Rus Articles Journal

Childbirth with ``obstacle``. What is the prelying of a placenta?

the Placenta are the body located in a uterus and functioning only during pregnancy. Exactly thanks to it there is possible a normal development of pregnancy before the childbirth therefore it is important that the placenta “worked“ normally. At the same time matters not only the correct structure of a placenta, but also its correct arrangement. Prelying of a placenta - serious complication of pregnancy which, fortunately, meets not really often.

the Placenta is put by

at the very beginning of pregnancy and completely formed by 16 weeks. It provides food of a fruit, removal of products of a metabolism, and also carries out for it function of lungs since through a placenta the fruit receives the oxygen necessary for his life. Besides, the placenta is the real “hormonal factory“: here the hormones providing preservation, normal development of pregnancy, growth and development of a fruit are formed.

the Placenta consists from vorsin - structures in which there pass vessels. In process of pregnancy development quantity vorsin, and respectively, and the number of vessels constantly grows.

placenta Arrangement: the norm and pathology

from a uterus in the place of an attachment of a placenta is available a thickening of an internal cover. In it deepenings which form interfleecy space are formed. Some vorsina of a placenta grow together with maternal fabrics (they are called anchor), the others are shipped in the maternal blood filling interfleecy space. To partitions of interfleecy spaces anchor vorsina of a placenta also fasten, in the thickness of partitions there pass vessels which bear the arterial maternal blood saturated with oxygen and nutrients.

Vorsina`s

of a placenta are allocated by special substances - enzymes which “melt“ the small arterial vessels bearing maternal blood therefore blood from them streams in interfleecy space. Exactly there is also an exchange between blood of a fruit and mother: by means of difficult mechanisms in blood of a fruit oxygen and nutrients, and come to mother`s blood - fruit exchange products. Connection of a fruit with a placenta is carried out by means of an umbilical cord. One its end is attached to umbilical area of a fruit, another - to a placenta. In an umbilical cord there pass two arteries and a vein bearing blood respectively from a fruit to a placenta and back. On an umbilical cord vein to a fruit blood rich with oxygen and nutrients flows, and on arteries the blue blood from a fruit containing carbonic acid and products of a metabolism flows.

Normal the placenta settles down closer to a uterus bottom on a lobby or, more rare, its back wall. It is caused by more favorable conditions for development of fetal egg in this area. The mechanism of the choice of the place of an attachment of fetal egg is up to the end not clear: there is an opinion that in the choice of the place gravitation force plays a role - for example if the woman sleeps on the right side, then egg is attached to the right wall of a uterus. But it is only one of theories. It is unambiguously possible to tell only that fetal egg is not attached in adverse for this place, for example in the locations of miomatozny knots or to places of damage of an internal cover of a uterus as a result of the previous vyskablivaniye. Therefore also other options of an arrangement of a placenta at which the placenta is formed closer to the lower part of a uterus meet. Allocate a low arrangement of a placenta and prelying of a placenta.

About a low arrangement of a placenta is told when its bottom edge is at distance no more than 6 cm from an internal pharynx of a neck of a uterus. This diagnosis is established, as a rule, during ultrasonography. And in the second trimester of pregnancy the frequency of this pathology is about 10 times higher, than in the third trimester. It is quite simple to explain it. Conditionally this phenomenon is called “migration“ of a placenta. Actually there is a following: fabrics of the lower part of a uterus, very elastic, with increase in term of pregnancy are exposed to considerable stretching and are extended up. As a result of it the bottom edge of a placenta as if moves up, and as a result the arrangement of a placenta becomes normal.

Predlezhany placentae - more serious diagnosis. In Latin this state is called placenta praevia.“ Pre via“ in a literal translation means before life. In other words, the term “prelying of a placenta“ means that the placenta is on the way of emergence of new life.

Predlezhany placentae happens full or central when all placenta settles down in the lower part of a uterus and completely blocks an internal pharynx of a neck of a uterus. Besides, partial prelying of a placenta meets. Regional and lateral prelying concerns to him. Tell about lateral prelying of a placenta when to 2/3 exhaust outlets of a uterus are closed by placenta fabric. At regional prelying of a placenta no more l/3 of an opening is closed.

of the Reason of anomalies

changes of an internal wall of a uterus therefore process of an attachment of the impregnated ovum is broken are the Main reason for anomalies of an attachment of a placenta.

These changes are most often caused by the inflammatory process of a uterus arising against a scraping of a cavity of a uterus, abortion or connected with infections, sexually transmitted. Besides, the deformation of a cavity of a uterus caused by either congenital anomalies of development of this body, or the acquired reasons - uterus myoma (a benign tumor of a uterus) contributes to development of similar pathology of a placenta.

Predlezhany placentae can also occur at the women having serious diseases of heart, liver and kidneys as a result of developments of stagnation in bodies of a small pelvis including in a uterus. That is these diseases in a wall of a uterus are resulted by sites with the worst, than other sites, blood supply conditions.

Predlezhany placentae of povtornorodyashchy meets almost three times more often than at women, bearing the firstborn. It can be explained with “baggage of diseases“ including gynecologic which are got by the woman to age of the second childbirth.

the opinion that this pathology of an arrangement of a placenta can be connected with violation of some functions of the most fetal egg therefore it cannot be attached in a site of a uterus, optimum for development, Is and begins to develop in its lower segment.

It is careful, bleeding!
Bleeding when prelying a placenta has the features. It is always external, i.e. blood streams outside via the channel of a neck of a uterus, but does not accumulate between a wall of a uterus and a placenta in the form of a hematoma.
Begin such bleedings always suddenly, as a rule, without the visible external reason, and are not followed by any pain. It distinguishes them from the bleedings connected with premature interruption of pregnancy when along with bloody allocations there are always skhvatkoobrazny pains.
Often bleeding begins at rest, at night (woke up “in a blood pool“). Once having arisen, bleedings always repeat, with a bigger or smaller frequency. And it is never impossible to expect in advance what will be the following bleeding on force and duration.
After 26 - 28 weeks of pregnancy similar bleedings can be provoked by physical activity, sexual intercourse, any increase of intra belly pressure (even cough, a natuzhivaniye and sometimes - survey of the gynecologist). In this regard inspection on the woman`s chair with prelying of a placenta has to be performed with observance of all precautionary measures in the conditions of a hospital where it is possible to give the emergency help in a case of emergence of bleeding. Bleeding is life-threatening mother and the kid.
Quite often prelying of a placenta can be combined by

with its dense attachment therefore the independent office of a placenta after the delivery is at a loss.

Should note

that the diagnosis of prelying of a placenta, except for its central option, quite correct will only be closer to childbirth since the provision of a placenta can change. All this is connected with the same phenomenon of “migration“ of a placenta at the expense of which at stretching of the lower segment of a uterus at the end of pregnancy and in labor the placenta can be removed from area of an internal pharynx and not interfere with normal childbirth.

Symptoms and possible complications

the Main complications and the only manifestations of prelying of a placenta are bloody allocations. Depending on a type of prelying bleeding can arise for the first time during various periods of pregnancy or in labor. So, at the central (full) prelying of a placenta of bleeding quite often begin early - in the second trimester of pregnancy; at lateral and regional options - in the third trimester or directly in labor. Bleeding force also depends on prelying option. At full prelying of bleeding usually more plentiful, than at incomplete option.

Most often bleedings develop at pregnancy term 28 - 32 weeks when preparatory activity of the lower segment of a uterus is most expressed. But every fifth pregnant woman with the diagnosis of prelying of a placenta notes emergence of bleeding in early terms (16 - 28 weeks of pregnancy).

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C what connected emergence of bleeding when prelying a placenta? During pregnancy the uterus sizes constantly increase. Before pregnancy they are comparable to the matchbox sizes, and by the end of pregnancy the weight of a uterus reaches 1000, and its sizes correspond to the fruit sizes together with a placenta, amniotic waters and covers. Such increase, generally due to increase in volume of each fiber forming a uterus wall is reached. But the maximum change of the size happens in the lower segment of a uterus which stretches the more, than the term of childbirth is closer. Therefore if the placenta is located in this area, then process of “migration“ goes very quickly, low-elastic fabric of a placenta does not manage to adapt to quickly changing size of subject uterus wall, and there is an otsloyka of a placenta on a bigger or smaller extent. In the place of an otsloyka there is a damage of vessels and, respectively, bleeding.

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When prelying a placenta quite often note pregnancy interruption threat: the raised tone of a uterus, pain in the bottom of a stomach and in a waist. Quite often at such arrangement of a placenta pregnant women have hypotonia - steadily reduced pressure. And pressure decline, in turn, reduces working capacity, causes emergence of weakness, feeling of weakness, increases probability of development of faints, emergence of a headache.

in the presence of bleedings anemia - decrease in level of hemoglobin in blood often comes to light. Anemia can aggravate hypotonia symptoms, besides, the deficiency of oxygen caused by decrease in level of hemoglobin adversely affects development of a fruit. Growth lag, the fruit growth inhibition syndrome (FGIS) can be observed. Besides, it is proved that the children who were born from mothers who had during pregnancy anemia on the first year of life always have the reduced hemoglobin level. And it, in turn, reduces protective forces of an organism of the kid and leads to frequent infectious diseases.

Because the placenta is located in the lower segment of a uterus, the fruit often holds the wrong position - cross or slanting. Quite often also pelvic prelying of a fruit when to an exit from a uterus his buttocks or legs, but not a head, as usual are turned meets. All this complicates or even makes impossible the child`s birth in the natural way, without surgery.

Diagnostics of prelying of a placenta

Diagnosis of this pathology most often does not present to

difficulties. It usually is established in the second trimester of pregnancy on the basis of complaints to periodically arising bleedings without pain.

the Doctor on survey or during ultrasonography can reveal the wrong provision of a fruit in a uterus. Besides, at the expense of a low arrangement of a placenta the underlying part of the child cannot fall to the lower part of a uterus therefore a characteristic sign also is high standing of the prelying part of the child over an entrance to a small pelvis. Of course, modern doctors are in much more advantageous situation in comparison with the colleagues 20 - 30 years ago. At that time obstetricians - to gynecologists had to be guided only on these signs. After introduction in broad practice of ultrasonic diagnostics the task considerably became simpler. This method is objective and safe; Ultrasonography allows to gain with a fine precision an impression about an arrangement and movement of a placenta. For these purposes it is expedient triple ultrasonography - control in 16, 24 - 26 and in 34 - 36 weeks. If according to ultrasonic research placenta arrangement pathology does not come to light, the doctor at survey can establish other reasons of bloody allocations. Various pathological processes in a vagina and a neck of a uterus can be them.

Supervision and treatment of prelying of a placenta

Future mother to whom the diagnosis of prelying of a placenta is made needs careful medical supervision. Special importance is gained by timely carrying out clinical trials. At identification even of slightly reduced level of hemoglobin or violations in system of fibrillation to the woman appoint iron preparations since in this case there is always a risk of fast development of anemia and bleeding. At identification of any, even insignificant, deviations in a state of health consultations of the corresponding experts are necessary.

Predlezhany placentae - terrible pathology, one of the main reasons for serious obstetric bleedings. Therefore in case of development of bleeding all available for the woman, even small, problems with health, can aggravate its state and lead to adverse effects.

the Mode plus a diet
If do not have
of bleedings, especially at partial option of prelying of a placenta, the woman can be observed in out-patient conditions.
In this case is recommended observance of the sparing mode: it is necessary to avoid physical and emotional activities, to exclude sexual contacts. It is necessary to sleep not less than 8 hours a day, to be more in the fresh air.
In a diet surely have to be the products rich with iron: buckwheat, beef, apples, etc. Sufficient protein content since even at big receipt in an iron organism hemoglobin will be left low without it is obligatory: in the absence of protein iron is badly acquired. It is regularly useful to eat vegetables and fruit rich with cellulose since the delay of a chair can provoke emergence of bloody allocations. A depletive when prelying a placenta is contraindicated. As well as to all pregnant women, patients with prelying of a placenta special polyvitaminic preparations are appointed. At observance of all these conditions manifestations of all symptoms described above accompanying in most cases prelying of a placenta decrease so, conditions for normal growth and development of the child are provided. Besides, in case of bleedings adaptation opportunities of an organism of the woman raise, and blood loss is transferred easier.
supervision and treatment of pregnant women with prelying of a placenta on pregnancy terms is carried out over 24 weeks by

in the presence of bloody allocations only in the obstetric hospitals having conditions for rendering the emergency help in conditions of intensive care unit. Even if bleeding stopped, the pregnant woman remains under supervision of doctors of a hospital to the term of childbirth.

In this case treatment is carried out by

depending on force and duration of bleeding, term of pregnancy, the general condition of the woman and a fruit. If bleeding insignificant, pregnancy premature and the woman feels well, conservative treatment is carried out. The high bed rest, preparations for decrease in a tone of a uterus, ul are appointedblood circulation uchsheniye. In the presence of anemia the woman accepts the preparations increasing hemoglobin level, all-strengthening preparations. For decrease in an emotional pressure sedatives are used.

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Childbirth

At full prelying of a placenta, even in the absence of bleeding, performs operation of Cesarean section on the term of pregnancy of 38 weeks since spontaneous childbirth in this case is impossible. The placenta is located on the way of an exit of the child from a uterus, and in attempt of independent childbirth there will be its full otsloyka to development of very severe bleeding that threatens with death of both a fruit, and mother.

also resort To operation on any term of pregnancy in the presence of the following conditions:

  • the prelying of a placenta which is followed by considerable bleeding, life-threatening;
  • the repeating bleedings with anemia and the expressed hypotonia which are not eliminated with purpose of special preparations and are combined by
  • with violation of a condition of a fruit.
operation of Cesarean section is performed by

In a planned order on the term of 38 weeks at a combination of partial prelying of a placenta to other pathology even in the absence of bleeding.

If the pregnant woman with partial prelying of a placenta informed

of pregnancy the term of childbirth, in the absence of considerable bleeding it is possible that childbirth will happen in the natural way. At disclosure of a neck of a uterus on 5 - 6 cm the doctor will finally define option of prelying of a placenta. At small partial prelying and insignificant bloody allocations opening of a fetal bubble is carried out. After this manipulation the head of a fruit falls and presses the bleeding vessels. Bleeding stops. In this case completion of childbirth is possible in the natural way. At inefficiency of the held events childbirth comes to the end quickly.

Unfortunately, after the birth of the child remains risk of development of bleeding. It is connected with decrease in sokratitelny ability of fabrics of the lower segment of a uterus where the placenta, and also with existence of hypotonia and anemia which were already mentioned above settled down. Besides, it was already told about a frequent combination of prelying and a dense attachment of a placenta. In this case the placenta after the delivery cannot separate independently completely from walls of a uterus and it is necessary to conduct manual examination of a uterus and office of a placenta (manipulation is carried out under the general anesthesia). Therefore after the delivery the women who had prelying of a placenta remain under fixed control of doctors of a hospital and have to implement all their recommendations carefully.

Infrequently, but nevertheless cases when, despite all efforts of doctors and the performed operation of Cesarean section, bleeding does not stop happen. In this case it is necessary to resort to removal of a uterus. Sometimes it is the only way to keep the woman`s life.

of the Precautionary measure

Should be noted also that when prelying a placenta it must be kept in mind a possibility of development of severe bleeding always. Therefore it is necessary to discuss with the doctor in advance what to do in that case to what hospital to go. To stay at home even if bleeding not plentiful, is dangerous. If there is no preliminary arrangement, it is necessary to go to the nearest maternity hospital. Besides, when prelying a placenta quite often it is necessary to resort to blood transfusion therefore if made you such diagnosis, learn in advance which of relatives has the same blood type, as you, and obtain its consent if necessary to take for you a blood test (the relative has to make tests on HIV, syphilis, hepatitises in advance).

Can agree in a hospital where you will be observed that your relatives took for you a blood test in advance. At the same time it is necessary to secure with a guarantee of that blood was used for you - and only if it is not required to you, she will be transferred to the general bank of blood. It would be ideal that a blood test was taken for yourself by you, but it is possible only if your state does not cause fears, all indicators normal and are not present bloody allocations. A blood test for storage can be taken several times during pregnancy, however at the same time guarantees are also necessary that your blood will not be used without your permission.

Though prelying of a placenta - the serious diagnosis, modern medicine allows to take out and give birth to the healthy child, but only on condition of timely diagnostics of this complication and at strict observance of all appointments of the doctor.

When everything will be already behind and you with the kid will appear at home, try to organize the life correctly. Try to have a rest more, eat properly, surely walk with the kid. Do not forget about polyvitamins and preparations for treatment of anemia. Whenever possible, do not refuse breastfeeding. It not only will lay the foundation for health of the kid, but also will accelerate restoration of your organism since stimulation of a nipple when sucking forces a uterus to be reduced, reducing risk of postnatal bleedings and inflammations of a uterus. It is desirable that at first someone helped you with care of the child and household chores, your organism transferred difficult pregnancy, and it needs to be restored.