Pregnancy is a significant and very important period in the life of every woman. It can be divided into three trimesters, in each of which an “abnormal” situation may arise, that is, a complication of pregnancy. In such circumstances, the main thing is not to panic, but to immediately seek medical help. In order not to miss the moment and notice the first signs of trouble in time, the expectant mother should know what complications can occur in each of the trimesters and their symptoms. nine0006

I TRIMESTR

ERROR IS OUT

For the first time, a woman is suspected of being pregnant when her period is delayed. To make sure that this is really the case, a blood test for human chorionic gonadotropin, a hormone whose level rises sharply during pregnancy, helps. And here it is necessary, without delay, to visit an obstetrician-gynecologist and do an ultrasound. It should confirm that the fetal egg is in the uterine cavity. Sometimes (recently, according to the literature, the percentage is growing), a fetal egg can also attach outside the uterine cavity. nine0006

In this case, one speaks of an ectopic pregnancy. Its most common form is tubal, when the fetal egg begins to develop in the fallopian tube. It happens that it is attached in the ovary, abdominal cavity or in the cervix. This condition is life-threatening and requires urgent surgical intervention. The risk is that no organ other than the uterus itself is fit for carrying a baby. A pipe, for example, has a very small volume and, under the “onslaught” of a growing embryo, it will burst sooner or later. The resulting bleeding poses a serious threat to a woman's life. nine0006

Against the background of a delay in menstruation, paroxysmal pains, often accompanied by weakness, dizziness, nausea, and bloody discharge from the genital tract, should cause anxiety. It is urgent to go to the doctor, since it is possible to accurately determine an ectopic pregnancy only with the help of ultrasound. When an ectopic pregnancy is detected, laparoscopic surgery is most often performed. After restorative treatment, a normal pregnancy often occurs.

EXPECTED COMPLICATION - TOXICOSIS

Everyone has heard about it, everyone is waiting with horror when it comes. What's this? That's right - toxicosis. The most anticipated and most common complication of early pregnancy. Mild nausea, intolerance to certain odors, sometimes dizziness - these are the symptoms of early toxicosis, which, not without reason, are also considered indirect signs of pregnancy.

If vomiting is repeated no more than 3-5 times a day and the expectant mother generally feels fine, there is no need to change her usual lifestyle. But when nausea and vomiting occur 10 or even 20 times a day and any food and even a sip of water do not go for the future, a woman needs hospitalization. Lack of food and dehydration - that's what will worry doctors the most. After all, the expectant mother is losing weight, heart palpitations begin, blood pressure drops, but she needs strength to carry the baby. In the hospital, the fluid deficiency will be replenished with the help of droppers, vomiting will be eliminated with the help of special medications approved for pregnant women, and a full examination of the expectant mother will be carried out. Thanks to this, the unborn child and his expectant mother will feel much better and return to their normal lifestyle again. nine0006

I-II TRIMESTER

THREAT OF TERMINATION OF PREGNANCY

At the beginning of pregnancy, this condition is associated with a hormonal imbalance. For some reason, the hormones that support pregnancy begin to be produced in smaller quantities. Genetic malformations of the embryo can also provoke such a complication. This will seem strange to many, but in Western Europe, doctors do not seek to keep the pregnancy at any cost in the early stages. It is believed that in this way nature conducts natural selection. nine0006

No matter how you feel about this problem and whatever the causes of the complication, the expectant mother should be alerted by pulling pains in the lower abdomen and lower back, bloody discharge from the genital tract. Any of these symptoms may indicate a threatened miscarriage. Moreover, if there is a discharge, the doctors diagnose "a miscarriage that has begun", but this does not mean that the situation cannot be reversed and the situation normalized. So, when you see such a record in medical documents, do not be alarmed. Doctors will make every effort to still save the pregnancy. nine0006

And in order for the efforts of doctors to be successful, you should visit a doctor as soon as possible and have an ultrasound scan done. With it, you can find out how the pregnancy develops, but if a woman is concerned about the discharge, then find out their cause: for example, malformations of the uterus or too low location of the placenta, as well as premature opening of the cervix caused by its shortening (isthmic-cervical insufficiency - ICI ). Another mandatory study is the level of hormones in the urine and blood.

In any case, bleeding, too much pain in the lower abdomen, increased uterine tension are a good reason for hospitalization. If hormonal deficiency is detected, hormonal therapy is prescribed to maintain the pregnancy. With a low location of the placenta, a woman will be advised to lead a calm lifestyle and take drugs that relieve tension in the uterus.

When signs of CCI are detected, the cervix is ​​sutured. All these measures help to prolong the pregnancy to full term - 37 weeks. If the baby is still born earlier, modern equipment and advances in medicine make it possible to nurse babies even with low body weight (from 500 g). nine0006

III TRIMESTER

PLACENTA PRESENTATION

The placenta is formed during pregnancy and is excreted from the body after childbirth. Normally, it should be located in the upper and middle third of the uterus so that the child can be safely born at the time appointed by nature. If the placenta occupies a place near the exit from the uterus, is attached at least partially to the cervix, they speak of placenta previa. The reasons for this situation may be malformations of the internal genital organs, chronic inflammation of the uterus and others. nine0006

A characteristic symptom is bloody discharge from the genital tract, most often after 7 months of pregnancy. To determine this complication, it is enough to do an ultrasound. The woman is recommended hospitalization and bed rest, as well as drug therapy. If placenta previa persists at the time of delivery, the baby can only be born by caesarean section. The expectant mother is hospitalized at the 37-38th week of pregnancy (at this time the pregnancy is considered full-term) in order to prepare for the operation. But if a woman has heavy bleeding, a caesarean section will have to be done on an emergency basis. nine0006

PLACENTAL DETECTION

This complication occurs when the placenta separates from the uterine wall before the baby is born. Most often this occurs at the end of the third trimester or during childbirth. Women with high blood pressure are most at risk, which is why doctors strongly recommend expectant mothers to carefully monitor their blood pressure levels and strictly follow the doctor's recommendations when it rises.

An expectant mother should be alerted by prolonged abdominal pain, increased activity of the uterus, bleeding from the genital tract. This situation is risky both for the woman herself and for her unborn child. The woman is threatened with blood loss, and the baby is in danger of hypoxia: extensive placental abruption in the truest sense of the word cuts off oxygen to him. The actions of doctors depend on how strong the labor activity is and how great the woman's blood loss is. If the bleeding is weak, the contractions continue, the baby's heartbeat is normal, the baby feels good, the doctors allow the birth to go naturally, but closely monitor the well-being of the mother and baby. With heavy bleeding and the appearance of signs of hypoxia in crumbs, an emergency caesarean section is performed. nine0006

PREMATURE ROUTING OF WATER

This complication is said to occur when the amniotic fluid breaks before contractions begin. There can be many reasons for this development of events, but the main one is infection. That is why doctors carefully monitor expectant mothers and during pregnancy several times do bacteriological culture of flora from the cervical canal. According to modern international recommendations, it is also desirable to take a smear for group B streptococci before childbirth at about 36-37 weeks. If an infection is detected during childbirth, a woman is given antibiotic therapy. nine0006

If the amniotic fluid is shed, regardless of the gestational age, call an ambulance or go to the maternity hospital. Making sure that this is really amniotic fluid is quite simple. If the flow of urine can be stopped by tensing the muscles, then the amniotic fluid will continue to flow even if the muscles are tensed. In addition, you can use the amniotest (test for amniotic fluid). If amniotic fluid is expelled, the test strip will change color. There are also special pads that are much easier to use. The principle of their action is the same: if amniotic fluid gets on them, the pads change color. nine0006

You should also see a doctor if the amniotic fluid starts to leak a little. Only a doctor can clarify the situation. Don't refuse hospitalization. If the leakage intensifies, medical attention is indispensable. In most cases, after the outflow of amniotic fluid, a woman and her unborn child begin to prepare for childbirth. If this happened before the 34th week of pregnancy, the baby is given medication to help his lungs open up. But when the waters have not completely poured out, it is possible to prolong the pregnancy. And the efforts of doctors will be directed precisely at this. nine0006

PRE-ECLAMPSIA

Another insidious complication in late pregnancy is preeclampsia, or, as it used to be called, preeclampsia. Another name for this complication is late toxicosis of pregnant women. Its main symptom is the presence of protein in the urine. It is for this reason that during pregnancy it is necessary to take this analysis so often. In addition, preeclampsia is manifested by an increase in blood pressure up to 130/90 mm Hg. and above, internal and external edema, due to which the expectant mother gains excess weight. DO NOT refuse hospitalization: adverse symptoms may increase, due to which the well-being of the unborn baby may deteriorate sharply. Complex therapy prescribed by the attending physician, as a rule, leads to a positive result. If the symptoms increase, you have to resort to emergency delivery - depending on the situation, induce labor or do a caesarean section. nine0006

To avoid trouble, doctors advise expectant mothers not to abuse salt, but rather to stop consuming it, lead a healthy lifestyle, drink 2 liters of fluid a day and observe a sleep and rest regimen.

Placenta previa. What is placenta previa?

IMPORTANT
The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor. nine0006

Placenta previa is an anomaly of the period of pregnancy, characterized by attachment of the placenta to the lower segment of the uterus with partial or complete overlap of the internal uterine os. Clinically, placenta previa is manifested by recurrent bleeding from the genital tract, anemia of the pregnant woman, the threat of miscarriage, and fetal placental insufficiency. Placenta previa is diagnosed during a vaginal examination, ultrasound. Identification of placenta previa requires the prevention of spontaneous abortion, correction of anemia and fetal hypoxia, the choice of optimal delivery tactics (more often - caesarean section). nine0006

ICD-10

O44 Placenta previa

• Causes of placenta previa
• Symptoms of placenta previa
• Diagnosis of placenta previa
• Treatment for placenta previa
• Prophylaxis
• Prices for treatment

General

The placenta (afterbirth, child's place) is an important embryonic structure that fits snugly against the inner wall of the uterus and provides contact between the organisms of the mother and fetus. During pregnancy, the placenta performs nutritional, gas exchange, protective, immune, hormonal functions necessary for the full development of the embryo and fetus. The location of the placenta in the region of the posterior and lateral walls of the body or the bottom of the uterus, i.e., in the zones of the best vascularization of the myometrium, is considered to be physiological. Attachment of the placenta to the posterior wall is optimal because it protects this embryonic structure from accidental damage. The location of the placenta on the anterior surface of the uterus is rare. nine0006

In the event that the placenta is attached so low that it overlaps the internal os to a certain extent, they speak of placenta previa. In obstetrics and gynecology, placenta previa occurs in 0.1-1% of all births. With the total closure of the internal pharynx by the placenta, there is a variant of complete placenta previa. This type of pathology occurs in 20-30% of cases of the number of presentations. With partial overlap of the internal pharynx, the condition is regarded as incomplete placenta previa (frequency 35-55%). With the localization of the lower edge of the placenta in the III trimester at a distance of less than 5 cm from the internal pharynx, a low location of the placenta is diagnosed. nine0006

Placenta previa creates conditions for prematurity and fetal hypoxia, incorrect position and presentation of the fetus, premature birth. The proportion of perinatal mortality in placenta previa reaches 7-25%, and maternal mortality due to bleeding and hemorrhagic shock is 3%.

placenta previa

Causes of placenta previa

Placenta previa is more often due to pathological changes in the endometrium that disrupt the course of the decidual reaction of the stroma. Such changes can be caused by inflammation (cervicitis, endometritis), surgical interventions (diagnostic curettage, surgical termination of pregnancy, conservative myomectomy, caesarean section, uterine perforation), multiple complicated births. nine0006

Among the etiological factors of placenta previa are endometriosis, uterine fibroids, uterine anomalies (hypoplasia, bicornuity), multiple pregnancy, cervical canal polyps. In connection with these factors, the timeliness of implantation of the fetal egg in the upper sections of the uterine cavity is disrupted, and its attachment occurs in the lower segments. Placenta previa is more likely to develop in re-pregnant women (75%) than in nulliparous women.

Symptoms of placenta previa

In the clinic of placenta previa, the leading manifestations are repeated uterine bleeding of varying severity. During pregnancy, bleeding due to placenta previa is recorded in 34% of women, during childbirth - in 66%. Bleeding can develop at different stages of pregnancy - from the first trimester to the very birth, but more often - after the 30th week of gestation. On the eve of childbirth, bleeding usually increases due to periodic uterine contractions.

The cause of bleeding is the repetitive detachment of the presenting part of the placenta, which occurs due to the inability of the placenta to stretch after the uterine wall during the development of pregnancy or labor. With detachment, a partial opening of the intervillous space occurs, which is accompanied by bleeding from the vessels of the uterus. The fetus at the same time begins to experience hypoxia, since the exfoliated area of ​​the placenta ceases to participate in gas exchange. With placenta previa, bleeding can be provoked by physical activity, coughing, sexual intercourse, straining during bowel movements, vaginal examination, thermal procedures (hot bath, sauna). nine0006

The intensity and nature of bleeding is usually due to the degree of placenta previa. Complete placenta previa is characterized by the sudden development of bleeding, the absence of pain, and the abundance of blood loss. In the case of incomplete placenta previa, bleeding, as a rule, develops closer to the term of labor, especially often at the beginning of labor, during the period of smoothing and opening of the pharynx. The greater the degree of placenta previa, the earlier and more intense the bleeding. Thus, bleeding during placenta previa is characterized by an external character, a sudden onset without visible external causes (often at night), the release of scarlet blood, painlessness, and mandatory repetition. nine0006

Recurrent blood loss quickly leads to anemia of the pregnant woman. A decrease in BCC and the number of red blood cells can cause DIC and the development of hypovolemic shock, even in the case of minor blood loss. Pregnancy complicated by placenta previa often occurs with the threat of spontaneous abortion, arterial hypotension, preeclampsia. Preterm birth occurs more often with complete placenta previa.

The pathology of the location of the placenta most adversely affects the development of the fetus: it causes fetal-placental insufficiency, hypoxia and delayed fetal maturation. With placenta previa, the pelvic, oblique or transverse position of the fetus is often observed. In the II-III trimesters of pregnancy, the localization of the placenta may change due to the transformation of the lower uterine segment and changes in the growth of the placenta in the direction of better blood-supplying areas of the myometrium. This process in obstetrics is called "migration of the placenta" and is completed by the 34-35th week of pregnancy. nine0006

Diagnosis of placenta previa

When recognizing placenta previa, the presence of risk factors in the anamnesis of the pregnant woman, episodes of recurrent external uterine bleeding, and objective examination data are taken into account. An external obstetric examination reveals a high standing of the uterine fundus, due to the location of the presenting part of the fetus, often a transverse or oblique position of the fetus. During auscultation, placental vascular noise is heard in the lower segment of the uterus, at the location of the placenta. nine0006

In the course of a gynecological examination, the cervix is ​​examined in the mirrors to exclude its injuries and pathologies. With a closed external pharynx, the presenting part of the fetus cannot be established. With complete placenta previa, a massive soft formation is palpated, occupying all the vaults of the vagina; with incomplete - the anterior or one of the lateral arches.

With the patency of the cervical canal in the case of complete presentation, the placenta closes the entire opening of the internal pharynx, and its palpation leads to increased bleeding. If fetal membranes and placental tissue are found in the lumen of the uterine os, an incomplete placenta previa is diagnosed. Vaginal examination with placenta previa is performed very carefully, in conditions of readiness for emergency assistance in the development of massive bleeding. nine0006

The safest objective method for detecting placenta previa, which is widely used in obstetrics and gynecology, is ultrasound. In the course of echography, a variant (incomplete, complete) of placenta previa, the size, structure and area of ​​the presenting surface, the degree of detachment during bleeding, the presence of retroplacental hematomas, the threat of miscarriage, is determined, "migration of the placenta" is determined in the process of dynamic studies.

Treatment for placenta previa

The tactics of conducting pregnancy with placenta previa is determined by the severity of bleeding and the degree of blood loss. In the I-II trimester, in the absence of spotting, a pregnant woman with placenta previa can be under outpatient supervision of an obstetrician-gynecologist. At the same time, a protective regimen is recommended, which excludes factors provoking bleeding (physical activity, sexual life, stressful situations, etc.).

At a gestational age of more than 24 weeks or bleeding that has begun, pregnancy is monitored in an obstetric hospital. Therapeutic tactics for placenta previa is aimed at maximizing the prolongation of pregnancy. Bed rest is prescribed, drugs with antispasmodic (drotaverine) and tocolytic (fenoterol, hexoprenaline) action, iron deficiency anemia is corrected (iron preparations). In order to improve fetoplacental and uteroplacental blood flow, the administration of pentoxifylline, dipyridamole, ascorbic acid, thiamine pyrophosphate is used. With the threat of the onset of preterm labor at a period of 28 to 36 weeks of pregnancy, glucocorticoids (dexamethasone, prednisolone) are prescribed for the prevention of respiratory disorders in a newborn. nine0006

Indications for emergency early delivery are repeated bleeding of more than 200 ml, severe anemia and hypotension, bleeding with a simultaneous blood loss of 250 ml, bleeding with complete placenta previa. Caesarean section in these cases is performed to save the mother, regardless of the gestational age and viability of the fetus.

With successful prolongation of pregnancy to a period of 37-38 weeks, the optimal method of delivery is selected. Cesarean section is shown in absolutely all cases of complete placenta previa, as well as with incomplete presentation, combined with a transverse position or pelvic presentation of the fetus; aggravated obstetric and gynecological history; the presence of a scar on the uterus, multiple pregnancy, polyhydramnios, narrow pelvis. nine0006

Natural childbirth is possible only with incomplete placenta previa, subject to the maturity of the cervix, good labor activity, head presentation of the fetus.

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