What to do if low placentation is detected during pregnancy. What threatens the low location of the placenta? What does low placentation mean during pregnancy?

Low placentation during pregnancy - a serious complication that requires constant monitoring of the woman and assistance emergency care if necessary.

The placenta is a temporary organ that forms by the second week of pregnancy, woven from the vessels of the mother and fetus. It attaches to the wall of the uterus, grows, develops and reaches maturity. Functions of the organ:

saturation of the child’s blood with oxygen and removal of carbon dioxide;
delivery of nutritional components to the fetus and removal of waste products;
synthesis of hormones necessary for the normal development of pregnancy and preparing female breast to milk production;
immune protection of the baby in the womb.

The norm is that the placenta is attached to the posterior or lateral wall of the uterus. But if it is located too low, problems may begin.

Low placenta previa is an abnormality during pregnancy. It is characterized by attachment in the lower part of the uterus, which completely or slightly covers the internal pharynx. This means that complications are possible during pregnancy and childbirth.

Schematic representation of the problem

The condition often resolves spontaneously as the upper uterus moves out of place. This phenomenon is called placental migration. But in general, the risk of fetal death is quite high: from 7 to 25%.

The cause of death of the baby may be acute hypoxia due to insufficient placental blood supply or premature birth.

This pathology is also dangerous for a pregnant woman. Bleeding that occurs with placenta previa causes death in 1-3% of women.

The exact location of the attachment can be determined by ultrasound in the 3rd trimester. Normally, the location of the organ is located at a distance of 5 or more centimeters from the internal os of the uterus.

Causes

Most causes of low placentation are due to diseases and conditions that occurred before pregnancy.

What causes deviation:

inflammatory and infectious processes in the genital organs;
damage to the uterine mucosa;
previous miscarriages or abortions;
gynecological interventions;
multiple pregnancy. Women with twins or triplets are automatically at risk;
childbirth by caesarean section;
fibroids, endometritis and other diseases of the uterus;
smoking, excessive alcohol consumption;
many births;
anomalies of the structure and development, functioning of the uterus;
woman's age over 35 years.

The most common cause of low presentation is a previous uterine curettage. The procedure damages the mucous membrane, which prevents the fertilized egg from attaching to the upper part of the organ.

Consult a doctor

The insidiousness of deviation is that it practically does not manifest itself. Symptoms appear already at an advanced stage, when irreversible processes take place in the body, for example, exfoliation. These signs:

heaviness in the lower abdomen, nagging pain;
bloody issues. When they appear you need to call ambulance;
death of the fetus in the womb or its excessive activity due to hypoxia - lack of oxygen;
severe toxicosis - 30% of women with this diagnosis suffer from it;
In approximately half of cases, pathology is detected on ultrasound breech presentation fetus

A pregnant woman herself cannot suspect an anomaly until clear symptoms appear. Status is viewed at scheduled ultrasound. The study allows not only to identify the problem, but to determine its extent and severity.

Types of low presentation depending on the location of the placenta:

rear This arrangement of the organ is the most favorable option. In most cases, in later stages, the baby's place moves upward, freeing the birth canal. Pregnancy is relatively comfortable;
front In this case, you need to prepare for difficulties. If the baby is large and active, he will put pressure on the placenta. This will cause problems with the umbilical cord, the risk of entanglement and compression. Such a presentation rarely changes before childbirth, which means that the birth canal will not be free;
complete or partial, when the organ obscures the os of the uterus. Deviation requires great care. It is important to discuss all the details with your doctor before giving birth and prepare for the fact that you will have to give birth by cesarean section.

What to do

Diagnosis of low placentation allows one to determine how dangerous this condition is for the pregnant woman and the child. Conducted:

analysis of symptoms: discharge, abdominal pain;
Ultrasound is the main type of diagnosis, safe and informative. Carried out at 12, 19-20 and 30 weeks;
bimanual examination of the vagina (provided there is no bleeding).

After confirming the diagnosis of low placenta previa, the doctor prescribes treatment and gives recommendations to correct the situation. If desired and competent actions are taken, the location of the organ can be changed.

If the pregnancy is proceeding normally, and the term has not reached 35 weeks, treatment is conservative. Strict bed rest, monitoring of the fetus and the intensity of bleeding are indicated. Any exertion or sexual contact is prohibited.

There are no medications that elevate the placenta. Medicines are prescribed to help improve the condition of the pregnant woman and promote migration of the baby's place. This:

tocolytics, antispasmodics – stimulate stretching lower parts uterus;
agents that reduce myometrial tone;
iron-containing drugs - prescribed to women with bleeding to prevent iron deficiency anemia;
medications that activate placental blood circulation - to avoid the development of hypoxia in the fetus;
magnesia, intravenous glucose, vitamins.

The drug Utrozhestan helps prevent premature birth with low placentation. To prevent breathing problems in the fetus during childbirth, glucocorticosteroids are prescribed.

If the presentation is partial and accompanied by mild bleeding, conservative treatment helps to save the baby. But a woman must remember that at the slightest discharge and deterioration in health, she must immediately call an ambulance.

If there is severe bleeding or the woman’s poor condition, the pregnancy is terminated for health reasons.

severe blood loss (more than 200 ml);
drop in blood pressure, anemia;
complete presentation together with bleeding.

Ultrasound analysis image

The choice of delivery method if the pregnancy is carried to term depends on the indications. In case of complete presentation, the cervix of the uterus is closed, so a caesarean section is performed. It is also carried out when:

placental abruption;
polyhydramnios;
incorrect positioning of the baby;
scars on the uterus;
multiple pregnancy;
age after 30 years.

If the presentation is partial, natural childbirth is not excluded. But only if the baby is positioned head down, labor is active and the cervix is mature. In case of sudden bleeding, a puncture of the amniotic sac is performed. This helps stop the bleeding and lead to a normal birth.

If the cervix is not ready and the baby's head is small, a caesarean section is performed.

Why is it dangerous?

The consequences can be dire

Low placenta previa during pregnancy is a condition that is dangerous for both the woman and the fetus. Among the unpleasant consequences:

the baby can damage the placenta with active movements. This is especially true for later periods, when big baby puts pressure on the organ and is able to catch the membrane of the placenta;
with low placentation, the cervix is not intensively supplied with blood, which is fraught with the development of fetal hypoxia;
the anomaly threatens complications during childbirth, since the baby’s place prevents the baby from leaving the womb;
insufficient placental blood circulation can cause increased activity of the fetus, which is fraught with twisting and clamping of the umbilical cord;
Placental abruption is a dangerous condition that leads to the death of the fetus, and sometimes the woman. When complications occur, the stomach begins to ache and bleeding appears;
Pregnant women with this diagnosis often experience low blood pressure and develop late gestosis.

The organ is densely intertwined with blood vessels connected to the uterus. This ensures placental blood exchange. And blood carries vitamins, proteins, oxygen, hormones and other substances necessary for life to the fetus.

With low presentation, the blood supply to the lower part of the uterus deteriorates. Consequently, the fetus is not fully fed with useful components. This increases the risks of intrauterine growth retardation and hypoxia.

If diagnosed placental insufficiency and deterioration of blood flow, maintenance therapy is prescribed to compensate for the lack of nutrients in the fetus.

This is what low placentation threatens. A child can suffer from an anomaly at any stage of pregnancy. Caution and strict adherence to the doctor’s recommendations will help protect him and yourself from complications.

When it rises

Low placental presentation is found on different dates. At the same time, it is difficult to predict the consequences, and it is unknown how long it will take to rise. Depending on the trimester of pregnancy, therapeutic actions to correct the pathology depend.

1st trimester. The first planned ultrasound is performed at 12-13 weeks, at which time the anomaly is detected. There is no need to worry during this period, since in 70% of cases the placenta rises by 20-21 weeks;
2nd trimester. By the period of twenty weeks, placental blood circulation is improved, but with low presentation it is disrupted, especially if the fetus is large and puts pressure on the organ from above. In this case, the gynecologist admits the pregnant woman to the hospital with strict adherence to bed rest and drug therapy. Usually by 22-23 weeks the baby's place rises up. If the situation does not change, the doctor gives the woman recommendations regarding lifestyle and continues to try to improve the situation;
3rd trimester. Mostly by 32-34.5 weeks the placenta moves upward under the pressure of the growing uterus. Then the problem disappears. If during pregnancy it does not come into place, at 36 weeks the issue of caesarean section is decided. This is especially important with complete presentation.

The cause could be curettage of the uterus

Depending on the trimester and the nature of the location of the placenta, different actions are taken to correct the anomaly. It is important for a woman to be patient and not panic.

In most cases, the placenta rises towards the end of pregnancy. If this does not happen, but the woman and baby feel well, a caesarean section is performed.

What not to do

Pregnant women with low placentation must be constantly monitored by a doctor. If you follow his recommendations exactly, everything will be fine. What you shouldn't do:

worry. Modern medicine successfully treats pregnant women with low placental attachment. In 90% of cases, a woman gives birth to a healthy baby. Moreover, 60% of births are carried out naturally, and only 40 - by cesarean section;
have sexual intercourse. Sex at any stage can damage the organ and lead to detachment. This only applies to women with low placenta previa;
play sports, do abdominal exercises, lift weights, walk a lot. Decide what's more important active image life or health of the child;
do douching and any other vaginal manipulations so as not to harm the pregnancy;
worry, get nervous, get irritated. This will lead to an unhealthy emotional atmosphere and aggravate the condition. Develop stress resistance;
travel to public transport, visit places with large crowds of people. They can push there, which will cause even greater prolapse of the organ;
Ignore the doctor's recommendations and do not go on conservation when necessary.

You have to be patient

If the presentation is low, the woman is advised to place a pillow under her legs so that they are higher than the level of the body. This will help the placenta quickly find its place.

Low placentation is not a disease, but a special condition. The situation requires, first of all, not treatment, but correction. Much depends on the mood of the pregnant woman, her actions, and how accurately they correspond to the advice of doctors.

Help to avoid anomalies preventive measures. These include:

prevention of infectious and inflammatory diseases, their timely treatment;
maintaining a healthy lifestyle: proper nutrition, adherence to work and rest schedules, avoiding alcohol and tobacco abuse;
protection against unwanted pregnancy, so that there is no history of abortion;
performing a caesarean section only in cases where there are vital indications;
performance of gynecological manipulations and operations in trusted clinics by experienced doctors.

: Borovikova Olga

gynecologist, ultrasound doctor, geneticist

Unfortunately, not a single woman who is in an “interesting” position is immune from various complications that can arise in a completely unexpected way. These include, for example, low placentation during pregnancy.

During my second pregnancy, I was given the same “diagnosis.” Sounds scary, right? So I urgently began to find out what it was and what to do. It turned out that this was not a “diagnosis” at all—just a statement of fact. But I won't get ahead of myself.

What does low placentation mean during pregnancy?

The phenomenon is considered normal when a fertilized egg is attached to the bottom of the uterus (it is located at the top) or the back wall. It is in this place that the placenta is formed, with the help of which the transfer of nutrients from the mother to the child’s body is ensured, supplying it with oxygen and removing carbon dioxide.

But it also happens that the embryo can attach at the bottom of the uterus, closer to the exit from it. This indicates a low location of the placenta. They talk about it if the distance between the placenta and the exit from the uterus (throat) is less than 6 cm.

Causes of low placental attachment

Features of the structure of a woman’s internal genital organs, the presence of congenital uterine defects;
Past infections, inflammatory processes of the reproductive system and pelvic organs;
Previous operations on the uterus;
If the woman is over 35 years old;
If you have previously had abortions (as a result of them, the endometrium is always damaged);
Heavy physical stress on a woman’s body before pregnancy and in the first months.

Those. any inflammation, abortion, cleansing - all this greatly injures the endometrium. The fertilized egg “moves” through the uterus and looks for the safest, high-quality attachment site. The lower it is attached, the worse the condition of the endometrium.

Signs of a low placenta

Low placentation is revealed during pregnancy at 12 weeks by ultrasound (find out from the article: What tests are taken during pregnancy?>>>);
In the early stages, a woman usually does not feel any symptoms of this phenomenon. Most often they appear when the fetus reaches a significant size - in the third trimester;
The detection of low placentation during pregnancy at 20 weeks is even more reliable. The doctor simply sees the attachment site using an ultrasound scan and writes this fact down in the statement.

At one time, I was greatly reassured by the words of the midwife who observed my pregnancy. She said: “The fact that you are now diagnosed with low placentation does not mean anything. The uterus is growing. And what now looks like 1 cm from the cervical pharynx will turn into 5-6 cm in 2 months and the attachment will no longer be low.”

Actually, that's exactly what happened.

Among the signs indicating both a low location of the placenta and other phenomena, one can highlight:

Nagging pain in the lower abdomen, in the lower back (important article on the topic: During pregnancy, the lower abdomen pulls >>>);
Bleeding. Its strength depends on the size of the placental abruption. If it is insignificant, then the amount of blood released is very small. In this case, there may not be any pain in the lower abdomen;

If the detachment area is large, the bleeding will be severe. In this case, it may be accompanied by dizziness, increased fatigue, fainting, and pain in the lower abdomen. Usually, spotting appears after increased physical activity, active movements, coughing, or constipation. Even with mild bleeding, be sure to consult a doctor.

Low blood pressure;
Weakness, increased fatigue.

What is the danger of low placentation?

Many expectant mothers, having not even encountered this phenomenon yet, wonder: what are the dangers of a low placenta?

Due to the fact that the placenta is close to the os of the uterus and can partially block the opening, bleeding usually occurs and there is a likely risk of detachment. In turn, this provokes the threat of miscarriage;
There is an increased risk that the baby will experience a lack of oxygen and nutrients, since there are not enough blood vessels at the bottom of the uterus;
When the placenta is located low on the posterior wall, complications are more common, although there is a higher likelihood that the situation will improve on its own over time. Often in this case, the bleeding may be internal, and there may be no discharge at all. But usually there is a feeling of pressure in the lower abdomen due to the accumulation of blood and slight pain, which intensifies over time;
What is the danger in a situation if the placenta is low on the anterior wall? As the uterus and fetus grow, it will move and can completely block the pharynx. There is also a high risk of getting entangled in the umbilical cord. With a low anterior placenta, a woman needs to be especially careful and attentive to her condition and strictly follow all the doctor’s recommendations.

Treatment of low placentation

The main questions for women who have low placentation during pregnancy are what to do and how to treat it?

There is no way to cure a low placenta. Where it is attached is where it will remain.

If the symptoms are not pronounced and there is no obvious deterioration in the woman’s condition and the development of the fetus, then you only need to follow a number of rules that contribute to the normal course of pregnancy with this deviation:

Avoid strenuous physical activity (do not lift heavy objects, do not play sports, do not move too fast, do not jump);
Avoid intimacy. Sex with a low placenta is prohibited;
When lying down, ensure that your legs are above body level (for example, by placing a pillow under them);
Avoid stress and conflict. Try to create a positive emotional background around yourself;

By the way, our course on preparing for childbirth is dedicated to this topic. There are no active ones physical exercise, and more emphasis is placed on your emotional state + calm training of the respiratory system + nutritional adjustments for natural birth on time.

Use public transport as little as possible. You definitely don’t need shaking and the risk of getting hit!
Follow proper nutrition;

Proper nutrition will allow your baby to get the necessary vitamins, but not from synthetic drugs, but from your daily diet.

What should be included in your diet every day, what foods should you give up, what 3 elements should you include in your diet for childbirth to go smoothly?

If you notice even slight spotting, contact your doctor immediately. If there is severe bleeding, you should urgently call an ambulance.

Childbirth with a low placenta

Quite often, low placentation does not manifest itself in any way until childbirth. Many women are very worried about how they will cope with such a diagnosis.

In most cases, in the absence of complications and satisfactory condition expectant mother, natural childbirth is prescribed. Of course, the woman’s condition, blood pressure, volume of discharge, as well as the position of the baby in the womb and his pulse are constantly monitored;
If, after 36 weeks of pregnancy, low placentation continues to be diagnosed (the placenta is at a distance of 2 cm and closer to the os of the uterus), various unfavorable symptoms and bleeding are detected, then most often the birth takes place by cesarean section.

Whatever the stage of pregnancy, you should never panic when you learn about low placentation. This is not a pathology, but only a statement of fact, in which you simply need to be more careful than in a normal situation.

Even the most emotionally balanced women slightly lose the ability to reason sensibly during pregnancy - this is “taken care of” by the hormonal background that changes greatly during pregnancy.

Maternal instinct makes a woman anxious for no apparent reason, and if the leading doctor announces the diagnosis of “low placentation during pregnancy,” some people even panic.

And completely in vain: this condition does not apply to pathological conditions and can change over the course of pregnancy.

According to WHO, 99% of pregnant women with low placentation, determined in the middle (or near the end) of pregnancy, successfully give birth on their own. But in one percent of cases this condition is truly dangerous. How not to get into this group?

Low placentation during pregnancy - what is it?

The placenta is a kind of “fortress” for the child, which provides him with maximum physical and immune protection, satiety, health and full development. Formed in the wall of the uterus, the placenta is a thickened part of the embryonic membranes and a branched network of blood vessels in it.

The weight of the placenta can reach one and a half kilograms. As a rule, it is located at the bottom of the uterus and begins to develop after the implantation of a fertilized egg into the wall of the uterus. To attach the egg and form the placenta, the area of the best blood supply in the uterus is selected, often next to a blood vessel at the base of the epithelium.

The end of placenta formation occurs at 12-16 weeks and is directly related to the end of pregnancy toxicosis.

Attachment of the placenta to the walls or bottom of the uterus is considered normal if the baby's place is located further than 5-6 centimeters from the os of the uterus. In the case of low placentation during pregnancy, the implantation of the egg occurs dangerously close to the pharynx, and can cause complications. The doctor monitors the condition of the placenta throughout pregnancy in order to see the presentation in time, which determines the method of delivery.

As pregnancy progresses, the uterus enlarges, while the implantation site remains in place. It is due to the increase in uterine tissue that the placenta “migrates” further from the internal os, up to the normal distance of 5-6 centimeters.

Symptoms of low placentation

A correctly formed placenta, which does not completely block the internal uterine os, may not make itself known to the pregnant woman at all: low placentation during pregnancy is often noticed only at the last ultrasound.

But in certain cases, the described condition leads to the threat of miscarriage, and the pregnant woman develops:

Spotting bloody discharge;

Regular aching pain in the lower abdomen and lower back;

Fetal hypoxia;

Reduced blood pressure in a pregnant woman.

Low placentation during pregnancy: causes

Women with their first pregnancy practically do not encounter a low placenta, since the more changes have occurred in the condition of the genital organs, the higher the risk of an undesirable location of the pregnancy.

The causes of this condition have not been fully studied to this day. The formation of the placenta in the cervix is considered normal by many. But there are conditions that contribute to deviations from the norm in the development of the placenta.

Causes of low placentation during pregnancy:

The pregnant woman is over 30 years old;

Second or more births;

Manual separation of the placenta during previous births;

Dystrophic and atrophic processes in the endometrium - uterine scars, damage to the mucous layer of the endometrium after cesarean section, abortion or cauterization of erosions;

Blastocyst immaturity;

Anatomical features of the structure of the reproductive organs (septa in the cavity, bending, underdevelopment of the uterus);

Pathology of the villous chorion (more often in women with impaired ovarian function or genital infantilism) - endometrial restructuring occurs untimely;

Congenital or acquired physical abnormalities;

Pathology of the cervix - endocervicitis, erosion, isthmocervical insufficiency;

Inflammatory processes in the pelvic organs;

Benign neoplasms, polyps;

Abortion or other surgical interventions on the functioning of the reproductive organs;

Multiple pregnancy;

Infectious diseases;

Chronic ailments (cardiovascular, kidney and liver diseases, intoxication) that provoke circulatory disorders in the reproductive organs.

Separately, it is necessary to say about benign neoplasms. The likelihood of low placentation during pregnancy in this case increases. If the doctor discovered polyps, fibroids and other tumors in the genitals while planning your pregnancy, and suggests surgery, it is undoubtedly better to agree.

Damaged endometrium after surgery and inflammatory diseases in the uterus indicate that it is advisable to wait at least a year before becoming pregnant.

The influence of low placentation on the course of pregnancy, complications

The larger the fetus becomes, the more it puts pressure on the uterine cavity. The blood vessels of the placenta are compressed, and blood flow in the uterus and placenta is disrupted. These processes can lead to fetal hypoxia (lack of oxygen) and intrauterine growth retardation. The pregnant woman at this time experiences weakness, low blood pressure, and may develop anemia.

The more dire consequences of low placentation during pregnancy are much less common. It can cause placental abruption with impaired blood supply, which develops acute hypoxia and even fetal death. Bleeding in this case forces doctors to perform surgical delivery.

Low placentation during pregnancy: diagnosis

By the end of the third trimester, the chorion, as a result of gestation, is transformed into the placenta, consisting of blood vessels. This is the time of the first ultrasound examination, genetic pathologies of the fetus and developmental defects are revealed. It is ultrasound that allows you to quickly and safely identify problems with the placenta.

At the first ultrasound at 12-16 weeks, 80% of pregnant women are diagnosed with “low placentation.” The diagnosis is confirmed at 22-25 and 30-35 weeks. Normally, towards the end of pregnancy, the baby's place shifts, and by the time of birth it is in its normal position.

If bleeding occurs and an ultrasound cannot be performed, the cervix is examined using speculum to detect part of the placenta in the cervical canal. The method is quite dangerous and is used only in extreme cases in the presence of an operating room.

Low placentation during pregnancy: what to do

Medical practice shows that the overwhelming majority of pregnant women with low placentation initially, by the end of the term, come to childbirth with a normal condition of the uterus and placenta. This is due to the constant modification of the lower segment of the uterus, which often increases and raises the baby's place higher and higher. Usually such women give birth on their own.

Low pracentation by the 32nd week of pregnancy persists only in five percent of women with this diagnosis. By week 37, only a third of the remaining retain this condition. By the date of birth, no more than one percent of pregnant women have the placenta located closer than 2 centimeters to the internal os of the uterus. These pregnant women are diagnosed with placenta previa and undergo a cesarean section.

The risk of bleeding during natural childbirth in pregnant women, when the placenta is located more than 2 centimeters from the internal os of the uterus, is no higher than when normal location placenta.

Although low pracentation during pregnancy is not pathological condition up to 38 weeks, Women with this diagnosis are recommended in their final stages:

Walk less, do not neglect rest;

In a lying position, place your legs on a hill;

Do not squat or bend low;

Do not miss scheduled examinations with the leading doctor, follow the ultrasound and test schedule;

Monitor vaginal discharge.

If the lower abdomen begins to bother you and bloody discharge appears, then you need to immediately tell the doctor if the pregnant woman is in the hospital, or call an ambulance and go to the department of pathology of pregnant women.

Is it possible to fly on an airplane with low placentation?

Pregnant women with this condition have great fears when traveling, especially if they need to fly on an airplane where there are strong pressure changes and g-forces. Consultation with a doctor is required, and if he gives the go-ahead for flying with low placentation, then you can safely go on a trip. As a rule, until the middle of pregnancy, almost nothing is prohibited for a woman, so until the 20th week there is, one might say, no risk of miscarriage or bleeding. Naturally, the shorter the flight, the better, and you should not take heavy luggage with you.

Low placentation during pregnancy: what not to do

By following certain rules of behavior, a pregnant woman can reduce the risk of complications with low placentation to zero.

Such requirements include:

1. Minimizing physical activity: running, brisk walking, active sports and sex life- It’s better to refrain from this.

2. Elimination of sudden movements and vibrations - travel less in any type of transport (especially in public).

3. Taking medications prescribed by a doctor.

4. Observation vaginal discharge, and in case of bleeding, immediately take a horizontal position and call an ambulance (the speed of these actions affects the outcome of the pregnancy and the preservation of the life of the fetus).

Childbirth with low placentation

In this case, only the doctor chooses the method of delivery. He may decide to puncture ovum, then the placenta will be fixed by the fetal head. Such births are most often carried out in operating rooms in order to have time to perform a cesarean section if the fetus is located in an unsuitable position for delivery (feet forward).

Low placentation during pregnancy at 37-38 weeks forces doctors to recommend that the woman be hospitalized in the pathological department of pregnant women, where she will be under constant supervision.

By the time of birth, the placenta can “move away” to an acceptable distance - then natural childbirth is possible.

However, during childbirth, the muscles of the uterus contract and it decreases in volume, but the placenta remains its original size.

As a result, the blood vessels connecting the low placenta to the walls of the uterus are greatly strained, and even their rupture and premature placental abruption are possible.

The fetus will not receive enough oxygen and the brain may be damaged.

To prevent such complications, doctors decide to perform a cesarean section if the situation with low placentation has not changed by 38 weeks.

The placenta supplies the baby with oxygen, vitamins and microelements, and cleanses amniotic fluid from waste products. Its formation begins at 10–12 weeks of gestation, but attachment to the lining of the uterus occurs much earlier, at the chorion stage. Low placentation during pregnancy occurs due to the placement of the placenta in the lower region of the uterus, which threatens a number of complications both during gestation and at the time of birth.

The transformation of the chorion into the placenta lasts until 16–17 weeks. However, the growth of the organ, which is important for the baby, continues in parallel with the development of the baby - until the 36th week. A low location of the placenta may move upward by the time of birth, then the risk negative consequences decrease. But if the placenta shifts towards the internal uterine os, is located less than 5-6 cm from it, or partially or completely blocks the lumen, this will already be called low placenta previa. Then the danger will increase.

Is low placentation dangerous for the expectant mother and baby?

The placenta attachment site is determined at the beginning of pregnancy. If a low-lying placenta was diagnosed, and by 24, 25 or 26 weeks it has not moved, complications may arise for the mother and baby. There is a danger associated with an increase in fetal weight by the 2nd trimester, which causes pressure on the embryonic organ. It drops even lower, and the risk of blocking the cervical canal increases.

This can lead to the following consequences:

Frequent bleeding will cause anemia in the pregnant woman;
low hemoglobin content in the mother’s blood will lead to hemorrhagic shock, which poses a threat to the health and life of the baby;
when blood vessels are compressed, blood flow deteriorates, which threatens hypoxia and delayed development of the baby;
insufficient space for the fetus in the uterus leads to incorrect presentation of the baby;
detachment of an embryonic organ leads to impaired blood circulation in the fetus;
premature detachment will cause premature birth;
a low-lying placental organ prevents the baby’s head from descending into the pelvis, which will lead to difficulty in natural childbirth;
during contractions, the embryonic organ can shift and block the birth canal, which will make natural childbirth impossible (an urgent cesarean section will have to be performed);
if a cesarean section is necessary, low placentation along the anterior wall of the uterus makes the operation difficult and leads to large blood loss.

If a pregnant woman experiences frequent and heavy bleeding in the third trimester, or there is a danger of fetal hypoxia, the mother is left in the hospital under round-the-clock medical supervision until labor begins.

If it is impossible to bear a child due date(40 weeks), they try to maintain pregnancy until 37 weeks. A caesarean section is then prescribed, since natural delivery in this situation is not recommended. If there is an urgent need, the operation is performed earlier.

Symptoms of the disease

It was noted that low placentation was recorded in 15% of women aged 30–35 years.

The reasons may be different, but the main ones are:

damage to the mucous wall of the uterus - formations of a different nature, trauma;
physiological features - bending of the uterus, poorly developed genitals;
inflammatory processes – endometriosis, salpingitis, urolithiasis and others;
mechanical damage to the walls of the uterus in the past - abortions, difficult childbirth, curettage, surgical operations;
hormonal imbalance – irregular or heavy periods;
illnesses internal organs– cardiovascular, liver, genitourinary system.

When the baby's place is not attached very close to the uterine os, no external symptoms of pathology are observed. The threat can only be detected at 12–13 weeks with an ultrasound scan.

The lower this organ is located to the exit of the uterus, the stronger the signs of low presentation or placentation will appear:

pain in the lower abdomen that has a pulling character;
slight spotting after intense physical exertion;
pain in the lower back and lower abdomen during detachment.

In addition to the above symptoms, 20% of pregnant women with low placentation experience:

headache or dizziness;
low pressure;
nausea and vomiting;
swelling.

The earlier the feature is diagnosed, the lower the risk of developing dangerous pathologies. Therefore on early You should definitely visit a gynecologist. Low placentation at the beginning of pregnancy is diagnosed in 80% of women. But after 30 weeks, for the majority, the embryonic organ rises.

Gynecological examination for women with low placentation is strictly contraindicated.

How does this condition affect pregnancy?

Often the baby's place is attached to the back wall of the uterus. The norm is considered to be its attachment to the bottom (at the top). But sometimes it is attached to the front wall. If its location is very low, less than 6 cm from the edge of the exit from the uterus, this is fraught with consequences. After 23–27 weeks, the baby begins to move, and after 31, movements become more active. During this period, it can damage the placental organ or the umbilical cord, especially with breech presentation.

The second disadvantage of this feature is the poor blood supply to the lower part of the uterus, which threatens the fetus with a lack of oxygen.

If at 18–19 weeks low placentation is recorded along the posterior wall, then the placental organ by the end of the period in most cases migrates higher. But with a front attachment, the opposite may be true, since migration is directed in the opposite direction.

Another danger is the extrachorial type of placentation, where the placenta is shifted to the center, creating a kind of shelf. This arrangement requires close monitoring of the pregnant woman throughout the entire period of gestation.

What not to do with low placentation

Certain features of pregnancy force a woman to more closely monitor her health. In order not to aggravate the circumstances and lead to even greater prolapse, it is necessary to follow the doctor’s recommendations.

With this diagnosis the following are contraindicated:

sudden movements;
excessive physical activity;
vaginal procedures;
lifting weights;
stress and overwork.

It is not recommended to sit with your legs crossed, as this position interferes with normal blood circulation. You also need to lie down and get up carefully, without jerking. Even coughing and sneezing can cause bleeding. Riding on public transport is also not advisable, especially during rush hour.

Sex with low placentation is possible only in the absence of obvious symptoms and contraindications - detachment of the placental organ, pain, bleeding.

When having sex with a partner, it is important to take basic precautions:

Maintaining hygiene. Be sure to visit the bathroom before starting intimacy;
No sudden movements. Strong shocks can cause harm, so friction must be done gently and penetration is shallow.
Position selection. There will be less pressure on the uterus if the woman lies on her side.

If there is a threat of miscarriage or low placental presentation, sexual intercourse is contraindicated. During this period, even masturbation and anal sex may cause serious complications due to contraction of the uterus during orgasm, which will lead to placental abruption. Therefore, you also need to masturbate with caution if there are no prerequisites for pathology.

What treatment methods are there?

There is no medical treatment for this disease. According to statistics, in 8–9 out of 10 cases, the placental organ independently takes the correct position as the uterus grows. Therefore, a diagnosis made at 20–22 weeks or 32 weeks of pregnancy should not be considered critical. Until 33–36 weeks, the position of the placenta changes, which means that there is a possibility of complete disappearance of the pathology.

In order not to aggravate the process, carry the child to term and give birth naturally, you need to listen to and follow all the doctor’s instructions. Throughout pregnancy, with a low-lying placenta, it is important to be observed by a specialist and undergo regular ultrasound examinations. Three times ultrasound examination, this is the norm - the first at 15–17 weeks, the second at 21–24 and the last at 34–36 weeks.

Starting from 28-29 weeks of pregnancy, with strong development pathologists prescribe a number of drugs to maintain pregnancy until the required period:

Papaverine and Ginipral help increase the elasticity of the muscles of the uterine walls, increase tone and relieve spasmodic impulses.
Increases hemoglobin Ferlatum, Hemofer, Aktiferin.
Enhances blood circulation, improves nutrition of placental tissue Curantil, folic acid and vitamins E and Magne B6.
Increases progesterone levels - Utrozhestan.

In some cases, if there is a risk of placental abruption, the doctor advises placing a pessary.

In case of bleeding and severe pain, you must quickly call for medical help. At this time you can’t do anything, it’s better to just lie down until the ambulance arrives.

Features of childbirth

If before the onset of labor the woman in labor underwent a full examination and monitoring of the course of pregnancy, natural delivery in most cases will go well.

But the course of labor is influenced by several factors:

placenta attachment site;
nature of pregnancy;
the occurrence of complications during pregnancy;
accompanying pathologies.

If the placental membrane does not cover the uterine os, the obstetrician punctures the amniotic sac. As a result, the baby’s head presses the placenta against the uterine wall, preventing it from detaching.

Caesarean section is preferable in case of placental presentation or incorrect position of the fetus - bottom down.

Preventive measures

For prevention purposes, attention should be paid to Special attention mother's nutrition. Increase the amount of vitamins and minerals entering the body that have a beneficial effect on pregnancy. Calcium, magnesium and iron are especially useful.

Rest more and walk in the fresh air. When resting, it is recommended to place your legs a little higher, using a pillow or bolster. This will ensure increased blood circulation in the placenta, which will help move it upward.

Excitement, overexertion and stressful situations have a bad effect on the situation. It is worth remembering that even with such symptoms, women can carry and give birth on their own, without surgery, as evidenced by numerous reviews on the Internet. You just need to follow all safety rules and listen to the supervising doctor.

You can do special gymnastics for pregnant women or go to the pool. But these issues should be discussed with a gynecologist. Exercises with low placentation should be light, without sudden movements. Heavy lifting and running are prohibited.

It is better not to engage in sexual games during this period. The placenta is located only 30–40 mm from the edge of the cervix, and rhythmic pushing can provoke its movement closer to the edge.

Is it possible to wear a bandage with low placentation? The attending physician will answer. Different types Placentations require various treatment and prevention.

Conclusion

Having learned in more detail what low placentation means and how it manifests itself, we can safely say that it does not pose any particular danger if the pregnant woman is under strict medical supervision throughout the entire period of bearing the baby. However, there may be complications if the recommendations are not followed. Then you should immediately consult a doctor.

7-8 days after conception, the fertilized egg enters the uterine cavity, where it attaches to one of its walls. Normally, embryo implantation should occur in the upper part of the organ. The physiological position of the fertilized egg is in the fundus of the uterus, but it can be located on the front, back, right or left side. If the embryo is fixed in the area of the lower segment, obstetricians-gynecologists talk about.

By approximately the 14th week of gestation, the placenta is formed from the chorion, the place of attachment of which depends on the primary implantation of the fertilized egg. However, the uterus grows throughout the entire period of gestation, so sometimes the incorrect position of the membranes can become physiological by the middle or end of pregnancy.

Low placentation along the anterior wall is the most favorable variant of the pathology, since due to the abdominal muscles, the outer uterine wall stretches well, and the baby's place moves along with it.

If the placenta is located on the back side of the organ, the chances of its normal position at the end of pregnancy are slightly lower. This is due to the fact that there is a spine behind the uterus, which prevents it from stretching too much.

The low location of the placenta should be distinguished from its presentation. The second diagnosis has the same etiology and development mechanism, but is a more severe variant of the first. Placenta previa is a pathology in which the baby's place extends onto the uterine os. Experts distinguish between complete and partial presentation.

With complete presentation, the placenta completely covers the uterine os. The pathology is accompanied by multiple and frequent complications; if it is detected, natural childbirth is impossible. With complete placenta previa, upward migration almost never occurs.

In partial presentation, the baby's place extends onto the uterine os, but does not completely cover it. This diagnosis has a more favorable outcome: upward migration of the baby’s place is possible, complications are less common, and in some situations, natural delivery is possible.

Causes of low placentation

Experts are not always able to determine the exact cause of incorrect implantation of the fertilized egg in a particular woman. Sometimes the development of low placentation occurs spontaneously without the presence of predisposing factors. However, doctors identify several reasons for improper embryo implantation. Most of them are associated with pathologies of the uterus, due to which the fertilized egg cannot settle in its proper place:

congenital anomalies of organ development;
chronic inflammatory process (endometritis, sexually transmitted infections, etc.);
scar on the uterus as a result of surgical interventions;
benign and malignant neoplasms;
damage to the uterine wall after abortion or curettage.

Sometimes low placentation is associated with abnormalities of the embryo - its chromosomal mutations, as a result of which it cannot settle in a physiological place. Pathology also occurs against the background of severe extragenital diseases, especially with lesions of the circulatory and urinary systems. Low placentation can be observed when carrying twins, when the chorion of one of the embryos grows in the lower segment of the uterus due to lack of space.

The danger of low placentation

Low placentation in itself does not affect the mother’s well-being; the danger of this pathology lies in possible complications. The most common consequence of an abnormal position of the baby's place is bleeding from the vagina. With low placentation, red discharge usually occurs after the 30th week of pregnancy, but sometimes it does not bother the woman at all. In more severe cases, uterine bleeding may appear at 23-24 weeks of gestation.

The reason for bleeding due to abnormal placentation is that the lower segment of the uterus is greatly stretched due to an increase in the weight of the fetus. The child's place does not have time to adapt to the stretching of the muscle wall, resulting in microdetachment. Its development is accompanied by exposure of the vessel, which leads to the release of blood from it.

Bleeding with low placentation has distinctive features. They almost always occur suddenly and are not accompanied by physical or emotional stress. Such bleeding is often observed at night. With low placentation, the discharge is scarlet in color and is not accompanied by pain. Bleeding tends to recur constantly.

Against the background of bleeding, accompanying complications sometimes occur - a drop in blood pressure and anemia. They impair the blood supply to the fetus, which can provoke hypoxia - oxygen starvation. Hypotension and anemia also worsen the well-being and performance of the expectant mother.

Attention! Low placentation may not manifest itself in any way in the first half of pregnancy, sometimes until the very end of the gestation period, so expectant mothers should not skip routine ultrasound examinations.

With chronic severe hypoxia, intrauterine growth retardation and development of the fetus develops. With this pathology unborn child lags behind its “peers” in weight and length by two or more weeks of gestational age. Intrauterine growth retardation and development of the fetus can provoke congenital pathologies of the nervous system and other organs, as well as death in the postpartum period.

Abnormal position of the placenta sometimes causes malposition- transverse (when the fetus is located transverse to the vertical axis of the uterus) and oblique (when the fetus is located at an acute angle to the vertical axis of the uterus). With these pathologies, it is impossible to give birth to a child without surgical intervention. Also, low placentation can provoke breech presentation - a position in which the fetus is born with the buttocks or legs, which complicates natural childbirth and often requires a cesarean section.

The most dangerous complication of low placentation is premature birth. They are observed as a result of detachment of a large area of the child's place. The complication is accompanied by a shortening of the length of the cervix, opening of the internal and external pharynx and the onset of labor.

Marina Aist - low placentation and normal placental location:

Symptoms of low placentation

Quite often, low placentation does not manifest itself in any way for a long time. The main and only possible symptom of this pathology is bleeding, which has the following characteristics:

scarlet color;
not accompanied by pain;
is not a consequence of physical activity;
more often observed at night and at rest;
tends to relapse.

If red uterine discharge is accompanied by cramping pain, it is a sign of premature termination of pregnancy. Indirect symptoms of low placentation that occur in response to repeated blood loss are constant weakness, decreased performance, “spots” before the eyes, and fatigue.

If any bleeding from the vagina occurs, a woman should consult a doctor immediately. The specialist conducts differential diagnostics, prescribes treatment, and performs emergency delivery according to indications.

Diagnostics

Currently diagnosis of “low placentation” is made using ultrasound examination when identifying the localization of the child's place near the uterine pharynx at a distance of 7 centimeters and below. Ultrasound at 19-21 weeks of pregnancy reveals this pathology in 2-3% of pregnant women. However, over time, the placenta can rise and take its normal position in the uterine cavity at the time of birth.

At ultrasound examination doctors may note indirect signs of low placentation. These include incorrect position of the fetus - oblique and transverse, as well as breech presentation. With a low position of the placenta, the unborn child is last weeks pregnancy cannot descend to the uterine pharynx; it is higher than normal, as can be seen on ultrasound.

A woman with detected low placentation should visit a doctor at certain intervals to monitor the dynamics of the pathology. If there is a history of bleeding, the obstetrician-gynecologist should refer the expectant mother for a blood test for iron and coagulation parameters.

Treatment of low placentation

Once the diagnosis is established and there is no bleeding, the woman needs careful monitoring. If necessary, she is prescribed iron supplements to prevent the development of anemia. While at home, the expectant mother must follow a gentle regimen until the end of pregnancy.

With a low position of the placenta of the expectant mother Sexual activity is strictly prohibited. She should also eliminate physical and emotional stress and allocate enough time to sleep. A pregnant woman needs to eat properly and balancedly, including lean meat, fish, vegetables, herbs, fruits, cereals, black bread, and vegetable oil in her diet.

If bleeding occurs, the woman should immediately go to the hospital, where she will be given emergency treatment. The expectant mother is prescribed an oxygen mask and a dropper with a 0.9% sodium chloride solution. This therapy helps stop bleeding and replenish fluid loss from the bloodstream.

If these measures do not have the desired effect, doctors prescribe more serious drugs that stop blood loss. When this does not help stop the bleeding, the woman is indicated for emergency delivery by cesarean section.

Childbirth with low placentation is most often carried out naturally. During them, the woman should be under close medical supervision, since she may develop bleeding at any time. Often during the birth process, obstetricians-gynecologists resort to artificial opening of the amniotic sac. Indications for cesarean section are recurrent uterine bleeding of more than 200 ml, severe simultaneous blood loss and general contraindications to natural childbirth (improper position of the fetus, clinically narrow pelvis, etc.).

Prevention

Incorrect attachment of the placenta quite often occurs due to a disruption of the normal structure of the uterine mucosa. Therefore, to prevent this pathology, expectant mothers are advised to plan their pregnancy and avoid abortion. Women should also promptly treat infectious and inflammatory diseases of the pelvic organs.

When performing a cesarean section, preference should be given to incisions in the lower uterine segment and, if possible, avoid corporal surgery (when the incision is made along the midline of the abdomen).

Since low placentation may be caused by abnormalities of the ovum, the expectant mother should plan for conception. Before pregnancy, a woman is advised to healthy image life - to play sports, not to have bad habits, eat properly and balanced.