of pathology is bleeding. The moment when it first appears depends on the type of presentation:

with full presentation, the expectant mother will notice very abundant bloody issues early - already in the 2nd trimester;
with the lateral and marginal location of the placenta, moderate bleeding usually appears in the 3rd trimester or during childbirth.

Where does blood come from? The pregnant uterus is constantly increasing in size. Highest magnification its volume occurs in the area of the lower segment, exactly where the placenta is located in previa. Muscles begin to change especially quickly shortly before birth, and accordingly, the process of placental migration accelerates. The placenta tissue is not particularly elastic, so it does not keep up with the changing wall of the uterus and exfoliates. At the site of detachment, blood vessels burst, causing bleeding.

Placenta previa is characterized by external bleeding, when the blood does not collect in the hematoma between the uterine wall and the detached placenta, but comes out through the cervix. Blood always appears unexpectedly and is never accompanied severe pain. This is the main one characteristic feature pathology. The specific location of the baby's place is usually discovered in the 2nd trimester of pregnancy, when the expectant mother complains to the doctor about bleeding that occurs every now and then, which most often begins at night, at a moment of complete relaxation and peace.

Location of the placenta during pregnancy. The dangers of placenta previa during pregnancy

In the presence of such a pathology, the risk of developing the following complications increases:

threat of miscarriage (symptoms - hypertonicity, pain in the lower abdomen and lumbar region);
systematic attacks of hypotension;
presyncope, headache.

Treatment of placenta previa during pregnancy

A pregnant woman with a specific location of the placenta is prescribed various clinical examinations, the main purpose of which is to prevent and prevent hemoglobin deficiency and blood clotting disorders. Such patients are prescribed iron supplements and a special diet to prevent the development of anemia and massive bleeding.

If there is no bleeding due to placenta previa, the doctor recommends that the pregnant woman adhere to a special gentle regimen:

dose physical activity;
don’t get upset, stay calm;
abstain from sex;
regularly take leisurely walks;
get a full night's sleep.

When the condition of a pregnant woman with a presentation for more than 24 weeks is complicated by bleeding, she is recommended to go to the hospital, where doctors will be able to provide assistance at any time of the day. necessary help in intensive care conditions. And even if the bleeding is episodic, it is safer for a woman to remain under the supervision of specialists until childbirth.

Childbirth with placenta previa

Complete placenta previa does not leave the woman a chance to give birth to a child on her own, and a planned cesarean section is performed at 38 weeks of pregnancy. When you try to give birth on your own, complete placental abruption occurs with the immediate development of severe bleeding and at the same time the risk of death of both the baby and the mother increases.

Surgical delivery with placenta previa can be carried out hastily at any stage in the following situations:

development of heavy bleeding that threatens the life of the fetus;
systematic bleeding due to anemia and severe low blood pressure that don't lend themselves drug treatment and are combined with disturbances in fetal development.

If the internal os is partially blocked, the possibility of spontaneous childbirth can be allowed, especially if the mother managed to carry the baby to the due date. The doctor will finally determine how exactly the birth will take place, when the cervix dilates by 5-6 cm. If the partial presentation is insignificant and the bleeding is mild, the amniotic sac is punctured, the baby’s head moves and puts pressure on the damaged vessels, stopping the bleeding. This scenario is ideal for continuing labor naturally. If any unforeseen circumstances arise, the baby is born promptly.

Postpartum manipulations with placenta previa

After the birth of the baby, the danger to the mother’s health still remains, since at any moment the bleeding can resume with renewed vigor: the uterus has difficulty contracting, which is complicated by the state of anemia and low blood pressure.

Moreover, in most cases, the placenta previa firmly adheres to the tissues of the uterus, as a result of which its independent birth is complicated. Then the birth canal is examined manually and the placenta is surgically separated under general anesthesia.

In isolated cases, bleeding cannot be stopped either after surgical delivery or after emergency drug therapy. With this development of events, it is possible to prevent the death of the mother only through removal of the uterus.

To summarize, we note that the type of placenta attachment is largely determined general condition woman's health. Fortunately, modern medicine is at the proper level to successfully bring a pregnancy with any complications to the successful birth of a child. And although placenta previa is undoubtedly very serious diagnosis, with timely diagnosis and compliance with all recommendations of the attending physician, avoid serious consequences This condition is successful in most cases.