Placenta previa

Placenta previa is a certain complication during pregnancy.

The placenta is a round, smooth organ that forms during pregnancy to provide the fetus with nutrients and oxygen. It is formed immediately after the fertilization of the egg on the inner wall of the uterus and with the normal course of pregnancy far enough from the cervix. But sometimes it happens that it partially or completely covers the cervix. In this case, the diagnosis is a placenta previa.

[1], [2]

What triggers placenta previa and how to reduce the risk of developing this pathology?

The reasons for the development of placenta praevia have not yet been established, but experts agree that the prevention of this pathology includes a reduction in risk factors, although some of them can not be controlled.

Controlled risk factors:

• smoking during pregnancy;
• taking cocaine.

Uncontrolled risk factors:

• operations on the uterus in the past that could change the shape of the uterus - scraping the uterine cavity, myomectomy;
• cesarean section;
• 5 or more pregnancies;
• age after 35 years;
• placenta previa during pregnancy in the past.

If before the 20th week of pregnancy the attending physician discovers placenta previa, it is likely that the situation can correct before delivery: in 9 out of 10 cases of placenta previa, which are diagnosed before 20 weeks, the pregnancy ends normally. This is because the uterus grows, and consequently the position of the placenta changes.

Symptoms of placenta previa

With placenta previa, one or more of the following symptoms can be observed:

• sudden painless vaginal bleeding, the intensity of which varies from mild to severe, while the blood has a bright color; bleeding can occur before the 20th week of pregnancy, but also often appears in the third trimester;
• Symptoms of premature birth: one in five women with placenta previa have contractions of the uterus.

Bleeding as a result of placenta previa can stop for a while, but almost always again resumes in a few days or weeks. Sometimes this pathology does not provoke any symptoms, and this pathology is diagnosed only during ultrasound.

Call an ambulance or go to the nearest admissions office when:

• mild or severe bleeding in the first trimester of pregnancy;
• vaginal bleeding in the second or third trimester of pregnancy.

Complications of placenta praevia

Placental presentation can cause a number of problems:

• premature placental abruption;
• severe vaginal bleeding before or during labor;
• augmentation of the placenta;
• if you can not stop bleeding, you may need to remove the uterus;
• need to extract a premature baby;
• congenital anomalies of the fetus.

[3]

Diagnosis of placenta praevia

Ultrasound is used to diagnose placenta previa (partial or total overlapping of the cervix), but the location of the placenta is not always determined. Vaginal examination should be performed only when a cesarean section is planned, as the intervention can cause severe bleeding and worsen the condition of the woman and put the fetus at risk. Usually, the fetal heartbeat is monitored to immediately detect a distress syndrome. If a decision is made about early removal of the fetus, an amniocentesis (puncture of the bladder) should be performed to determine the condition of the lungs and their ability to function independently. During this procedure, a sample of amniotic fluid from the fetal bladder is taken and a laboratory analysis is performed, the results of which indicate the degree of maturity of the lungs of the child.

[4], [5], [6]

Treatment of placenta praevia

Treatment of placenta previa depends on:

• severity of bleeding;
• the impact of the problem on the general condition of women and children;
• term of pregnancy.

In the absence of bleeding, it is important to keep from sexual relations, and if you have such a bleeding immediately go to the doctor who will make a thorough gynecological examination. When bleeding a pregnant woman is hospitalized. If, with severe bleeding, there is a threat to the life of a woman or child who can be considered complete, the doctor decides to immediately remove the fetus by caesarean section, since there is a deterioration in the vaginal delivery.

If a placenta previa is diagnosed, the treatment depends on:

• the severity of the bleeding (it is important that the woman is at home or in the hospital), the need for blood transfusions and early fetal extraction;
• the general condition of the pregnant woman (the development of anemia as a result of a large loss of blood);
• the maturity of the fetus and its physical condition (if possible, the extraction of the fetus is postponed until the lungs can not function themselves);
• the degree of blocking of the cervix by the placenta (a caesarean section is usually done, since during the vaginal births it is possible to increase bleeding and worsen the condition of the woman).

If a placenta previa is diagnosed and there is no bleeding, a woman should follow the recommendations:

• avoid physical exertion (do not lift weights and do not run);
• go to the doctor at the first occurrence of bleeding, and again remind him of placenta previa;
• have the phone handy for an emergency;
• if necessary, to warn doctors about placenta previa and not consent to a vaginal examination;
• to abstain from sexual relations after 28 weeks of pregnancy, and until 28 weeks to consult a doctor about the possibility of risk;
• Do not use tampons and do not rinse the vagina;
• be near the maternity hospital in case of the need to provide urgent medical assistance to the woman herself whether the premature baby.

If a placenta previa is diagnosed and bleeding begins, you should go to the hospital, where proper care is provided and all emergency measures taken. If the child is full, a cesarean section is performed, but it can be postponed for a while, when the bleeding decreases or stops. The possibility of observation depends on many factors:

• if the gestation period is 24-34 weeks: 1) corticosteroids are prescribed to accelerate the fetal lung maturation and prepare for premature birth; 2) Amiocentesis is performed (analysis of the amniotic fluid, which shows the degree of maturity of the fetal lungs); 3) iron-containing preparations are prescribed for the prevention of anemia; 4) recommended foods rich in fiber, as well as light laxatives to exclude any stress while visiting the toilet; 5) Rhesus-antibodies are inoculated with a negative Rh factor, as the fetus can have a positive Rh, and when the blood is mixed, the immune system of a woman can begin to reject the fetus;
• if the bleeding does not stop, be ready for hospitalization and constant monitoring until the fetus ripens; with a moderate loss of blood, blood transfusion is performed;
• when observing contractions of the uterus, tocolytic drugs are introduced, which reduce labor activity;
• if it happens that stopping bleeding is not possible, an emergency cesarean section and blood transfusion are performed (the only possible way out of the situation).

Childbirth

With the placenta previa, a caesarean section is made. According to statistics, in 25 out of 100 cases of placenta previa the child is born prematurely (before 37 weeks of pregnancy). The state of the child in this case is envy of the degree of his maturity. If the baby was born prematurely, he is for some time in intensive care (from several days to several weeks), depending on the severity of the condition. The child is supervised by a neonatologist or perinatologist.

[7], [8], [9]

Home Treatment

During pregnancy, vaginal bleeding is not excluded. Sudden painless bleeding may be the only symptom of placenta previa, which partially or completely blocks the cervix. Immediately call for an ambulance in case of severe vaginal bleeding - allocation of blood clots and the need to change the gasket every two hours (you can not use tampons). Call the attending physician or go to the nearest admissions department at the first sign of vaginal bleeding.

History

If during the previous pregnancy there was a placenta previa, you may have many questions about the next pregnancy. Depending on the state of health of the woman, the doctor will answer all the questions of interest. In rare cases, as a result of this pathology, a child can be born dead. If this happens, give yourself time to burn and mourn the loss. Be prepared for the fact that your spouse, children and family members will also grieve. Attend support groups, socialize with other women who have experienced a similar grief, talk with family members or a psychologist.