Regional placenta previa: how to avoid complications.

The placenta is an organ that forms in the female uterus during pregnancy and provides communication between the organisms of the child and the mother. Intrauterine development, excretion of metabolic products, nutrition and respiration of the fetus - all this occurs through the placenta.

Externally, the placenta looks like a disc. Its thickness is 2-4 cm, diameter is 15-20 cm, and weight is 0.5-0.6 kg, which is approximately 1/6 of the weight of the fetus. If the pregnancy proceeds normally, then the placenta, as a rule, is located in the area of ​​the uterus, not adjacent to the pharynx. However, it often happens that the placenta is positioned incorrectly. One of these cases is marginal placenta previa, in which the lower part of this organ lies at the level of the edge of the internal os.

Regional placenta previa: causes

All existing factors that provoke an abnormal location of the placenta in the body of a pregnant woman are divided into two groups. The first group includes factors related directly to the specific structure of the fetal egg. The fact is that disruption of the trophoblast implantation process and the late manifestation of enzymatic actions leads to untimely implantation of the fertilized egg into the upper part of the uterus, and therefore a marginal placenta occurs. If it persists until the 24th week of pregnancy or longer, they speak of the presence of marginal placenta previa.

The second group includes factors that directly depend on the characteristics of the body and the health status of the expectant mother. These include:

• Pathological changes in the endometrium, contributing to disruption of the normal decidual reaction;
• Diseases such as endocervicitis or endometriosis;
• Uterine fibroids;
• Pregnancy with more than one fetus.

A marginal placenta can be diagnosed using ultrasound.

Regional placenta previa: symptoms

The main manifestation of marginal placenta previa is bleeding that occurs during the third trimester of pregnancy, as well as during childbirth. These discharges are characterized by a sudden onset for no apparent reason, absence of accompanying pain and variable frequency. As a rule, it is not possible to determine their strength and duration in advance. In case of rupture of the marginal sinus of the placenta, presentation will be accompanied by heavy bleeding.

The diagnosis of “marginal placenta previa” requires regular medical supervision and timely completion of all necessary tests. With such a common phenomenon as a decrease in hemoglobin, pregnant women are prescribed medications that contain iron. This will help avoid frequent and severe bleeding, as well as the rapid development of anemia.

Marginal placenta: consequences

What are the dangers of marginal placenta previa? As mentioned above, this deviation is fraught with bleeding, but this is not the only thing to be wary of. There is also a high probability that during the birth process the baby, by compressing the placenta, will block its own oxygen supply. In this regard, doctors usually insist that in case of marginal placenta previa, delivery is carried out by cesarean section.

Regional placenta previa: treatment

In order to raise the marginal placenta, they resort to either drug treatment or physical therapy in the form of electrophoresis with vitamins. In addition, experienced gynecologists recommend that women adhere to the following simple rules when treating marginal placenta previa:

• Wear a special bandage;
• Get into the knee-elbow position for several minutes, five times a day, making sure that the time intervals between approaches are equal;
• Avoid any physical activity;
• Do not have sexual intercourse.

Compliance with the recommendations of the attending physician in most cases helps to raise the placenta to the desired level, and therefore the risk of complications during childbirth, and with it the need for a caesarean section, disappears.54 votes)

The placenta is an important organ, the vascular bed of which provides nutrition to the fetus and protection from harmful external factors (hemo-placental barrier).

Usually the placenta forms near the fundus of the uterus. The smooth muscle wall does not interfere with the development of blood vessels. It is elastic and evenly stretches in accordance with the growth of the placenta without interfering with its functions.

But other situations are also possible when the placenta is attached to the anterior wall of the uterus and enters partially or... In this case, complete or partial presentation is diagnosed.

If the placenta covers the internal os by no more than 1/3 and touches it only with the lower edge, this is called marginal placenta previa .

If marginal presentation is diagnosed in the early stages of pregnancy, then over time, as the uterus grows, the edge of the baby's place may also rise, moving along with the uterine wall.

However, in assessing the expected complications of placenta previa, the location of placenta attachment - along the back or the front wall - plays an important role.

With marginal placenta previa in the posterior position, the forecasts are quite optimistic: the risks towards the end of pregnancy and during childbirth will be significantly lower.

However, if by 24 weeks the placenta has not changed its position, the woman needs additional observation and a more gentle regimen, limiting exercise.

What is the danger for mother and child?

1. The growing fetus will put pressure on the body of the placenta, which can lead to circulatory disorders, the appearance of foci of ischemia, and early aging of the placenta.
2. The lower segment of the uterus is less plastic and cannot always stretch to match the size of the placenta, and this leads to bleeding - an extremely dangerous condition for the life of the mother and fetus.
3. Even if the pregnancy proceeded normally, the internal os is not blocked and the woman is allowed to give birth naturally, there is a risk of complications. During contractions, the lower edge of the placenta may block the birth canal. As a result, the newborn may die.
4. Or, passing through the birth canal, the baby will “pull” the body of the placenta along with it - this is fraught with a sharp separation and heavy bleeding.

Complications during natural childbirth are an indication for an emergency caesarean section.

Causes of the pathological location of the placenta

Doctors do not know how to influence the place where the placenta attaches; this process is uncontrollable.

But there are some known reasons that increase the risk of an abnormal location of the placenta.

Some of them are associated with the pathology of the ovum, others with the somatic health of the woman herself.

Appropriate preventive measures can reduce the likelihood of improperly securing a child's seat.

Abnormalities of the ovum

• genetic diseases affecting the development of the embryo
• taking strong medications
• effect of environmental factors

All of the above reasons disrupt the formation of chorionic villi or their weakness, as a result of which they do not have time to penetrate the endometrium of the upper parts of the uterus and are fixed only after descending below.

Reasons related to maternal health

• Bad habits.

Smoking, alcoholism, and drug addiction lead to vascular disorders.

Not finding a place with sufficient nutrition in the area of ​​the uterus, the fetus is fixed closer to the cervix - the places where large vessels pass.

• Chronic diseases of the mother.

Diabetes, high cholesterol, heart failure, which also lead to blockage of blood vessels, resulting in impaired blood supply to the upper parts of the uterus.

• Frequent vaginal infections or endometriosis.

As a result of inflammatory processes, the endometrium becomes thinner and its thickness and density are not enough to secure the chorion in the desired part of the uterus.

• Multiple births.
• Frequent abortions.
• History of caesarean section.
• Presence of fibroids.
• Late first pregnancy (mother's age over 30 years).

Symptoms

As a rule, marginal placenta previa is diagnosed during an ultrasound examination even before external signs of trouble appear.

But if for some reason the woman did not do so, or the placenta is located on the back wall and the position of the fetus in the uterus does not clearly determine its location - in this case, some external signs may indicate a low presentation.

In the early stages, the doctor may be alerted to a highly raised uterine fundus (not corresponding to the stage of pregnancy). The placenta, located below and actively growing, seems to push upward the “light” uterus with a thin bottom.

A more typical symptom is periodic bleeding. They are not accompanied by or anxiety of the child.

They are caused by excessive pressure from the low placenta on the vaginal vessels. Small vessels burst, unable to withstand the load. This is the source of bleeding. Usually it passes quickly and is not dangerous for the baby, since the placental blood flow is not affected.

But as the fetus grows, in late pregnancy, especially in slender women, bleeding from external vessels becomes frequent. Blood loss may occur.

More dangerous are bleeding caused by. They are abundant, may be accompanied by pain, and require emergency hospitalization.

Diagnostics

A presumptive diagnosis of placenta previa can be made as a result of manual palpation examination or by. To clarify the diagnosis, it is prescribed.

Ultrasound examination allows you to accurately determine the position of the body of the placenta and, most importantly, the localization of its edges.

Its size, thickness, and distance from the lower edge to the inner pharynx are determined. The likelihood of possible complications depends on this parameter.

What to do with marginal placenta previa: treatment methods

To reduce pressure on the edge of the placenta and the vessels of the vagina, a woman should wear a special bandage, avoid physical activity, stress accompanied by a rise in blood pressure, and avoid sexual intercourse.

There are recommendations to get on all fours 3-4 times a day. Thus, reducing pressure on the lower edge of the placenta. And at the same time, by stretching the anterior wall of the uterus, you can sometimes achieve some upward displacement of the placenta. The exercise is effective in the second trimester.

Drug treatment includes vascular and antiaggregation drugs in dosages that are safe for the fetus.

As a rule, women with marginal presentation at 24 weeks are hospitalized in a hospital for a number of preventive measures, including:

• tocolytic therapy.

The expectant mother is prescribed a number of medications designed to reduce the contractile activity of the uterus. Most often, Ginipral and Partusisten are prescribed, which are administered intramuscularly or by drip;

• prevention of fetoplacental insufficiency.

Vitamins are prescribed, as well as drugs that improve blood circulation - "", "Actovegin", "Trental";

• prevention of anemia.

Taking medications that increase;

• taking antispasmodics.

The action of these drugs is aimed at reducing the existing tone of the uterus. Women are prescribed either No-shpa, as well as magnesium-B6, magnesium sulfate.

If there is a high risk of premature birth due to placental abruption, additional therapy with corticosteroids (Dexamethasone, Hydrocortisone) is carried out to prevent respiratory disorders in the baby.

Management of labor in marginal presentation

If exercises and a bandage do not help to change the level of the placenta, and according to ultrasound, marginal presentation remains, at 36-38 weeks a decision is made on a possible method of delivery.

In any case, the decision is made by the obstetrician-gynecologist who will conduct the birth. In this case, early hospitalization may be required

If a woman has no bleeding during marginal presentation, natural childbirth is possible.

In this case, when dilated to 3 fingers, a prophylactic amniotomy is performed.

Even if there is bleeding, some obstetricians will allow you to give birth on your own. If the cervix is ​​soft and smooth, an amniotomy is performed even before contractions, due to which the child is lowered and pressed against the entrance to the pelvis and presses the exfoliated lobules.

This helps stop the bleeding. Oxytocin is also prescribed, which, on the one hand, prevents heavy blood loss during childbirth, and on the other hand, accelerates labor, causing frequent and strong contractions.

If amniotomy does not bring the desired results, a woman with bleeding is delivered abdominally.

In cases where, in addition to ultrasound data, bleeding is also present, early surgical delivery is possible (up to 36 weeks).

Bleeding limits the ability to use antiplatelet agents to improve blood flow. In addition, developing anemia threatens fetal hypoxia and deterioration of maternal health.

If a woman is prepared for a caesarean section at 36 weeks, the baby will also be prepared for an early birth. Medicines will speed up the formation of alveoli in the lungs.

Using an ultrasound, it will be possible to assess the maturity of the fetus and the readiness of its organs for life outside the mother’s body. Such a baby may have to spend some time in the premature ward, but this will be much safer for his life and health.

Doctors rarely encounter the diagnosis of “marginal placenta previa”. But if the pathology of the location of the child’s place is confirmed, the pregnant woman requires additional observation, possibly with drug therapy.

If a woman follows the doctor’s instructions and treats the restrictions imposed with understanding and seriousness, she has every chance of giving birth to a healthy and strong baby.

Today we will tell you in more detail about the diagnosis that scares all future parents -. Previously, we have already talked about the role of the placenta for mother and child, but marginal placenta previa must be considered with special care.

The placenta is a very important organ for an easy pregnancy, so a lot depends on its development and condition. Normally, the marginal placenta should be located in the area of ​​the fundus of the uterus, which is located on top, and not block the pharynx - the entrance. The placenta, as a rule, is attached to the uterus in places with the best blood circulation, which is logical - good blood flow is necessary for the baby’s nutrition and vital functions.

There is also a term - migration of the placenta, which is possible only due to the enlargement of the uterus during labor. With marginal placenta previa in the early stages, there is a chance that it will disappear with the growth of the uterus. But if this did not happen, and marginal placentation persisted, then the mother needs to know as much as possible about it.

Marginal placentation during pregnancy is fraught with the fact that the placenta, being on the way of the fetus to the os of the uterus, blocks it. Thus, the natural process of childbirth is interrupted, and it can become unpredictable, and the resulting bleeding can be fatal for both mother and child.

Marginal placenta previa is characterized by the fact that the placenta covers the pharynx only with the lower edge, but the mortality rate with such placentation is still high, ranging from 7 to 25 percent.

The reasons for marginal presentation may be related to the health of the mother and the development of the fetus. Only an examination will help to find out exactly what the exact cause of the pathology is.

How do you know if you have marginal placentation?

1. Bleeding – causeless or caused by minor reasons, bleeding is actually a sign of placental abruption, so any bleeding must be reported to the doctor

2. – indicates that the expectant mother may well experience constant bleeding, which affects the level of hemoglobin

Marginal placentation can only be determined by collecting a complete medical history of the pregnant woman, because this pathology is very difficult to determine in simple ways.

IMPORTANT TO UNDERSTAND: Defects in the development of the placenta, as well as its location, are not a fatal diagnosis, but an increased risk area. With this diagnosis, the expectant mother is usually monitored very carefully, which helps to avoid complications during childbirth. Therefore, it is very important to determine the diagnosis in advance and be prepared.

Update: October 2018

Placenta previa is rightfully considered one of the most serious obstetric pathologies, which is observed in 0.2 - 0.6% of all pregnancies resulting in childbirth. Why is this pregnancy complication dangerous?

First of all, placenta previa is dangerous due to bleeding, the intensity and duration of which no doctor can predict. That is why pregnant women with such obstetric pathology belong to a high-risk group and are carefully monitored by doctors.

What does placenta previa mean?

The placenta is a temporary organ and appears only during pregnancy. With the help of the placenta, the mother and fetus communicate, the child receives nutrients through its blood vessels and gas exchange occurs. If the pregnancy proceeds normally, the placenta is located in the area of ​​the fundus of the uterus or in the area of ​​its walls, usually along the back wall, moving to the sides (in these places the blood supply to the muscle layer is more intense).

Placenta previa is said to be present when the latter is located incorrectly in the uterus, in the area of ​​the lower segment. In fact, placenta previa is when it blocks the internal os, partially or completely, and is located below the presenting part of the baby, thus blocking the path for birth.

Types of choreon presentation

There are several classifications of the described obstetric pathology. The following is generally accepted:

Separately, it is worth highlighting low placentation or low placenta previa during pregnancy.

Low placentation- this is the localization of the placenta at a level of 5 or less centimeters from the internal os in the third trimester and at a level of 7 or less centimeters from the internal os during pregnancy up to 26 weeks.

A low location of the placenta is the most favorable option; bleeding during gestation and childbirth rarely occurs, and the placenta itself is prone to so-called migration, that is, an increase in the distance between it and the internal os. This is due to the stretching of the lower segment at the end of the second and third trimesters and the growth of the placenta in the direction that is better supplied with blood, that is, to the uterine fundus.

In addition, the presenting vessels are identified. In this case, the vessel/vessels are located in shells, which are located in the area of ​​the internal pharynx. This complication poses a threat to the fetus if the integrity of the vessel is damaged.

Provoking factors

The reasons that cause placenta previa can be associated both with the condition of the mother’s body and with the characteristics of the fetal egg. The main reason for the development of complications is degenerative processes in the uterine mucosa. Then the fertilized egg is not able to penetrate (implant) into the endometrium of the fundus and/or body of the uterus, which forces it to descend lower. Predisposing factors:

Chronic endometritis, numerous intrauterine manipulations (curettage and abortion), myomatous nodes lead to the formation of an incomplete second phase of the endometrium, in which it prepares for implantation of a fertilized egg. Therefore, when forming the chorion, she looks for the most favorable place, which is well supplied with blood and optimal for placentation.

The severity of the proteolytic properties of the embryo also plays a role. That is, if the mechanism for the formation of enzymes that dissolve the decidual layer of the endometrium is slowed down, then the egg does not have time to implant in the “right” part of the uterus (in the fundus or along the back wall) and descends lower, where it is implanted into the mucosa.

Symptoms of placenta previa

The course of pregnancy, complicated by placenta previa, is conventionally divided into “silent” and “pronounced” phases. The “silent” phase is practically asymptomatic. When measuring the abdomen, the height of the uterine fundus is greater than normal, which is due to the high location of the presenting part of the child. The fetus itself is often located incorrectly in the uterus; there is a high percentage of pelvic, oblique, transverse positions, which is due to the localization of the placenta in the lower part of the uterus (it “forces” the baby to take the correct position and presentation).

Symptoms of placenta previa are explained by its incorrect localization. The pathognomic sign of this obstetric complication is external bleeding. Bleeding from the uterus can occur at any stage of pregnancy, but more often in the last weeks of gestation. This has two reasons.

• Firstly, in term (Braxton-Hicks contractions), which promotes stretching of the lower part of the uterus (preparation for childbirth). The placenta, which does not have the ability to contract, “comes off” from the uterine wall, and bleeding begins from its ruptured vessels.
• Secondly, the “unfolding” of the lower segment of the uterus in the second half of pregnancy occurs intensively, but the placenta does not have time to grow to the appropriate size and it begins to “migrate,” which also causes placental abruption and bleeding.

Typically, bleeding always begins suddenly, often against the background of absolute rest, for example, in sleep. It is impossible to predict when bleeding will occur and how intense it will be.

Of course, the percentage of profuse bleeding with central presentation is much greater than with incomplete presentation, but this is not necessary. The longer the gestational age, the greater the chance of bleeding.

• For example, marginal placenta previa may not manifest itself at all at 20 weeks, and bleeding will occur (but not necessarily) only during childbirth.
• Low placentation most often occurs without clinical symptoms, pregnancy and childbirth proceed without any special features.

One of the typical characteristics of bleeding during presentation is its recurrence. That is, every pregnant woman should know about this and always be on guard.

• The volume of bleeding varies: from intense to insignificant.
• The color of the blood released is always scarlet, and the bleeding is painless.

Any minor factor can provoke bleeding:

• straining during bowel movements or urination
• cough
• sexual intercourse or vaginal examination

Another difference between placenta previa is the woman’s progressive anemia (see). The volume of blood lost almost always does not correspond to the degree of anemia, which is much higher. During repeated bleeding, the blood does not have time to regenerate, its volume remains low, which leads to reduced blood pressure, the development of disseminated intravascular coagulation syndrome or hypovolemic shock.

Due to the incorrect location of the placenta, progressive anemia and reduced volume of circulating blood, it develops, which leads to intrauterine growth retardation and the occurrence of intrauterine hypoxia.

Case study: A 35-year-old woman was seen at the antenatal clinic; she was pregnant for the second time and was wanted. At the first ultrasound at 12 weeks, she was diagnosed with central placenta previa. An explanatory conversation was held with the pregnant woman, and appropriate recommendations were given, but my colleague and I observed with fear and expectation of bleeding. During the entire period of pregnancy, she experienced bleeding only once, at 28–29 weeks, and even then, it was not bleeding, but minor bloody discharge. Almost the entire pregnancy, the woman was on sick leave; she was hospitalized in the pathology ward at dangerous times and during the period of bleeding. The woman safely reached term and at 36 weeks was sent to the maternity ward, where she successfully prepared for the upcoming planned caesarean section. But, as often happens, on a holiday she started bleeding. Therefore, an operating team was immediately convened. The baby was born wonderful, even without signs). The afterbirth was separated without problems, the uterus contracted well. The postoperative period also proceeded smoothly. Of course, everyone breathed a sigh of relief that such a huge burden had been lifted from their shoulders. But this case is rather atypical for central presentation, and the woman, one might say, was lucky that everything ended with little bloodshed.

How to diagnose?

Placenta previa is a hidden and dangerous pathology. If the pregnant woman has not yet had bleeding, then presentation can be suspected, but the diagnosis can only be confirmed using additional examination methods.

A carefully collected anamnesis (in the past there were complicated childbirths and/or the postpartum period, numerous abortions, diseases of the uterus and appendages, operations on the uterus, etc.), the course of the current pregnancy (often complicated by the threat of miscarriage) and external obstetric data helps to suggest a placenta previa. research.

During an external examination, the height of the uterine fundus is measured, which is greater than the expected gestational age, as well as abnormal position of the fetus or breech presentation. Palpation of the presenting part does not give clear sensations, as it is hidden under the placenta.

If a pregnant woman complains of bleeding, she is hospitalized in a hospital to exclude or confirm the diagnosis of such a pathology, where, if possible, an ultrasound is performed, preferably with a vaginal sensor. A speculum examination is carried out to determine the source of bloody discharge (from the cervix or varicose veins of the vagina).

The main condition that must be observed when examining with mirrors: the examination is carried out against the backdrop of a deployed operating room and always with heated mirrors, so that in case of increased bleeding, the operation can be started without delay.

Ultrasound remains the safest and most accurate method for determining this pathology. In 98% of cases, the diagnosis is confirmed; false positive results are observed when the bladder is overly full, so when examined with an ultrasound probe, the bladder should be moderately full.

Ultrasound examination allows not only to determine the presentation of the choreon, but also to determine its type, as well as the area of ​​the placenta. The timing of ultrasound examinations during the entire period of gestation is somewhat different from the timing of normal pregnancy and corresponds to 16, 24 - 26 and 34 - 36 weeks.

How pregnant women are managed and delivered

If placenta previa is confirmed, treatment depends on many circumstances. First of all, the period of pregnancy when bleeding occurred, its intensity, the amount of blood loss, the general condition of the pregnant woman and the readiness of the birth canal are taken into account.

If chorionic presentation was established in the first 16 weeks, there is no bleeding and the woman’s general condition does not suffer, then she is treated on an outpatient basis, having previously explained the risks and given the necessary recommendations (sexual rest, limitation of physical activity, prohibition of taking baths, visiting baths and saunas).

Upon reaching 24 weeks, the pregnant woman is hospitalized in a hospital, where preventive therapy is carried out. Also, all women with bleeding are subject to hospitalization, regardless of its intensity and stage of pregnancy. Treatment of the described obstetric pathology includes:

• medical and protective regime;
• treatment of fetoplacental insufficiency;
• anemia therapy;
• tocolysis (prevention of uterine contractions).

The protective treatment regime includes:

• prescription of sedatives (tincture of peony, motherwort or valerian)
• maximum restriction of physical activity (bed rest).
• Therapy of fetoplacental insufficiency prevents fetal development delay and consists of prescribing:
  • antiplatelet agents to improve the rheological qualities of blood (trental, chimes)
  • vitamins (folic acid, vitamins C and E)
  • , cocarboxylase
  • Essentiale-Forte and other metabolic drugs
  • It is mandatory to take iron supplements to increase hemoglobin (sorbifer-durule c, tardiferon and others).

Tocolytic therapy is carried out not only in the case of a threatened miscarriage or threatening premature birth, but also for the purpose of prevention, the following are indicated:

• antispasmodics (magne-B6, magnesium sulfate)
• tocolytics (ginipral, partusisten), which are administered intravenously.
• in the case of threatening or beginning premature labor, prevention of respiratory disorders with corticosteroids and (dexamethasone, hydrocortisone) is mandatory for a duration of 2–3 days.

If bleeding occurs, the intensity of which threatens the woman’s life, regardless of the gestational age and the condition of the fetus (dead or nonviable), abdominal delivery is performed.

What to do and how to deliver a child with chorionic presentation? Doctors ask this question when they reach 37–38 weeks. If there is a lateral or marginal presentation and there is no bleeding, then in this case the tactics are expectant (the beginning of spontaneous labor). When the cervix is ​​dilated by 3 centimeters, an amniotomy is performed for prophylactic purposes.

If bleeding occurs before the onset of regular contractions and there is a soft and distensible cervix, an amniotomy is also performed. In this case, the baby’s head lowers and is pressed against the entrance to the pelvis, and, accordingly, presses the detached lobules of the placenta, which causes the bleeding to stop. If the amniotomy has no effect, the woman is delivered abdominally.

Caesarean section is routinely performed for those pregnant women who have been diagnosed with complete presentation, or in the presence of incomplete presentation and concomitant pathology (improper position of the fetus, pelvic end presentation, age, uterine scar, etc.). Moreover, the surgical technique depends on which wall the placenta is located on. If the placenta is localized along the anterior wall, a corporal cesarean section is performed.

Complications

This obstetric pathology is very often complicated by the threat of miscarriage, intrauterine hypoxia, and delayed fetal development. In addition, placenta previa is often accompanied by its true accretion. In the third stage of labor and the early postpartum period, the risk of bleeding is high.

Case study: A multiparous woman was admitted to the obstetric department with complaints of bleeding for three hours from the birth canal. Diagnosis on admission: Pregnancy 32 weeks. Regional placenta previa. Intrauterine growth restriction of the 2nd degree (according to ultrasound). Uterine bleeding. The woman had no contractions, the fetal heartbeat was dull and irregular. My colleague and I immediately called the doctor. aviation, since it is still unclear how the matter might end other than a mandatory caesarean section. During the operation he was extracted alive. Attempts to remove the placenta were unsuccessful (true placenta accreta). The scope of the operation was expanded to hysterectomy (the uterus along with the cervix is ​​removed). The woman was transferred to the intensive care ward, where she remained for a day. The child died on the first day (prematurity plus intrauterine growth retardation). The woman was left without a uterus and a child. This is such a sad story, but, thank God, at least the mother was saved.

By the end of the 16th week of pregnancy, an organ is formed in the woman’s uterus - the placenta (baby place), which provides a connection between the body of the mother and the child. It is through it that intrauterine development, respiration and nutrition of the fetus, as well as the excretion of metabolic products are carried out.

Externally, the placenta resembles a disk, its diameter is 15-20 cm, its thickness is 2-4 cm, and its weight is 500-600 g, which is 1/6 of the weight of the fetus. During the normal course of pregnancy, its location is the area of ​​the uterus that is not adjacent to the pharynx, but there are often cases when the placenta lies in an incorrect way.

The fetal part of the organ is covered with villi, supplied by capillaries from the umbilical vessels, and the umbilical cord is attached to it. 180-320 spiral arteries pass through the maternal part of the organ into the placenta itself, through which maternal blood enters the intervillous space. Then the blood flows into the marginal sinus of the placenta and into the veins - thus blood flows in two directions.

Marginal placenta previa is referred to as incomplete presentation, in which the lower part of this organ is at the same level as the edge of the internal os.

Causes of marginal placenta

There are two groups of factors that provoke an abnormal location of the placenta in the body of a pregnant woman. The first group includes factors associated with the structural features of the fetal egg. As a result of a disruption in the process of trophoblast implantation and the late manifestation of enzymatic actions, the fertilized egg cannot be implanted in a timely manner in the upper part of the uterus, which results in the appearance of a marginal placenta.

The second group includes factors that depend on the health and characteristics of the pregnant woman’s body, namely:

• Pathological changes in the endometrium that disrupt the normal decidual reaction;
• Myoma or underdevelopment of the uterus;
• Endometriosis or endocervicitis;
• Multiple pregnancy.

If the attachment persists into the 28th week of pregnancy and beyond, this condition is called marginal placenta previa.

The marginal placenta can be detected using an ultrasound; the doctor may also suspect an anomaly based on the pregnant woman’s complaints.

Symptoms of marginal placenta

The main manifestation of marginal placenta previa is bloody discharge that occurs in the third trimester of pregnancy at 28-32 weeks, as well as directly during childbirth.

Bleeding with marginal placenta has a number of features - it begins suddenly without any external causes, and is also often not accompanied by pain. They can be repeated with greater or less frequency; it is quite difficult to determine in advance what their duration and strength will be. When the marginal sinus of the placenta ruptures, presentation is accompanied by particularly severe bleeding.

When diagnosing marginal attachment of the placenta, the expectant mother requires frequent and careful medical supervision, as well as timely completion of all necessary studies. Often, pregnant women's hemoglobin begins to decrease, so they are prescribed medications containing iron. This is the only way to avoid frequent bleeding and the rapid development of anemia.

Consequences of marginal placental attachment

This pathology is fraught with bleeding; there is a high probability that the child may compress the placenta during childbirth, thereby stopping the access of oxygen to itself.

If a diagnosis of “marginal placenta” is made, doctors will insist on delivery by cesarean section. Fortunately, if premature placental abruption does not occur, the pathology does not affect the development of the baby in any way.

Regional placenta previa: treatment

There are several ways to raise the marginal placenta - this can be drug treatment or physical therapy in the form of electrophoresis with vitamins. When treating marginal placenta previa, it is recommended that a woman wear a special bandage, take a knee-elbow position for a few minutes every day (4-5 times a day), and also avoid even minimal physical activity and sexual intercourse.

If you follow your doctor's recommendations, there is a good chance that the placenta will rise to a sufficient level, so many are able to avoid a cesarean section or complications during childbirth. According to statistics, in 5% of cases after 32 weeks of pregnancy, the marginal placenta is preserved, so timely treatment can guarantee a completely successful birth.

Marginal placenta is a presentation that significantly complicates labor. With this condition, the probability of perinatal death is 7-25%, depending on the age of the pregnant woman. This pathology occurs mainly in multiparous women and is accompanied by multiple bleedings.

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