Location of the placenta: norm and pathology, causes of anomalies, symptoms and possible complications, diagnosis and treatment. Childbirth and precautions

The placenta is an organ located in the uterus and functions only during pregnancy. It is thanks to him that the normal development of pregnancy until the very birth becomes possible, therefore it is important that the placenta "works" normally. In this case, not only the correct structure of the placenta is important, but also its correct location. Placenta previa is a serious complication of pregnancy, which, fortunately, is not very common.

The placenta is laid at the very beginning of pregnancy and is fully formed. It provides nutrition to the fetus, excretion of metabolic products, and also performs the function of the lungs for it, because. it is through the placenta that the fetus receives the oxygen necessary for its life. In addition, the placenta is a real "hormonal factory": hormones are formed here that ensure the preservation, normal development of pregnancy, growth and development of the fetus.

The placenta is made up of villi - structures within which blood vessels pass. As pregnancy progresses, the number of villi, and, accordingly, the number of blood vessels is constantly growing.

Location of the placenta: norm and pathology

From the side of the uterus at the site of attachment of the placenta there is a thickening of the inner membrane. Deepenings are formed in it, which form the intervillous space. Some placental villi fuse with maternal tissues (they are called anchor), while the rest are immersed in maternal blood, which fills the intervillous space. Anchor villi of the placenta are attached to the partitions of the intervillous spaces, vessels pass through the thickness of the partitions, which carry maternal arterial blood saturated with oxygen and nutrients.

The villi of the placenta secrete special substances - enzymes that "melt" the small arterial vessels that carry maternal blood, as a result of which the blood flows out of them into the intervillous space. It is here that the exchange between the blood of the fetus and the mother takes place: with the help of complex mechanisms, oxygen and nutrients enter the blood of the fetus, and metabolic products of the fetus enter the mother's blood. The fetus is connected to the placenta by the umbilical cord. One end is attached to the umbilical region of the fetus, the other to the placenta. Inside the umbilical cord are two arteries and a vein that carry blood, respectively, from the fetus to the placenta and vice versa. Blood rich in oxygen and nutrients flows through the vein of the umbilical cord to the fetus, and venous blood from the fetus, containing carbon dioxide and metabolic products, flows through the arteries.

Normally, the placenta is located closer to the bottom of the uterus along the anterior or, less often, its posterior wall. This is due to more favorable conditions for the development of the fetal egg in this area. The mechanism for choosing the place of attachment of the fetal egg is not completely clear: there is an opinion that the force of gravity plays a role in choosing a place - for example, if a woman sleeps on her right side, then the egg is attached to the right wall of the uterus. But this is just one of the theories. It can only be unequivocally said that the fetal egg does not attach to places that are unfavorable for this, for example, to the locations of myomatous nodes or to places of damage to the inner lining of the uterus as a result of previous curettage. Therefore, there are other options for the location of the placenta, in which the placenta is formed closer to the lower part of the uterus. Allocate a low location of the placenta and placenta previa.

They say about the low location of the placenta when its lower edge is at a distance of no more than 6 cm from the internal pharynx of the cervix. This diagnosis is established, as a rule, during ultrasound. Moreover, in the second trimester of pregnancy, the frequency of this pathology is approximately 10 times higher than in the third trimester. It's pretty easy to explain. Conventionally, this phenomenon is called the "migration" of the placenta. In fact, the following happens: the tissues of the lower part of the uterus, very elastic, with an increase in the duration of pregnancy, undergo significant stretching and stretch upwards. As a result of this, the lower edge of the placenta seems to move upward, and as a result, the location of the placenta becomes normal.

Placenta previa is a more serious diagnosis. In Latin, this condition is called placenta praevia. "Pre via" literally means before life. In other words, the term "placenta previa" means that the placenta is on the way to the emergence of a new life.

Placenta previa is complete or central, when the entire placenta is located in the lower part of the uterus and completely covers the internal cervical os. In addition, there is a partial placenta previa. It includes marginal and lateral presentation. They say about lateral presentation of the placenta when up to 2/3 of the outlet of the uterus is covered with placental tissue. With marginal placenta previa, no more than 1/3 of the opening is closed.

Causes of anomalies

The main cause of anomalies of placental attachment are changes in the inner wall of the uterus, as a result of which the process of attaching a fertilized egg is disrupted.

These changes are most often caused by an inflammatory process of the uterus that occurs against the background of curettage of the uterine cavity, abortion, or associated with sexually transmitted infections. In addition, deformity of the uterine cavity predisposes to the development of such a pathology of the placenta, due either to congenital anomalies in the development of this organ, or to acquired causes - the uterus (benign tumor of the uterus).

Placenta previa can also occur in women suffering from serious diseases of the heart, liver and kidneys, as a result of congestion in the pelvic organs, including in the uterus. That is, as a result of these diseases, areas with worse blood supply conditions than other areas appear in the wall of the uterus.

Placenta previa in multiparous women occurs almost three times more often than in women carrying their first child. This can be explained by the "baggage of diseases", including gynecological ones, which a woman acquires by age.

There is an opinion that this pathology of the location of the placenta may be associated with a violation of some functions of the fetal egg itself, as a result of which it cannot attach itself to the most favorable part of the uterus for development and begins to develop in its lower segment.

Beware of bleeding!
Bleeding with placenta previa has its own characteristics. It is always external, i.e. blood flows out through the cervical canal, and does not accumulate between the wall of the uterus and the placenta in the form of a hematoma.
Such bleeding always begins suddenly, as a rule, without any apparent external cause, and is not accompanied by any pain. This distinguishes them from bleeding associated with premature termination of pregnancy, when, along with spotting, there are always cramping pains.
Often bleeding begins at rest, at night (woke up "in a pool of blood"). Once having arisen, bleeding always repeats, with greater or lesser frequency. Moreover, it is never possible to foresee in advance what the next bleeding will be in terms of strength and duration.
After such bleeding can be provoked by physical activity, sexual intercourse, any increase in intra-abdominal pressure (even coughing, straining, and sometimes a gynecologist's examination). In this regard, examination on the chair of a woman with placenta previa should be carried out with all precautions in a hospital, where emergency assistance can be provided in case of bleeding. The bleeding itself is dangerous for the life of mother and baby.

Quite often, placenta previa can be combined with its dense attachment, as a result of which the independent separation of the placenta after childbirth is difficult.

It should be noted that the diagnosis of placenta previa, with the exception of its central variant, will be quite correct only closer to childbirth, because. the position of the placenta may change. This is all due to the same phenomenon of "migration" of the placenta, due to which, when the lower segment of the uterus is stretched at the end of pregnancy and during childbirth, the placenta can move away from the area of ​​\u200b\u200bthe internal pharynx and not interfere with normal childbirth.

Symptoms and possible complications

The main complications and the only manifestations of placenta previa are spotting. Depending on the type of presentation, bleeding may occur for the first time during various periods of pregnancy or in childbirth. So, with central (complete) placenta previa, bleeding often begins early - in the second trimester of pregnancy; with lateral and marginal options - in the third trimester or directly in childbirth. The amount of bleeding also depends on the type of presentation. With a complete presentation, bleeding is usually more abundant than with an incomplete version.

Most often, bleeding occurs during pregnancy, when the preparatory activity of the lower segment of the uterus is most pronounced. But every fifth pregnant woman with a diagnosis of placenta previa notes the appearance of bleeding in the early stages (16-28 weeks of pregnancy).

What causes bleeding in placenta previa? During pregnancy, the size of the uterus constantly increases. Before pregnancy, they are comparable to the size of a matchbox, and by the end of pregnancy, the weight of the uterus reaches 1000 g, and its dimensions correspond to the size of the fetus along with the placenta, amniotic fluid and membranes. Such an increase is achieved, mainly due to an increase in the volume of each fiber that forms the wall of the uterus. But the maximum change in size occurs in the lower segment of the uterus, which stretches the more, the closer the term of delivery. Therefore, if the placenta is located in this area, then the process of "migration" is very fast, the low-elastic tissue of the placenta does not have time to adapt to the rapidly changing size of the underlying uterine wall, and occurs over a greater or lesser extent. In the place of detachment, damage to the vessels occurs and, accordingly, bleeding.

With placenta previa, the threat of abortion is often noted: increased uterine tone, pain in the lower abdomen and in the lumbar region. Often, with this location of the placenta, pregnant women suffer - stably reduced pressure. A decrease in pressure, in turn, reduces performance, causes weakness, feelings of weakness, increases the likelihood of fainting, the appearance of a headache.

In the presence of bleeding, anemia is often detected - a decrease in the level of hemoglobin in the blood. Anemia can exacerbate the symptoms of hypotension, in addition, oxygen deficiency caused by a decrease in hemoglobin levels adversely affects the development of the fetus. There may be growth retardation, fetal growth retardation syndrome (FGR). In addition, it has been proven that children born to mothers who suffered from anemia during pregnancy always have a reduced hemoglobin level in the first year of life. And this, in turn, reduces the defenses of the baby's body and leads to frequent infectious diseases.

Due to the fact that the placenta is located in the lower segment of the uterus, the fetus often takes the wrong position - transverse or oblique. Often there is also a fetus when its buttocks or legs are turned towards the exit from the uterus, and not the head, as usual. All this makes it difficult or even impossible to have a child naturally, without surgery.

Diagnosis of placenta previa

Diagnosis of this pathology is most often not difficult. It is usually established in the second trimester of pregnancy based on complaints of intermittent bleeding without pain.

The doctor on examination or during an ultrasound scan may reveal an incorrect position of the fetus in the uterus. In addition, due to the low location of the placenta, the underlying part of the child cannot descend into the lower part of the uterus, therefore, a high standing of the presenting part of the child above the entrance to the small pelvis is also a characteristic feature. Of course, modern doctors are in a much more advantageous position compared to their counterparts 20-30 years ago. At that time, obstetrician-gynecologists had to navigate only by these signs. After the introduction of ultrasound diagnostics into wide practice, the task has become much simpler. This method is objective and safe; Ultrasound allows you to get an idea of ​​the location and movement of the placenta with a high degree of accuracy. For these purposes, it is advisable to triple ultrasound control at 16, 24-26 and at. If, according to the ultrasound examination, no pathology of the location of the placenta is detected, the doctor may, during examination, identify other causes of spotting. They can be various pathological processes in the vagina and cervix.

Observation and treatment of placenta previa

An expectant mother who has been diagnosed with placenta previa needs careful medical supervision. Of particular importance is the timely conduct of clinical trials. If even a slightly reduced level of hemoglobin or disorders in the blood coagulation system are detected, the woman is prescribed iron supplements, because. in this case, there is always a risk of rapid development of anemia and bleeding. If any, even minor, deviations in the state of health are detected, consultations of the relevant specialists are necessary.

Placenta previa is a formidable pathology, one of the main causes of serious obstetric bleeding. Therefore, in the event of bleeding, all a woman’s health problems, even small ones, can aggravate her condition and lead to adverse consequences.

regime plus diet
If there is no bleeding, especially with a partial variant of placenta previa, a woman can be observed on an outpatient basis.
In this case, it is recommended to observe a sparing regime: physical and emotional stress should be avoided, sexual contacts should be excluded. It is necessary to sleep at least 8 hours a day, more to be in the fresh air.
In the diet, there must be foods rich in iron: buckwheat, beef, apples, etc. Be sure to have a sufficient protein content, because. without it, even with a large intake of iron, hemoglobin will remain low: in the absence of protein, iron is poorly absorbed. It is useful to regularly eat vegetables and fruits rich in fiber, because. stool retention can provoke the appearance of spotting. Laxatives for placenta previa are contraindicated. Like all pregnant women, patients with placenta previa are prescribed special multivitamin preparations. If all these conditions are met, the manifestations of all the symptoms described above, which in most cases accompany placenta previa, are reduced, which means that conditions are provided for the normal growth and development of the child. In addition, in the event of bleeding, the adaptive capabilities of the woman's body increase, and blood loss is more easily tolerated.

In the presence of bloody discharge, observation and treatment of pregnant women with placenta previa at gestational ages over is carried out only in obstetric hospitals that have conditions for providing emergency care in an intensive care unit. Even if the bleeding has stopped, the pregnant woman remains under the supervision of the hospital doctors until the due date.

In this case, treatment is carried out depending on the strength and duration of bleeding, the duration of pregnancy, the general condition of the woman and the fetus. If the bleeding is insignificant, the pregnancy is premature and the woman feels well, conservative treatment is performed. Strict bed rest, drugs to reduce, improve blood circulation are prescribed. In the presence of anemia, a woman takes drugs that increase the level of hemoglobin, general strengthening drugs. Calming agents are used to reduce emotional stress.

childbirth

With complete placenta previa, even in the absence of bleeding, a caesarean section is performed at 38 weeks of gestation, because. spontaneous childbirth in this case is impossible. The placenta is located on the way the baby leaves the uterus, and if you try to give birth on your own, it will completely detach with the development of very severe bleeding, which threatens the death of both the fetus and the mother.

The operation is also resorted to at any stage of pregnancy in the presence of the following conditions:

• placenta previa, accompanied by significant bleeding, life-threatening;
• recurrent bleeding with anemia and severe hypotension, which are not eliminated by the appointment of special drugs and are combined with a violation of the fetus.

In a planned manner, a cesarean section is performed when a partial placenta previa is combined with another pathology, even in the absence of bleeding.

If a pregnant woman with partial placenta previa carried the pregnancy to term, in the absence of significant bleeding, it is possible that childbirth will occur naturally. With the opening of the cervix by 5-6 cm, the doctor will finally determine the variant of placenta previa. With a small partial presentation and slight bleeding, an opening of the fetal bladder is performed. After this manipulation, the fetal head descends and compresses the bleeding vessels. The bleeding stops. In this case, the completion of childbirth in a natural way is possible. With the ineffectiveness of the measures taken, childbirth is completed promptly.

Unfortunately, after the birth of a child, the risk of bleeding remains. This is due to a decrease in the contractility of the tissues of the lower segment of the uterus, where the placenta was located, as well as the presence of hypotension and anemia, which have already been mentioned above. In addition, it has already been said about the frequent combination of presentation and dense attachment of the placenta. In this case, the placenta after childbirth cannot completely separate from the walls of the uterus on its own and it is necessary to conduct a manual examination of the uterus and separation of the placenta (the manipulation is performed under general anesthesia). Therefore, after childbirth, women who had placenta previa remain under the close supervision of hospital doctors and must carefully follow all their recommendations.

Infrequently, but still there are cases when, despite all the efforts of doctors and a caesarean section, the bleeding does not stop. In this case, it is necessary to resort to the removal of the uterus. Sometimes this is the only way to save a woman's life.

Precautionary measures

It should also be noted that with placenta previa, one should always keep in mind the possibility of developing severe bleeding. Therefore, it is necessary to discuss with the doctor in advance what to do in this case, which hospital to go to. Staying at home, even if the bleeding is light, is dangerous. If there is no prior agreement, you need to go to the nearest maternity hospital. In addition, with placenta previa, you often have to resort to blood transfusions, so if you have been diagnosed with such a diagnosis, find out in advance which of your relatives has the same blood type as you and get their consent to donate blood for you if necessary (the relative must pre-test for HIV, syphilis, hepatitis).

You can arrange in a hospital where you will be observed so that your relatives donate blood for you in advance. In this case, it is necessary to enlist a guarantee that the blood is used specifically for you - and only if you do not need it, it will be transferred to a general blood bank. It would be ideal for you to donate blood for yourself, but this is only possible if your condition does not cause concern, all indicators are normal and there is no spotting. You can donate blood for storage multiple times during your pregnancy, but you also need to ensure that your blood is not used without your knowledge.

Although placenta previa is a serious diagnosis, modern medicine allows you to endure and give birth to a healthy child, but only if this complication is diagnosed in a timely manner and all doctor's prescriptions are strictly observed.

When everything is over and you and your baby are at home, try to organize your life properly. Try to rest more, eat right, be sure to walk with the baby. Do not forget about multivitamins and drugs for the treatment of anemia. If possible, do not refuse breastfeeding. This will not only lay the foundation for the health of the baby, but also speed up the recovery of your body, because. stimulation of the nipple by sucking causes the uterus to contract, reducing the risk of postpartum hemorrhage and uterine inflammation. It is desirable that at first someone helps you in caring for the child and household chores, because your body has suffered a difficult pregnancy, and it needs to recover.

Evgenia Nazimova
obstetrician-gynecologist, Moscow

Attachment of the placenta along the anterior and posterior wall of the uterus. What is the difference?

The next desire of women who finally saw the cherished two stripes on the test is the desire to quickly get to know the future baby. Their next opportunity will be at the end of the first trimester during a routine fetal ultrasound examination, to which women come with many questions.

However, the ultrasound procedure often raises even more questions. The doctor’s on-duty phrase “the placenta along the anterior (posterior) wall of the uterus” causes silent bewilderment and reflection on whether this is the norm or a deviation

What is placenta. The placenta is an amazing organ, it appears only during pregnancy in order to ensure the full functioning of the fetus. The precursor of the placenta, the villous chorion, begins to develop from the 9th day of pregnancy, which at the 16th week of pregnancy turns into the placenta or, as it is also called, the placenta.

Placenta on the posterior wall of the uterus. More often, the placenta is attached to the back wall of the uterus. The posterior wall is the side of the uterus closest to the woman's spine. The location of the placenta usually depends on the location of the egg at the time of fertilization. The fertilized egg attaches to the wall of the uterus and begins to grow in this place. However, it is possible to find out the final place of attachment of the placenta only in the third trimester, since as the uterus grows, the location of the placenta may also change. Many midwives consider the development of the placenta along the posterior wall to be the most optimal, as it creates favorable conditions for the correct location of the fetus in the uterus on the eve of childbirth.

Placenta on the anterior wall of the uterus. With an anterior location, a child's place develops along that wall of the uterus, which is closer to the woman's stomach. This is a variant of the norm, however, some difficulties may arise:

• due to the fact that the child is located behind the placenta, it is more difficult for a woman to feel movements;
• the fetal heartbeat when listening may not be so distinct;
• amniocentesis and delivery by caesarean section can be somewhat difficult, although most physicians are experienced.
• extremely rare is the pathological accretion of the placenta to the muscular layer of the uterus, which occurs if the previous birth ended in a caesarean section, and the risk of such a complication increases in direct proportion to the number of CS. Therefore, women are advised to avoid childbirth through surgery without medical indications.
During childbirth, the location of the placenta on the anterior or posterior wall of the uterus does not matter and does not pose a threat to the life of the mother and baby. The main thing for the child is your care and love, and the location of the placenta worries him the least.

The placenta is formed in the first weeks of pregnancy and acts as a conductor of nutrients and oxygen to the fetus and removal of its waste products, and also serves as a barrier to infections.

There are several options for its attachment in the uterus. One of them is the location on the front wall. Having heard such a verdict from a doctor, it is important for a woman to know how this threatens the normal course of pregnancy and the development of the child.

From a physiological point of view, the attachment of the placenta along the posterior wall is considered the most optimal. The fact is that during pregnancy, the walls of the uterus are stretched unevenly. As the child grows, the front wall increases in size and stretches more, while the back wall retains its density and stretches much less.

The anterior wall becomes thinner as it stretches. From this it becomes clear that for the normal functioning of the placenta, the location along the back wall is more advantageous, because in this way it is subjected to a minimum of stress.

Advantages of the back wall

• The placenta is provided with immobility - placenta previa along the posterior wall is extremely rare, the placenta does not fall down and there is no threat of pregnancy.
• Uterine contractions and increased tone will not increase.
• The placenta is less exposed to shocks and shocks from the baby during movements.
• Lower risk increment.
• Lower risk of injury to the placenta in case of accidental impact to the abdomen.
• With a caesarean section, the risk of bleeding is lower.

Causes of anterior placenta previa

However, not always everything during pregnancy happens according to the ideal scenario. Often the placenta is attached in a different place - on the side or in front. At the moment, many doctors consider the attachment of the placenta along the anterior wall as a variant of the norm, requiring special observation.

There can be many reasons why the placenta is attached to the anterior wall of the uterus. The mechanism of such attachment has not been fully studied, but it has been found that it can be provoked by:

• change in the endometrium of the uterus;
• Features of the development and implementation of the fetal egg;
• scars and adhesions on the walls of the uterus.

Various inflammatory diseases of the genital area, endometriosis can lead to changes in the endometrium.

Cicatricial changes on the walls of the uterus appear as a result of operations on the uterus, abortions, inflammatory diseases. This leads to the conclusion that multiple abortions and caesarean sections increase the risk of anterior attachment of the placenta.

According to statistics, such attachment rarely occurs during the first pregnancy. But in multiparous and multiparous women, this is a much more frequent occurrence, which can be explained by changes in the uterus and a special inner lining.

If for some reason the fetal egg does not have time to penetrate into the endometrium for a certain time, then it is attached to the anterior wall.

Possible complications of anterior attachment of the placenta to the uterus

Is there any danger in this position of the placenta? It is impossible to answer this question unambiguously.

The fact is that with a high location of the placenta along the anterior wall, pregnancy can proceed quite normally and end in natural childbirth without pathologies.

At the same time, there are some risks. This is due to the fact that the placenta is an organ that is not capable of stretching. And when the wall on which it is attached begins to stretch too actively, complications are possible.

First of all, this is insufficient functioning of the placenta and a violation of the delivery of nutrients and oxygen to the fetus. And this in turn can lead to or .

If the distance to the uterine pharynx is reduced to 4 cm, we will talk about such a complication of the anterior location as. Anterior placenta previa can cause dysfunction of the placenta,.

In extremely rare cases (if located too low), the placenta can completely block the cervix of the uterus, which excludes the possibility of natural childbirth. More often this complication develops during repeated pregnancy.

Anterior placenta previa in combination with placental insufficiency can provoke such a formidable complication of pregnancy as partial or complete abruption.

In some cases, indirect symptoms are:

• weakly felt fetal movements;
• difficulties with - sometimes the sound of the heart is completely inaudible in the absence of pathology of the fetal cardiovascular system;
• Large belly.

Unpleasant symptoms may appear if the placenta begins to descend and its presentation occurs. In this case, a woman should pay attention to:

• severity and;

Diagnostic methods

Diagnosis is quite simple and is based on a gynecological examination and ultrasound.

Only ultrasound gives a complete picture of how the placenta is located and whether there is a risk of its presentation.

Therefore, you should not refuse to undergo an ultrasound scan on time. The sooner such a feature of the course of pregnancy is revealed, the easier it will be to prevent possible complications.

Features of pregnancy management

In itself, the anterior location does not cause a woman any trouble and does not worsen her well-being. Being just a feature of the course of pregnancy, it does not require treatment. In addition, there is no treatment for it, since it is impossible to influence the location of the placenta, as well as change its position and move it to the back wall.

However, this feature of pregnancy requires constant and close monitoring in order not to miss the possible onset of complications, which are still more likely with an anterior location than with a normal one.

To reduce the risk, pregnant women with this arrangement are advised to rest more, completely refuse to lift weights (even if it seems that the objects are not heavy at all), avoid excitement, stress, and physical exertion.

If, then you should try to touch your stomach as little as possible so as not to provoke an increase in tone and placental abruption.

This is especially important in the later stages.

It is important to visit the doctor on time so as not to miss changes in the placenta and its location. This approach will allow you to notice in time that the children's place tends to move down.

Childbirth with placenta on the anterior wall

In the absence of complications, such an arrangement of the child's place has no effect on the course of childbirth. Moreover, some women note that childbirth is easier and faster. But this is true when it comes to natural childbirth.

If a woman is shown a caesarean section, then the anterior location can complicate the course of the operation, increasing the risk of large blood loss. This is due to the fact that the incision is made in the place where the placenta is located.

Therefore, when indications for caesarean section, doctors must take into account the location of the placenta and adjust the surgical intervention in such a way as to minimize the risks of large blood loss. Naturally, for this, a woman must be regularly observed and have all the necessary studies.

The anterior location has no effect on the health of the born child.

Anterior location is not a pathology, but an individual feature of pregnancy.

Therefore, do not worry and expect complications - in the vast majority of cases, everything ends with a successful birth without complications. The only feature here is the need for closer monitoring of the course of pregnancy.

In contact with

Attachment of the placenta along the anterior and posterior wall of the uterus

What is the difference?

The next desire of women who finally saw the cherished two stripes on the test is the desire to quickly get to know the future baby. Their next opportunity will be at the end of the first trimester during a routine fetal ultrasound examination, to which women come with many questions.

However, the ultrasound procedure often raises even more questions. The doctor’s on-duty phrase “the placenta along the anterior (posterior) wall of the uterus” causes silent bewilderment and reflection on whether this is the norm or a deviation

What is placenta. The placenta is an amazing organ, it appears only during pregnancy in order to ensure the full functioning of the fetus. The precursor of the placenta, the villous chorion, begins to develop from the 9th day of pregnancy, which at the 16th week of pregnancy turns into the placenta or, as it is also called, the placenta.

Placenta on the posterior wall of the uterus. More often, the placenta is attached to the back wall of the uterus. The posterior wall is the side of the uterus closest to the woman's spine. The location of the placenta usually depends on the location of the egg at the time of fertilization. The fertilized egg attaches to the wall of the uterus and begins to grow in this place. However, it is possible to find out the final place of attachment of the placenta only in the third trimester, since as the uterus grows, the location of the placenta may also change. Many midwives consider the development of the placenta along the posterior wall to be the most optimal, as it creates favorable conditions for the correct location of the fetus in the uterus on the eve of childbirth.

On her own, a woman is unlikely to be able to feel on which wall the placenta is located. Although it is believed that if it is placed on the back wall, then the woman will feel the movements of the fetus earlier and more clearly, since the child's place fills the back space of the uterus, and the fetus is tightly pressed against the woman's stomach, where the baby's movements and heartbeat are easiest to determine.

Placenta on the anterior wall of the uterus. With an anterior location, a child's place develops along that wall of the uterus, which is closer to the woman's stomach. This is a variant of the norm, however, some difficulties may arise:

• due to the fact that the child is located behind the placenta, it is more difficult for a woman to feel movements;
• the fetal heartbeat when listening may not be so distinct;
• amniocentesis and delivery by caesarean section can be somewhat difficult, although most physicians are experienced.
• extremely rare is the pathological accretion of the placenta to the muscular layer of the uterus, which occurs if the previous birth ended in a caesarean section, and the risk of such a complication increases in direct proportion to the number of CS. Therefore, women are advised to avoid childbirth through surgery without medical indications.
• During childbirth, the location of the placenta on the anterior or posterior wall of the uterus does not matter and does not pose a threat to the life of the mother and baby. The main thing for the child is your care and love, and the location of the placenta worries him the least.

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The placenta is one of several temporary organs that develop in a woman's body during pregnancy. It is difficult to overestimate the importance of the placenta in the development of the fetus: it is an intermediary between the child and his mother, transfers nutrients and oxygen from the mother’s blood to the baby, removes toxins and waste products from the fetus, filters the mother’s blood from harmful substances and infections, thereby protecting the baby, whose immunity until it is able to withstand the influence of the external environment.

Given all this, it is easy to understand why doctors are so closely monitoring the condition of the placenta, its location, and so on.

The placenta is formed only by the 4th month of pregnancy. Prior to this, its functions are distributed among other temporary organs: the fetal membrane and the corpus luteum, formed at the site of the bursting follicle. For the development of the baby, it is very important that the placenta is properly formed, and even its location is of great importance for the correct course of pregnancy.

What are the features of the location of the placenta, and how does it affect the course of pregnancy?

The most ideal option for the location of the placenta in the uterine cavity is to attach it along the back wall in the upper part of the uterus, closer to the bottom. The fact is that the walls of the uterus are designed in such a way that as the fetus grows, they stretch very much. However, they do not stretch evenly.

The uterus is designed in such a way that stretching occurs for the most part along front wall. It becomes thinner and more stretchable, while the back wall remains dense and much less prone to stretching.

That is why nature has laid down the attachment of the fetal egg precisely to the back wall, because the placenta, unlike muscle tissue, does not have the ability to stretch. Thus, the placenta fixed on the back wall experiences much less stress, which is not at all beneficial to it.

So it turns out that the back wall is an ideal option for attaching the fetus, and then the development of the placenta.

Options for the location of the placenta

For various reasons, the fetal egg can be attached not only to the upper part of the posterior wall of the uterus, but also to other parts of it. Quite often there is a side mount: to the right or left of the rear wall. In some, also not very rare cases, the placenta is fixed on the anterior wall of the uterus.

All these options for the location of the placenta are not considered pathology, although in such cases there is a deviation from the ideal location conceived by nature. Women with a lateral location of the placenta, as well as with a placenta attached to the anterior wall, most often carry and give birth to children naturally without complications. Of course, among them there are those who are faced with various pathologies, but, as a rule, they have other reasons for complications.

Certainly, placenta located on the anterior wall undergoes somewhat greater stress due to the constant stretching of the walls of the uterus, the movements of the fetus, the actions of the mother. To some extent, this increases the risk of damage to the placenta, premature detachment, and so on. The direction of placental migration may also change.

Due to the constant stretching of the muscles of the uterus, the placenta can gradually sink too close to the os of the uterus, and sometimes even block the exit from the uterus into the birth canal. If 6 centimeters or less remains between the edge of the placenta and the cervical os, they talk about, but if the placenta partially or completely blocks the exit from the uterus, this pathology is called placenta previa.

However, low placentation and placenta previa can be caused by a number of other reasons, which will be discussed later. Posterior presentation occurs much less frequently than along the anterior wall. We have already discussed why this is the case above.

Causes of anterior placenta previa

What are the causes of placenta previa on the anterior wall? Unfortunately, these reasons are not fully understood. However, some of them have already been established reliably. In particular, they include various endometrial damage- the inner layer of the uterus. These can be inflammatory processes, scars from operations, such as caesarean section, the effects of curettage after miscarriages or abortions.

uterine fibroids, as well as its other pathologies can cause placenta previa along the anterior wall. It is noticed that in women giving birth for the first time, this pathology occurs much less frequently than in the course of the second and subsequent pregnancies. It is connected, most likely, also with the state of the mucous membrane of the uterus.

However, not only on the part of the mother, there may be reasons for this pathology. In some cases, they are in underdevelopment fertilized egg. Due to this delay, the fertilized egg does not have time to implant in the endometrium in time. Implantation occurs in this case in the lower part of the uterus.

It also happens that the fetal egg is attached to the anterior wall in the upper part of the uterus, however, as a result, the placenta migrates as a result of the stretching of the uterus to the lower part.

Degrees of anterior presentation

Distinguish between full and partial presentation. It is easy to understand that full presentation The situation is called when the placenta completely covers the cervical os.

Partial presentation also divided into 2 different types: lateral and marginal. Regional - when the placenta passes along the very edge of the cervix of the uterus. Lateral presentation is when the placenta still blocks the exit from the uterus, although not completely.

Symptoms of anterior presentation and why it is dangerous

Unfortunately, very often anterior placenta previa proceeds completely asymptomatically. Of course, this does not mean that it will be impossible to diagnose pathology. Methods for defining the problem will be discussed later. The main thing in the absence of symptoms is that it is not always possible to diagnose presentation on time.

In some cases, placenta previa makes itself felt bleeding. This means that there was a premature detachment of the placenta. Actually, this is precisely the main danger of presentation, although not the only one.

As you remember, the placenta supplies the fetus with nutrients and oxygen. When the placenta is located low, and even more so blocks the exit from the uterus, it turns out that the child presses on it with all its weight. It can compress blood vessels in the placenta. This, in turn, can cause oxygen starvation - hypoxia.

As the fetus grows, the pressure on the placenta increases, in addition, the movements of the child become more active, it touches the placenta. As a result, premature placental abruption. In this case, the consequences can be deplorable not only for the child, but also for the mother. Especially if she has problems with blood clotting.

Bleeding during presentation can occur as early as the second trimester, immediately after the formation of the placenta. However, most often it occurs at a later date, sometimes just before childbirth, or even during childbirth.

Therefore, if a symptom of placenta previa becomes vaginal bleeding, it is necessary to urgently consult a doctor to establish the cause and begin treatment.

Separately, it is worth talking about childbirth during presentation. Full presentation, a condition when the placenta blocks the exit from the uterus, completely excludes the possibility of natural childbirth.

Placental tissue simply will not release the fetus into the birth canal. But in the case of partial presentation, natural childbirth, in principle, is possible. The main thing is that the doctors who take delivery carefully monitor the woman in labor. In the event of bleeding, it still makes sense to perform an emergency caesarean section.

Diagnosis of anterior presentation

Placenta previa can be diagnosed in several ways. Including when gynecological examination. Full and partial presentation by palpation are felt differently. With full presentation, it is felt to the touch that the cervix of the uterus is completely blocked by the placenta.

With partial presentation, both placental tissue and fetal membranes are felt. By the way, when viewed from the side and marginal presentation are perceived equally. So the gynecologist, without additional devices, will not be able to determine what kind of partial presentation in question.

If a woman was initially diagnosed with low placentation, for example, during the first planned ultrasound, then later she will be regularly examined, including with the help of ultrasound. Then, in the case of placental migration and the development of presentation, this will be detected in a timely manner during the next study. Ultrasound will show the presence of pathology even if it is asymptomatic. That is why women are advised to attend all routine examinations and ultrasound examinations.

Treatment of women with anterior presentation

Unfortunately, modern medicine is not able to influence the location of the placenta. Treatment of placenta previa comes down to the constant supervision of doctors and timely examinations. In this case, not only the condition of the fetus and placenta, but also the pregnant woman is monitored. Be sure to do a blood test regularly. The level of hemoglobin and the ability of the blood to clot are checked. The fact is that anemia or acute blood incoagulability can play a bad joke on the expectant mother in case of bleeding.

If, for a period of more than 24 weeks, a woman diagnosed with anterior placenta previa opens vaginal bleeding, no matter how severe it is, the woman is hospitalized. And be sure to go to the hospital where there is a special resuscitation unit. In case of extensive blood loss. The main and first appointment for all women with bleeding during pregnancy is absolute peace.