Low placentation in pregnancy

Low placentation in pregnancy is a problem that often causes bleeding in late pregnancy and can cause complications of labor. This pathology is characterized by abnormal attachment of the placenta, which can develop for various reasons. Knowing the main symptoms and clinical manifestations of the disease will promptly seek help and keep your health and baby's health.

[1], [2], [3], [4]

Epidemiology

Epidemiology of complications of pregnancy with low placentation is such that only 15% of cases can be complicated by bleeding or threat. In most women, this problem is asymptomatic and the birth is good. Among the etiological factors of low placentation, surgical interventions and frequent abortions are the first in terms of prevalence, which should be taken into account and the risk groups of this pathology identified.

[5], [6], [7]

Causes of the low placentation in pregnancy

To understand the main reasons for the development of this pathology, it is necessary to understand how placentation occurs in normal conditions. The placenta is the place where the baby "lives" and develops all his time. By its structure, the placenta is a connective tissue that contains many vessels. This is necessary for good blood circulation of the fetus and sufficient nutrition, as all the nutritious foods enter the bloodstream, and then to the baby. One of the main functions of the placenta is protection from external factors, as it is a very serious barrier to viruses, bacteria, toxins, drugs. Therefore, in order to ensure that all functions of the placenta performed normally, it is necessary to have its correct location. In normal conditions, the placenta is attached to the bottom of the uterus or to its posterior wall. This ensures normal blood flow, the vessels are not pinched and the child receives all the beneficial substances. The uterine base and the posterior wall have a very dense layer of the endometrium, and when the placenta is attached at this site, it is very tightly fixed until the time of delivery. There is no risk of delamination of the placenta or other complications. In any case, the placenta should be attached so that it is 7 cm above the internal pharynx. Then it's about the normal attachment of the placenta. If the placenta is below seven centimeters, but at the same time does not overlap the pharynx, then it is a question of low placentation. Sometimes the placenta covers the inner throat partially or completely, then this placenta previa is a more complicated case.

The reasons for this abnormal location of the placenta may be different. In the first place in the prevalence can be considered inflammatory diseases of the internal genital organs of a woman.

Among other causes of low placentation can be called congenital defects of the uterus, which violate the entire topic of the organ and do not allow normal placentation. Very often girls with congenital defects of the uterus are born, which are not critical and a girl can conceive and bear a healthy child. To such vices it is possible to carry a two-horned uterus, a one-horny uterus, a hypoplasia of the uterus. At the same time, the normal structure of the uterus is broken and the fertilized egg can not be implanted in one horn, as the blood circulation will be violated as the fetus grows. Therefore implantation occurs a little lower, where the placenta will later be formed, which is the cause of low placentation.

Operative interventions on the uterus also often change the topic of the organ. In certain cases, can carry out operations for fibroids with partial resection of myometrium. This leads to the fact that in the day there can not be a normal attachment of the placenta. Sometimes a simple suture on the uterus after caesarean section can cause low placentation.

Uterine fibroids may be another cause of low placentation. This disease is characterized by the formation of a good-quality seal in the thickness of the myometrium or the formation of a node. Such nodes can form in one horn, which directly interferes with normal placentation.

The age of a woman directly affects the development of a normal pregnancy. If the first pregnancy in a woman after 35 years, only this can cause low placentation. After all, with normal blood circulation in the uterus is disrupted and this prevents normal placentation.

[8], [9], [10], [11]

Risk factors

Based on these reasons, we can identify the main risk factors for low placentation in women during pregnancy, which must be considered for timely prevention of complications. Such risk factors include:

1. chronic inflammatory diseases of internal genital organs;
2. surgical interventions on the uterus;
3. uterine fibroids;
4. congenital malformations of the uterus;
5. the first pregnancy at an elderly age;
6. frequent abortions or miscarriages in the anamnesis;
7. heavy physical work of mother before pregnancy or on early terms.

Such risk factors may not lead to low placentation, but if they are, then with these mummies you must necessarily carry out thorough examinations and prevent these problems.

[12], [13], [14]

Pathogenesis

The pathogenesis of the development of such a problem in such diseases is the violation of the structure of the endometrium under the influence of prolonged inflammation. If we are talking about chronic infections or transferred acute endometritis, then the inflammatory cells constantly support the pathological focus. In response to such interference, the synthesis of connective tissue may become more active, which can cause a disruption in the structure of the endometrium. Because of this, the fetal egg can not be implanted in the bottom area, since the connective tissue does not allow penetration into the depth of the endometrium. Therefore, the fetus is looking for a place where the blood circulation is slightly better and can be implanted below, where the placenta will subsequently develop. Thus inflammatory processes in the uterus and promote low placentation.

[15], [16], [17], [18], [19]

Symptoms of the low placentation in pregnancy

The first signs of low placentation may appear only in the third trimester, when the size of the fetus is such that the placenta may flake slightly. Then only there can be signs, or any changes can and not be before sorts.

Low placenta in the early stages of pregnancy is not manifested if the woman has no heavy loads. At the same time the child develops normally, he has sufficient blood circulation and nutrition. When the child's weight grows, his needs also grow. He can move more actively, and if a woman makes some sharp movement or something podymet, then this can disrupt the connection of the placenta with the endometrium. Then the first symptoms may appear.

Manifestations of low placentation are often the discharge of blood from the vagina. This can occur at any time, but more often in the second half of pregnancy. Such spotting appears after active walking or physical activity. Excretions are not accompanied by increased uterine tone or pains in the lower abdomen. In addition to such insignificant discharges, a woman can not disturb anything more. Blood appears due to the fact that if the placenta is located low, then under certain loads it can exfoliate and secrete blood. Its number may be small, as well as a small part of the detachment, so the discharge may cease by itself. But even then, you need to see a doctor.

If the detachment is significant, then there is a heavy bleeding. This may be dizziness, fatigue, headache, fainting. This is due to severe blood loss.

Low placentation in pregnancy on the back wall is more dangerous, since complications occur more often. In this bleeding may be internal and external signs may not be. Blood can accumulate outside the zone of the placenta detachment and may not go out because of the squeezing of the fetus. Therefore, no bloody discharge may not be. But at the same time due to the accumulation of blood there may be a feeling of pressure in the lower abdomen or a minor pain. It is not expressed, but constant and intensified with time.

Symptoms of low placentation during pregnancy may not manifest at all until the period of childbirth. Already during labor during labor there may be a slight detachment of the placenta, since it is located low and the fetus can move under the action of fights. Then there may be a slight bleeding, which requires an immediate response from doctors.

Complications and consequences

Low placentation in pregnancy twins is often, because both placentas can not attach properly, they just do not have enough space. In this case complications occur less often, since compression of the uterus from all sides by two fruits does not allow the placenta to peel off. Only during childbirth can the first symptoms appear, when already one fruit has come out and pulled the other placenta.

Bleeding at low placentation during pregnancy is the most common symptom, so you should pay attention to it regardless of the term.

Complications that can develop against a background of low placenta and which are the most threatening is the detachment of the placenta. When a child grows, its size also increases. Such a fetus can actively move and with sudden movements, especially against the background of a short umbilical cord, there may be a placenta detachment, because at this point it is not tightly attached to the endometrium. This is accompanied by bleeding, which threatens the termination of pregnancy. Sometimes there can be no external bleeding, and then the blood accumulates behind the uterine cavity. This leads to the formation of a hematoma and on the eyes of a woman's condition worsens, and the cause is difficult to establish. The consequence of such a hematoma may be the formation of the uterus of Kuveler, when the blood percolates all layers of the uterus and such a myometrium can no longer contract. It threatens with great bleeding, so the only treatment is to remove the uterus.

[20], [21], [22], [23], [24]

Diagnostics of the low placentation in pregnancy

Diagnosis of low placentation during pregnancy can be final only in the second trimester, when the formation of the placenta is completely over. It is important to know about the notion of the significance of this pathology. Low placentation may be in a woman throughout pregnancy, but it does not cause any symptoms and the birth is good. And vice versa - low placentation can cause bleeding in the first half of pregnancy, then it is considered a significant diagnosis. Therefore, if such a pathology is established in the first half, then you just need to know what it is and prevent complications. After all, until the end of pregnancy, there may not be symptoms. And if the diagnosis is established already with the appearance of bleeding or other symptoms, then we need to talk about treatment. Therefore, the diagnosis period is not as important as the symptomatology of pathology.

In any case, routine examinations of the pregnant woman allow to reveal pathology in time. Therefore, if you do not deviate from normal pregnancy management, then no special examinations are required.

If there are complaints from a woman in the form of bloody discharge, then you need to carefully examine the woman on the armchair or couch. Under normal conditions, palpation can not reach the edge of the placenta through the internal pharynx. If at a palpation a small part of the placenta is determined, then it is already possible to suspect a low placentation or presentation. At low placentas, the tone of the uterus is not increased and there are no pains during palpation.

Analyzes that need to be carried out are not specific. Since the placenta is located low, that is, the risk of infection. Therefore, it is important to carry out a vaginal secretion study with the exception of the inflammatory process of the vagina or uterus.

[25], [26], [27], [28], [29]

Differential diagnosis

Instrumental diagnosis of pathology is very important also for the purpose of differential diagnosis. The main method of diagnosing this pathology is ultrasound. This method allows you to specify how the placenta is located, what distance from the internal throat, whether there is no presentation. Also with the help of ultrasound it is possible to study blood circulation in the placenta. If there is a suspicion of retroplacental hematoma, then on the ultrasound will be visualized a focus of enhanced echogenicity in the area of placental abruption.

After the thirtieth week for more accurate diagnosis of the fetus, cardiotocography should be performed. This is a method that allows you to diagnose the movement of the fetus, the heart rate, the tone of the uterus. This allows you to exclude premature birth, as the cause of bloody discharge.

Differential diagnosis of low placentation at an early stage should be conducted primarily with the threat of abortion. These pathologies are accompanied by identical discharges of blood from the vagina. But unlike low placentation, the threat is accompanied by pain and pulling in the lower abdomen and increased tone of the uterus. This is due to the fact that the uterus shrinks in an attempt to expel the fetus. With low placentation and tone of the uterus, and pain is not expressed. At a later date and directly in childbirth, low placenta should differentiate with full or partial placenta previa. During palpation with full presentation, the internal pharynx will completely cover the placenta, while a low placenta is accompanied only by a slight palpation of the placenta tissue. The most accurate way to differentiate these pathologies is through ultrasound.

Diagnosis of low placentation should be by ultrasound, and not when symptoms appear. Only in this case it is possible to avoid complications by preventing a woman and preventing.

Treatment of the low placentation in pregnancy

Active treatment of such pathology can be used in case if symptoms are expressed or there is data on bleeding. Then use medicamentous drugs that are aimed at stopping bleeding, improving uteroplacental blood circulation and maintaining pregnancy. Women with such a diagnosis necessarily need a sparing regimen, it is necessary to avoid loads and long walks.

Sometimes a low placentation in later terms can cause placenta detachment, then the tone of the uterus may increase and this requires taking tocolytic drugs in an acute period. Further, when the condition is normal, women are prescribed drugs that improve the rheological properties of the blood and normalize the uterine circulation. But it should be taken into account that such an active tactic can be used only with severe symptoms, if clinically low placenta is not evident, then no external intervention is required.

Ipradol is a drug from the group of selective sympathomimetics, which acts by binding to the uterine receptors and leads to a relaxation of the muscle fibers. Therefore, the drug is used for low placentation, which is complicated by the threat of miscarriage and is accompanied by an increase in the tone of the uterus and rhythmic contractions. The method of application of the drug - intravenous, which allows you to quickly achieve an effect. Dosage - 10 micrograms of the drug must be injected slowly, and then switch to infusion. Side effects are palpitations, heart rhythm disturbances, headache, fever, increased pressure, tremors, diarrhea. Precautions - the medicine should not be used at the time of pregnancy before 22 weeks.

Against the background of active tocolytic therapy, it is possible to carry out parallel hemostatic therapy if bleeding is expressed.

Tranexamic acid is a remedy for systemic hemostasis, which acts by inhibiting fibrinolysis and is widely used in gynecology. The drug can be used for the treatment of complications with low placentation, including in the formation of retrocolocate hematoma. Method of application of the drug intravenous drip. Dosage of 100 milliliters of solution throughout the first hour, and then under the control of the condition and blood test. Side effects of tranexamic acid - violation of the heart rhythm, headache, tinnitus, thrombosis, nasal congestion, dizziness, convulsions. Precautions - if there is blood in the urine, use the drug with caution, as this may cause further anuria.

If a woman with low placentation had a slight bleeding, but the tone of the uterus and the state of the child is not violated, then a small hematoma may form which will eventually resolve. But it can be a source of infection, since blood is a good breeding ground for pathogenic microorganisms. Therefore, after such a majority is inclined to the mandatory reception of an antibacterial agent, which is not dangerous to the fetus. This not only prevents infection, but also affects microorganisms that can multiply during this period of the disease. A group of antibiotics of the cephalosporin series is considered the most acceptable for use by pregnant women.

Ceftibuten is a beta-lactam antibiotic of the third generation, it is especially effective when acting on gram-positive and gram-negative flora. The drug has a bactericidal effect on possible anaerobic pathogens of infection, so it can be used for preventive purposes in gynecology. Dosage of the drug - 200 milligrams twice a day, taking into account the preventive reception, at least five days. Side effects are possible with the influence on the stomach - develops colitis or dysbiosis, which manifests itself by bloating, a violation of the stool. Precautions - do not use the drug for allergies to antibiotics-penicillins, as well as for congenital fermentopathies.

The use of vitamins in the therapy of low placentation is very important, as often there is a violation of blood flow in the umbilical cord and placenta. Therefore, the use of vitamins that contain magnesium and ascorbic acid in their composition helps improve blood circulation in the uterus and placenta, which reduces the effect of insufficient oxygen on the child's brain.

Actovegin - a drug that is most often used for the prevention and treatment of uteroplacental insufficiency. This drug is a derivative of different amino acids, which in the human tissues normalize cellular respiration and improve the absorption of oxygen. The drug is used in ampoules. To receive and complex treatment of placental anomalies, a dosage of 10 milliliters per day is recommended. Method of application intramuscular. Side effects can occur in the form of pronounced allergic reactions to a foreign protein. Precautions - the preparation for injections can be dissolved only in physiological solution or glucose, with other solvents the preparation is not applied. It is necessary to conduct a sample for sensitivity before applying the medication, since it is allergenic.

The use of other drugs can only be symptomatic. There is no etiologic therapy of low placentation, since the agents can not affect the very location of the placenta.

Physiotherapy treatment, given pregnancy, is also not recommended, because it is difficult to predict the reaction of the child and the placenta to such an intervention. Therefore, in an acute period, thermal and radiation procedures are not used.

Alternative treatment of low placentation

Alternative methods for treating low placenta can be used very widely. Such methods can be used even if there are no manifestations of a diagnosis for the prevention of complications. For this purpose, you can use herbs and infusions, which improve utero-placental blood circulation, because often a child may not have enough nutrients. In order to prevent detachment and the threat of premature birth, use means that reduce tone and sympathetic activity. Therefore, to drink infusions of herbs and to be treated by alternative means can be throughout the entire pregnancy right up to delivery.

1. Juice from carrots, apples and beets is very useful for taking low placentation to normalize the structure of the vascular walls and improve blood circulation, unless of course there is an allergy. To prepare the juice you need to squeeze a half liter of apple juice, add a juice of grated carrots one glass and a glass of beet juice, mix everything thoroughly and add honey before using. Dosage - half the glass of juice is taken in the morning and in the evening.
2. Tea from ginger, lemon juice and raspberry branches is very useful for improving trophism of the uterus and preventing infectious complications. It well tones up the body of a pregnant woman, has a calming effect and invigorates in the morning. It can be taken about two liters per day, of course if there is no edema and hypertension. To do this, you need to boil tea from the raspberry sprigs, boiling them for several minutes, and then pour the tea into the cup and add ten grams of ginger and a quarter of lemon juice. You need to drink this tea instead of plain water several times a day, then you can lie down a bit, throwing your legs on a hill to improve the flow of blood to the uterus.
3. For the prevention of ascending infection, it is very good to use a herbal solution for washing. To do this, you need to take the bark of oak and grass, alternate, steam, and warm grass to wash every day.

Treatment with herbs is used very often, since many herbs have a good effect on the tone of the uterus, the local circulation and the fetus, while they also have a systemic effect with the sedation of the body.

1. St. John's wort is a plant that normalizes the tone of the vessels of the placenta and improves blood circulation in the uterus, regulating nerve conduction. To make medicinal tea, you need to take 50 grams of St. John's wort, it should be cooked over low heat for five to ten minutes and then filtered. You need to drink this tea three times a day by a teaspoon, you can until the thirty-seventh week.
2. Especially effective in the prevention of complications of low placentation and the appearance of detachment of infusion from nettle dioecious. To make medicinal tea you need to take ten grams of grass, pour water in the amount of half a liter, and then after it tinges for twenty minutes, strain and drink. Dosage - about a liter of tea you need to drink a day, controlling another fluid in the presence of edema.
3. Tincture of calendula is an excellent tocolytic agent, and besides it also has the properties to reduce the activity of bleeding, in the presence of retrocolaric hematoma. To make medicinal tea you need to take the flowers and fruits of marigold, pour water in the volume of a half liter, and then after it tinges for twenty minutes, strain and drink. In an acute period, you can drink up to half a liter of tincture per day, and then you can drink a prophylactic dose of a tablespoon twice a day.
4. You need to take 100 grams of dry grass dandelion and plantain, make tea from a liter of water and drink on a tablespoon three times a day. The course of treatment is four weeks. This is an excellent tool for normalizing fetal trophism, as it expands the blood vessels and activates the intake of oxygen and nutrients to the fetus.

Homeopathy is used to treat low placentation as widely as alternative treatments. And the main advantage of such methods is the possibility of their long reception.

1. Arnica is a homeopathic remedy, which consists of herbal preparations that are more effective in patients with low placentation, which is manifested by bleeding after a mechanical stroke. The method of application of the drug - one drop every two hours for the first and second days after the onset of symptoms, and then one drop three times a day, under the control of the heartbeat - when a tachycardia occurs, the dose can be reduced. There were no side effects. Precautions - do not take if you are allergic to linden pollen.
2. Tsinkum valerianikum is an inorganic homeopathic preparation. Used to treat low placentation, which is accompanied by pulling pains in the lower abdomen. Taking this medication can prevent detachment if the medication begins before any symptoms appear in the initial diagnosis. The way of using the drug depends on the form. Dosage in case of taking drops - one drop per ten kilograms of body weight, and when taking capsules - two capsules three times a day. Side effects are possible in the form of hyperemia of the skin of hands and feet, as well as sensation of heat. Precautions - do not use simultaneously with antispasmodics.
3. Gamamellis is the number one agent with low placentation or placenta previa. This is a homeopathic medicine that improves circulation in the placenta and strengthens the connection in this place, which prevents exfoliation. Issued in the form of drops and used in the dosage of eight drops at a time. Method of application - the solution should be dripped into 100 milliliters of boiled water and drunk half an hour before meals. The course of treatment can begin with a dose of three drops twice a day, and then a month later, you can increase the dose to five drops, as the duration of pregnancy increases. Side effects are rare, allergic skin reactions are possible.
4. Hydra-stice is a homeopathic remedy based on the yellow-root plant, which is very effective in preserving pregnancy due to its action, which is like the natural hormone progesterone. The drug normalizes blood circulation, which, even with low placentation, improves the trophism of the placenta. The drug is especially effective at late stages in the pregnancy of twins or anemia in the mother. The drug is produced in granules and dosed six granules every six hours. Taking the drug before pregnancy is not recommended.

Operative treatment of low placentation is not used, because it is impossible to change the natural place of attachment of the placenta even by any physical exercises. As for surgical intervention with low placentation, it should be said about the period of childbirth. Often, low placenta with active labor can give a slight detachment. Then the doctor at palpation define the whole fruit bladder, which requires intervention. If you perform an amniotomy, the fetus descends lower along the birth canal and even with a slight detachment there is compression - it can stop the bleeding and the formation of a hematoma. Thus, the intervention is performed - amniotomy, which can be considered as an invasive intervention with low placentation. In the consecutive period, low placenta can give complications in the delay of the fetal membranes, then it also requires surgical intervention in the form of a manual separation of the placenta.

Other cases of low placentation of active surgical treatment do not require.

[30], [31]

Prevention

Speaking about the prevention of low placentation, you must first prepare for pregnancy. If possible, the first child should be born before the age of 35, because in the future the risk of developing such a pathology increases. Any surgical interventions on the uterus can cause abnormal placentation, so pregnancy should be planned in such a way that after the operation the time necessary for the regeneration of the uterus has passed. If the diagnosis is already established, then complications should be prevented. It is very important to lie more, do not lift weights, do not lead an active lifestyle, exclude stress and eat well. After all, any violation of the regime can lead to detachment.

[32], [33], [34], [35], [36],

Forecast

The prognosis of bearing a normal child with low placentation is very good, because the problem is not so great and when correct actions of complications can be avoided.

Low placentation in pregnancy - this is not so terrible diagnosis, as it seems at first glance. This is a pathology in which the placenta is attached in an uncharacteristic place. There is a risk of impaired blood circulation and fetal hypoxia, or a risk of complications in childbirth. But often the pathology does not manifest itself throughout the pregnancy and everything ends well. If there is a symptomatology of such a pathology, then only in this case the treatment measures are applied.

[37], [38], [39]