Author of the article - an obstetrician Grigorieva Xenia S.
Placenta previa call it unusual attachment at the bottom of the uterus area. Thus it overlaps the internal os partially or completely, being located in the path nascent fetus.
The pathology occurs in 0.2-0.8% of the total number of births. In multiparous women the incidence of disease increases to 75-80%.
Upon detection of placenta previa in the 2nd trimester, do not worry too much, since an increase in uterine growth of the placenta can move up to 8-10 cm. Such a shift is called "placental migration".
Causes
Clear evidence of the occurrence of disease does not exist. The most common causes include:
- inflammatory diseases (e.g., endometritis);
- a large number of genera (2-3);
- abortion;
- the scars on the uterus, such as after cesarean section;
- myoma uterus;
- abnormalities of the uterus.
Most of these reasons cause structural changes in the endometrium, which disrupt the normal attachment of the ovum.
Also produce fruit causes that due to the peculiarities of the ovum.
Symptoms of placenta previa
The main and sometimes the only sign of placenta previa acts uterine bleeding. It occurs suddenly, without being accompanied by other symptoms. Most often, it begins in the period of 28-30 weeks, because at this time there is an intensive stretching of the lower part of the uterus. Bleeding is characterized by its features:
- not accompanied by pain;
- scarlet;
- often repeated;
- there is anemia in pregnant women.
Bleeding in the second trimester often speaks about the complete previa (completely covers the cervix), and in late pregnancy or childbirth first period characteristic of incomplete previa (partially overlaps os). Allocate more low prelying (placenta is close to the mother zevu).
The gynecologist with obstetric study can reveal:
- painless palpation of the uterus;
- fetal breech;
- malposition (oblique or transverse);
- the absence of uterine hypertonus;
- high standing fetal presenting part.
Using ultrasound can determine the degree previa:
- 1 degree: placenta edge is located near the uterine throat at a distance of 3-5 cm (the most favorable option);
- 2nd stage: placenta edge reaches to the mouth, but it does not overlap;
- Grade 3: placenta edge overlaps the cervix;
- Grade 4: placenta completely covers the pharynx.
When this disease for the prevention of bleeding should avoid strenuous exercise, air travel and observe sexual rest.
If pregnancy occurs severe anemia or hemorrhagic shock, the child may be acute hypoxia. Therefore, in case of detection of blood, you need to immediately report to the doctor-gynecologist.
Placenta previa can be detected before the appearance of bleeding, since screening with ultrasonography performed necessarily at each trimester.
Diagnostics
The most accurate and safe diagnostic method performs ultrasound. All pregnant women a screening study conducted in each trimester during which determine the location of the placenta.
Vaginal examination is not recommended because it can cause placental abruption and increase bleeding.
Treatment of placenta previa
Treatment is carried out in a hospital. Goal - to stop the bleeding. If the bleeding is absent, and the placenta is low, the ambulatory carried fetal hypoxia prevention and developmental delay.
Non-pharmacological therapy
- Appointed bed rest. It is recommended to exclude physical exertion and sexual activity.
medication
- When spotting assigned medication. Apply tocolysis (hexoprenaline, fenoterol), glucocorticoids (5% ascorbic acid intravenously) and means to strengthen the vascular wall (dexamethasone intramuscularly and orally). The first and last group of drugs used at any stage. Glucocorticoids are assigned to 34 weeks for the prevention of respiratory distress syndrome of the newborn (respiratory failure due to lung immaturity in premature infants).
- Also conduct therapy aimed at the prevention of anemia in pregnant women. During treatment necessary to control the location of the placenta using ultrasound.
Surgery
- If bleeding takes place of 250 ml or more, it shows an emergency caesarean section at any time during pregnancy.
delivery
When spotting delivery is carried out via caesarean section.
With a partial previa, and no bleeding at the onset of labor may maintain vaginal delivery route. But this problem is solved individually and only by a physician.
Possible complications of placenta previa
Complications may arise with placenta previa:
- Prematurity (20%).
- Threatened miscarriage.
- Excessive bleeding.
- Anemia in pregnant women due to blood loss.
- Malposition or breech. It arises from the fact that the placenta previa prevents head down to the pelvis.
- Thick placentation or true increment (placenta invades deeply into the muscle layer of the uterus and thus causes bleeding). This complication is rare, but ends up in the main removal of the uterus.
- Chronic hypoxia and growth retardation. It is due to a reduced blood supply to the lower uterine segment.
- Abruption placenta previa. Accompanied by bleeding, it is shown an emergency Caesarean section. The most dangerous for the fetus.
The prognosis for mother and child
When minor bleeding and timely cesarean section prognosis. Placenta previa a dangerous pathology, it is recommended to take all necessary survey (especially screening ultrasound) and to comply strictly with all appointments your doctor obstetrician-gynecologist.
Upon detection of this pathology in the first or second trimester you should not worry too much, as there is a high probability of "placental migration".
Some studies in pregnancy
- Smears in pregnancy
- Analyzes during pregnancy trimesters
- Ultrasound in pregnancy
- Urinalysis in pregnancy
- coagulation
- Installing pessary
- glucose tolerance test
- Homocysteine in pregnancy
- Anesthesia during childbirth
- Fetal CTG (cardiotocography)
- cordocentesis
- Epidurals in labor
