Pain with placenta previa: Placenta Accreta and Total Placenta Previa in the 19th Week of Pregnancy

13.08.197221.08.2021 by alexxlab

Содержание

Placenta Accreta and Total Placenta Previa in the 19th Week of Pregnancy

Geburtshilfe Frauenheilkd. 2015 Aug; 75(8): 839–843.

Language: English | German

S. Findeklee

Gynecology and Obstetrics, Universitätsklinikum Magdeburg, Magdeburg

S. D. Costa

Gynecology and Obstetrics, Universitätsklinikum Magdeburg, Magdeburg

Correspondence Dr. med. Sebastian Findeklee Universitätsklinikum Magdeburg, Gynecology and Obstetrics, Gerhart-Hauptmann-Straße 35, 39108 Magdeburg, [email protected]

Received 2014 Dec 31; Revised 2015 Apr 17; Accepted 2015 Jun 3.

Abstract

Placentation disorders are the result of impaired embedding of the placenta in the endometrium. The prevalence of these disorders is estimated to be around 0.3 %. A history of previous prior uterine surgery (especially cesarean section and curettage) is the most common risk factor. Impaired placentation is differentiated into deep placental attachment; marginal, partial and total placenta previa; and placenta accreta, increta and percreta. Treatment depends on the severity of presentation and ranges from expectant management to emergency hysterectomy. In most cases, preterm termination of pregnancy is necessary. We report here on the case of a 39-year-old woman with placenta accreta and total placenta previa who underwent hysterectomy in the 19th week of pregnancy.

Key words: placenta previa, placenta accreta, pregnancy

Abstract

Zusammenfassung

Plazentationsstörungen entstehen durch eine fehlerhafte Einnistung der Plazenta im Bereich des Endometriums. Ihre Prävalenz wird mit ca. 0,3 % angegeben. Als Risikofaktoren gelten vorangegangene operative Eingriffe am Uterus (v. a. Sectio und Kürettage). Man unterscheidet bei Störungen der Plazentation den tiefen Plazentasitz von der Placenta praevia marginalis, partialis sowie totalis und der Placenta accreta, increta sowie percreta. Das therapeutische Spektrum reicht je nach Ausprägungsgrad vom exspektativen Vorgehen bis hin zur notfallmäßigen Hysterektomie. In den meisten Fällen wird eine vorzeitige Schwangerschaftsbeendigung erforderlich. Wir berichten über eine 39-jährige Frau mit Placenta accreta und Placenta praevia totalis, bei der eine Hysterektomie in der 19. Schwangerschaftswoche (SSW) durchgeführt wurde.

Schlüsselwörter: Placenta praevia, Placenta accreta, Schwangerschaft

Introduction

Placentation disorders are disorders which occur during attachment of the placenta to the uterine wall; their incidence depends on the week of gestation. The incidence of placentation disorders in the 20th week of gestation (GW) is estimated to be around 5 in 100 pregnancies. At delivery, the incidence is only around 0.3 %, as uterine growth in pregnancy often leads to migration of the placenta away from the internal os 1, 2.

There are different forms of placentation disorders and they occur with varying degrees of severity, depending on the underlying pathophysiological process. Placentation is a complex process, mediated by prostaglandins, sexual hormones, cytokines and immunological factors 3. It occurs in the early days after fertilization of the ovum. The fertilized ovum or zygote reaches the uterine cavity around 4 days after fertilization. The zygote divides repeatedly, developing into a blastocyst consisting of two layers. The outer layer of the blastocyst is made up of trophoblast cells which will form the placenta and the fetal membranes. The inner cell layer, the embryoblast, will later develop into the embryo. Physiologically, invasion of the endometrium by the trophoblast is limited to the decidua basalis. Placenta accreta is present when there is excessive invasion during placentation extending beyond the decidua basalis. If invasion by the placenta extends into the uterine myometrium, this is known as placenta increta. If the placental villa penetrate the myometrium and reach the uterine serosa or even invade neighboring organs such as the bladder, this is known as placenta percreta 4. Rosen has suggested that placentation is regulated by the degree of oxygen saturation of the tissue, with local hypoxia promoting invasion by placental villi. This would explain why scar tissue resulting from previous uterine surgical procedures contributes to placentation disorders 5.

In addition to faulty invasion by placental villi, placental disorders include low-lying placenta (placental edge closest to the cervix < 2 cm from the inner os), marginal placenta previa (placenta extends to the edge of the cervix), partial placenta previa (a portion of the cervix is covered by the placenta), and total placenta previa (inner os completely covered by the placenta) 4.

Case Report

We report here on a 39-year-old woman, gravida 8, para 4, who was transferred to our department from another hospital on November 12, 2014 in the 18 + 3 week of pregnancy because of suspicion of placenta percreta and total placenta previa. The woman had been admitted to the other hospital 3 days earlier for antepartum bleeding and lower abdominal pain. A diagnosis of total placenta previa was made following examination on admission. Doppler sonography raised the suspicion of placenta percreta with involvement of the bladder. The suspicion of placenta percreta was confirmed by an MRI of the pelvis. After 3 daysʼ expectant management which included bed rest, oral magnesium substitution and rhesus prophylaxis (blood group 0, rhesus negative), the patient was transferred to our department.

Medical History

On admission the patient complained of dragging lower abdominal pain and a feeling of abdominal pressure (“bloated abdomen”). She had not had any further bleeding since three days. She had been suffering from diffuse lower abdominal pain since several weeks. Outpatient examinations had not yielded any findings and parameters had always been within normal ranges. The patient had previously given birth to four children. The first delivery was by primary cesarean section for breech presentation in 1997. In 2000 she gave birth to a girl by forceps-assisted vaginal delivery performed in the expulsion period for obstructed labor. Three years later she gave birth to a boy by secondary cesarean section, performed for nuchal cord. She last gave birth in 2006 by primary cesarean section (her third cesarean section) for breech presentation. The possibility of bilateral tubal ligation was discussed at the time, but the patient opted to take oral contraceptives. The patient had had 3 further surgical uterine procedures: 2 terminations in 2001 and 2005, respectively, and one abortion curettage in the 8th week of gestation in May 2014. The patient reported smoking between 8–10 cigarettes daily. The patient did not consume alcohol. She was allergic to nickel and perfume. When asked about her social history, the patient reported having worked as a shop assistant in a bakery but that she was currently not employed.

Clinical Findings

No vaginal bleeding was found on examination at admission. Vaginal pH was 4.0. A routine vaginal smear test was performed. The pathogen Enterococcus faecalis was found with no resistances. On palpation the cervix was sacral, medium soft and closed. Abdominal sonography showed an intact singleton pregnancy appropriately developed for age. Cervical length on vaginal sonography was 35 mm without funneling. The placenta covered the inner os. Doppler sonography was suspicious for placenta percreta with placental vessels invading the bladder ().

Doppler sonography image showing vessels pointing in the direction of the bladder wall. White arrow: bladder, red arrow: placenta, star: fetal head.

Course after Admission

We admitted the 39-year-old, gravida 8, woman as an inpatient in our gynecological department and continued oral magnesium substitution (200 mg 3 × per day). Because of the suspicion of placenta percreta she additionally received prophylactic oral antibiotics with metronidazole (400 mg 3 × per day). On November 13, 2014 she underwent ultrasound for detailed diagnosis. After imaging clearly showed pronounced vasculature between the scarred uterine wall and the maternal bladder, a tentative diagnosis of placentation disorder in the 19th week of pregnancy following 3 cesarean sections, total placenta previa and placenta percreta was made (). A residual myometrium thickness of 4 mm was measured at the anterior uterine wall.

Detailed ultrasound imaging done on November 13, 2014: placental villi appear to be invading the bladder, confirming a diagnosis of placenta percreta and demonstrable total placenta previa. White arrow: bladder, yellow arrow: placenta.

After an extensive and detailed discussion of the diagnosis with the patient and careful weighing up of the pros and cons of continuing the pregnancy (giving birth to a fifth child on the one hand, maternal and fetal risk from infiltration of the bladder, uterine rupture or threatening miscarriage on the other) the decision was taken to perform planned abdominal hysterectomy without adnexectomy. During the consultation we also discussed expectant management as another potential option in this specific situation and explained the difficulties of obtaining a precise preoperative diagnosis of placentation disorders. The patient ultimately opted for hysterectomy to forestall potential serious injuries to organs and prevent strong hemorrhaging.

The surgical intervention was performed on November 14, 2014 in GW 18 + 5. Intraoperatively, the bladder was found to be stretched cranially across the uterus. The preoperative suspicion of placental invasion of the bladder was not confirmed. However, the lower uterine segment was massively overextended, extremely thin and very soft. The uterus measured around 10 × 12 cm. After the bladder had been dissected caudally, the extent of the defect in the uterine wall became clear. The entire lower anterior uterine wall consisted only of a thin translucent layer of peritoneum with the placenta clearly visible through it (). These clinical findings led to a diagnosis of placenta accreta. Coverage of the defect would not have been possible as the defect was the size of the palms of two hands. The patient received 2 erythrocyte concentrations intraoperatively after losing 1000 ml of blood and presenting with an intraoperative Hb of 5.9 mmol/l (preoperative Hb was 8.1 mmol/l). A male fetus weighing 210 g without morphological anomalies was found in utero. The uterus and placenta weighed 400 g (). It was sent for histological examination. Histopathological workup resulted in a diagnosis of placenta accreta, total placenta previa and concealed uterine rupture.

Surgical site with thin, extended, lower anterior uterine wall and partially visible placenta. Black arrow: concealed rupture of the anterior uterine wall; white arrow: bladder extended across the uterine wall.

Uterus with placenta after hysterectomy. Thin white arrow: placenta in the uterus; thick white arrow: uterine body; black arrow: uterine cervix.

The patientʼs postoperative course was uneventful. After 24-hour monitoring in the recovery room, the patient was transferred to a regular ward on November 15, 2014. A detailed postoperative discussion was held with the patient who was also offered pastoral care at the bedside. The patient did not want a postmortem autopsy of the fetus. On November 21, 2014 (7th postoperative day) the 39-year-old patient was discharged home after findings at final examination were unremarkable.

Discussion

This clinical case report describes a case of placentation disorder which took the form of placenta accreta and total placenta previa after 3 previous cesarean sections. The case additionally presented with concealed uterine rupture. This clinical case illustrates the potential complications which may appear after repeated cesarean sections. The status post cesarean section is one of the main risk factors for the development of placentation disorders in the next pregnancy. The largest study on this issue to date, published in 2006, was carried out by Silver et al. and investigated the association between cesarean section and later maternal complications in 30 132 women. The study found a risk of 0.24 % for placenta accreta in the subsequent pregnancy after cesarean section. The risk after 6 cesarean sections was 6.47 % 6. Endometrial scarring of other provenance, for example after curettage or endometritis, also increased the incidence of impaired placentation. Other risk factors for placentation disorders include maternal age > 35 years, multiparity, submucous fibroids, and deposition of the embryo close to the cervix during embryo transfer with assisted reproductive technology 7.

Ultrasound, potentially combined with Doppler sonography, is the gold standard for the diagnosis of placentation disorders. The placenta is located during the first ultrasound examination performed between GW 9–12. A low-lying placenta or a placenta covering all or part of the inner os are still fairly common at this point as the uterus has not grown much yet 1. If a second ultrasound examination performed sometime in the 19th to the 22nd week of pregnancy again raises the suspicion of placentation disorder and it is not possible to confirm or disprove the suspicion, then – as was done with our patient – MRI is recommended 8. The 2010 DGGG guideline recommends that pregnant women with impaired placentation after previous cesarean section contact their maternity hospital early on, preferably before the start of the 30th week of pregnancy, to plan the birth 9.

Management of placentation disorders depends, in the first instance, on the extent of the disorder as well as on the patientʼs wish to have a child. Co-morbidities and clinical presentation of the impaired placentation must also be considered. The standard management of pregnancy in women with placental invasion of the myometrium is cesarean hysterectomy 10. Another therapy option for patients with placenta accreta, increta or percreta who wish to have further children consists of leaving the part of the placenta adhering to the uterine wall in situ after performing cesarean section. This option must then be followed by non-surgical treatment such as interventional radiology for uterine artery embolization and/or the administration of methotrexate. Treatment with the folic acid antagonist methotrexate was first proposed in 1986 by Arulkumaran. He reported on a patient who had received intravenous methotrexate for a period of 2 weeks after cesarean section for placenta accreta. At the end of this period there were no signs of the placenta on ultrasound examination, and the patient was discharged 15 days postpartum 11, 12. Khan et al. described performing uterine artery embolization within 2 hours of cesarean section in a patient with placenta accreta in whom the placenta remained in utero, followed by the administration of methotrexate 50 mg by weekly intramuscular injection for 3 weeks with folic acid. Beta HCG in this patient after 5 months was less than 5 mIU/ml. However, in their review, the authors noted that this conservative therapy cannot yet be considered the standard treatment 13. Potential risks of a conservative approach which leaves the placenta in utero include hemorrhage, clotting disorders and septicemia 14. The consensus is that in cases with total placenta previa, delivery should be by primary cesarean section after the pregnancy has been prolonged under close monitoring. In cases with partial placenta previa the choice of delivery can be an individual decision between vaginal delivery and cesarean section; however, vaginal delivery should be the delivery method of choice for women with marginal placenta previa 15.

If placenta accreta, increta or percreta is only recognized in labor, the lack of uterine tone can result in life-threatening hemorrhage. Welsch et al. collected data on cases of fatal postpartum hemorrhage due to placentation disorders in women who were status post cesarean section from the Bavarian Perinatal Survey. There were 11 deaths between 1983 and 2007 in Bavaria, but there have been no cases of fatal uterine rupture since 1987 16. Because ultrasound imaging in our patient was suspicious for placenta percreta with invasion of the bladder and the patient considered prolonging the pregnancy to be of secondary importance in view of the potential health risks to herself, we agreed with her that we would terminate the pregnancy by performing a hysterectomy. The aim was to prevent maternal risks such as hemorrhage, clotting disorder or infection with its threat of subsequent sepsis. The intraoperative findings proved to be less complex, and a diagnosis of placenta accreta was made. This clearly illustrates the limitations of ultrasound in the prenatal diagnosis of impaired placentation. The case report demonstrates that it is not possible to make a definitive diagnosis of placentation disorder with the available prenatal diagnostic methods, meaning that it is important to be cautious when deciding on further measures. In a recently published retrospective cohort study, Hall et al. reported that cases of placenta accreta not diagnosed prenatally on ultrasound tended to be less complex and that maternal and neonatal outcomes in patients with prenatally undiagnosed placenta accreta were statistically similar to outcomes where impaired placentation had been diagnosed prenatally. This raises questions about the diagnostic accuracy of ultrasound for the detection of this entity. Ultrasound was found to be more accurate for the diagnosis of placenta percreta compared to placenta accreta 17.

As the prenatal diagnosis was not confirmed in our case, the decision to terminate the pregnancy in the 19th week of pregnancy must, in hindsight, be considered critically. Retrospectively it is possible to say that the hysterectomy might have been avoided. It must also be noted that continuing the pregnancy would have been possible despite the prenatal findings, but this would have involved incalculable maternal and fetal risks. This is made very clear by the intraoperative finding of concealed uterine rupture. After detailed discussions in which the patient was informed of the pros and cons of the various options in her specific situation, the mother of 4 children opted to terminate the pregnancy. This shows how much therapy decisions for placentation disorders are based on the individualʼs specific circumstances, particularly when definitive clinical evidence is lacking.

Conclusion

Placentation disorders can present with heterogeneous symptoms of varying severity and clinical findings can differ. Placentation disorders should be considered in the differential diagnosis of woman who have previously had several uterine surgical interventions. Diagnosis is made using imaging techniques, primarily ultrasound, complemented by MRI where necessary. The therapy depends, in the first instance, on the type of placentation disorder and on whether the patient wishes to have children. In addition to expectant management and a number of experimental drug therapies, in most cases treatment consists of primary cesarean section, often performed early on, curettage and even hysterectomy. Our case report emphasizes the difficulty of making a definitive diagnosis of placentation disorder prenatally. It also illustrates the far-reaching consequences of cesarean sections and, above all, the impact repeated cesarean sections can have for affected women. This underlines how strict the indications for cesarean section should be. Nevertheless, the numbers of medically indicated cesarean sections have continued to increase in the last decades. Timely diagnosis of impaired placentation can help reduce the risk for affected women.

Footnotes

Conflict of Interest None.

References

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Bleeding in Pregnancy/Placenta Previa/Placental Abruption

Bleeding may occur at various times in pregnancy. Although bleeding is alarming, it may or may not be a serious complication. The time of bleeding in the pregnancy, the amount, and whether or not there is pain may vary depending on the cause.

Bleeding in the first trimester of pregnancy is quite common and may be due to the following:

Placenta previa is a condition in which the placenta is attached close to or covering the cervix (opening of the uterus). Placenta previa occurs in about one in every 200 live births. There are three types of placenta previa:

The cause of placenta previa is unknown, but it is associated with certain conditions including the following:

Women who have scarring of the uterine wall from previous pregnancies
Women who have fibroids or other abnormalities of the uterus
Women who have had previous uterine surgeries or cesarean deliveries
Older mothers (over age 35)
African-American or other minority race mothers
Cigarette smoking
Placenta previa in a previous pregnancy
Being pregnant with a male fetus

The greatest risk of placenta previa is bleeding (or hemorrhage). Bleeding often occurs as the lower part of the uterus thins during the third trimester of pregnancy in preparation for labor. This causes the area of the placenta over the cervix to bleed. The more of the placenta that covers the cervical os (the opening of the cervix), the greater the risk for bleeding. Other risks include the following:

The most common symptom of placenta previa is vaginal bleeding that is bright red and not associated with abdominal tenderness or pain, especially in the third trimester of pregnancy. However, each woman may exhibit different symptoms of the condition or symptoms may resemble other conditions or medical problems. Always consult your doctor for a diagnosis.

In addition to a complete medical history and physical examination, an ultrasound (a test using sound waves to create a picture of internal structures) may be used to diagnose placenta previa. An ultrasound can show the location of the placenta and how much is covering the cervix. A vaginal ultrasound may be more accurate in diagnosis.

Although ultrasound may show a low-lying placenta in early pregnancy, only a few women will develop true placenta previa. It is common for the placenta to move upwards and away from the cervix as the uterus grows, called placental migration.

Specific treatment for placenta previa will be determined by your doctor based on:

Your pregnancy, overall health, and medical history
Extent of the condition
Your tolerance for specific medications, procedures, or therapies
Expectations for the course of the condition
Your opinion or preference

There is no treatment to change the position of the placenta. Once placenta previa is diagnosed, additional ultrasound examinations are often performed to track its location. Bed rest or hospital admission may be necessary. It may be necessary to deliver the baby, depending on the amount of bleeding, the gestational age, and condition of the fetus. Cesarean delivery is necessary for most cases of placenta previa. Severe blood loss may require a blood transfusion.

Placental abruption is the premature separation of a placenta from its implantation in the uterus. Within the placenta are many blood vessels that allow the transfer of nutrients to the fetus from the mother. If the placenta begins to detach during pregnancy, there is bleeding from these vessels. The larger the area that detaches, the greater the amount of bleeding. Placental abruption occurs about once in every 100 births. It is also called abruptio placenta.

Other than direct trauma to the uterus such as in a motor vehicle accident, the cause of placental abruption is unknown. It is, however, associated with certain conditions, including the following:

Placental abruption is dangerous because of the risk of uncontrolled bleeding (hemorrhage). Although severe placental abruption is rare, other complications may include the following:

The most common symptom of placental abruption is dark red vaginal bleeding with pain during the third trimester of pregnancy. It also can occur during labor. However, each woman may experience symptoms differently. Some women may not have vaginal bleeding that is detectable, but there may be bleeding inside the uterus. Symptoms may include:

The symptoms of placental abruption may resemble other medical conditions. Always consult your doctor for a diagnosis.

The diagnosis of placental abruption is usually made by the symptoms, and the amount of bleeding and pain. Ultrasound may also be used to show the location of the bleeding and to check the fetus. There are three grades of placental abruption, including the following:

Grade 1. Small amount of vaginal bleeding and some uterine contractions, no signs of fetal distress or low blood pressure in the mother.
Grade 2. Mild to moderate amount of bleeding, uterine contractions, the fetal heart rate may shows signs of distress.
Grade 3. Moderate to severe bleeding or concealed (hidden) bleeding, uterine contractions that do not relax (called tetany), abdominal pain, low blood pressure, fetal death.

Sometimes placental abruption is not diagnosed until after delivery, when an area of clotted blood is found behind the placenta.

Specific treatment for placental abruption will be determined by your doctor based on:

Your pregnancy, overall health, and medical history
Extent of the disease
Tolerance for specific medications, procedures, or therapies
Expectations for the course of the disease
Your opinion or preference

There is no treatment to stop placental abruption or reattach the placenta. Once placental abruption is diagnosed, a woman’s care depends on the amount of bleeding, the gestational age, and condition of the fetus. Vaginal delivery may be possible if the fetus is tolerating labor. If placental abruption is affecting the fetus, then cesarean delivery may be necessary. Severe blood loss may require a blood transfusion.

What complications can affect the placenta?

Complications that can affect the placenta during pregnancy or childbirth include:

low-lying placenta
retained placenta – when part of the placenta remains in the womb after giving birth
placental abruption – when the placenta starts to come away from the wall of the womb

These complications aren’t common.

Low-lying placenta

As your pregnancy progresses, your womb expands and this affects the placenta’s position. The area where the placenta is attached usually stretches upwards, away from your cervix.

If the placenta stays low in your womb, near to or covering your cervix, it may block the baby’s way out.

This is called low-lying placenta or placenta praevia. It affects about 1 in every 200 births, but in most cases the cervix is not completely covered.

The position of your placenta will be recorded at your 18- to 21-week ultrasound scan.

If your placenta is significantly low, you’ll be offered an extra ultrasound scan later in your pregnancy (usually at about 32 weeks) to check its position again.

For 9 in every 10 women, the placenta will have moved into the upper part of the womb by this point.

If the placenta is still low in your womb, there’s a higher chance that you could bleed during your pregnancy or during your baby’s birth. This bleeding can be very heavy and put you and your baby at risk.

You may be advised to come into hospital at the end of your pregnancy so emergency treatment (such as a blood transfusion) can be given very quickly if you bleed.

If the placenta is near or covering the cervix, your baby can’t be delivered through the vagina, so a caesarean section will be recommended.

A low-lying placenta can be associated with painless, bright red bleeding from the vagina during the last 3 months of pregnancy. If this happens to you, contact your midwife or GP immediately.

Retained placenta

After your baby’s born, part of the placenta or membranes can remain in the womb. This is known as retained placenta. If untreated, a retained placenta can cause life-threatening bleeding.

Breastfeeding your baby as soon as possible after the birth can help your womb contract and push the placenta out.

Your midwife may also ask you to change your position (for example, by moving to a sitting or squatting position). In some cases, you may be given an injection of a medicine to help your womb contract.

If these methods don’t work, you may need an operation to remove the placenta.

Placental abruption

Placental abruption is a serious condition in which the placenta starts to come away from the inside of the womb wall.

It can cause stomach pain, bleeding from the vagina and frequent contractions.

It can also affect the baby, increasing the risk of premature birth, growth problems and stillbirth.

It’s not clear what causes placental abruption, but factors that increase the risk include injury to the abdominal area, smoking, cocaine use and high blood pressure.

If you’re near your due date, the baby will need to be born straight away and a caesarean section may be recommended.

But if the baby’s very premature and the abruption is minor, you may be kept in hospital for close observation.

Always speak to your midwife or GP if you’re concerned about any aspect of your health when you’re pregnant. You can also call NHS 111.

Further information

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18. Crowley P.
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21. Cobo E,
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22. Dashe JS,
McIntire DD,
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2002;99(5 pt 1)692–7.

23. Taipale P,
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24. Becker RH,
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25. National Collaborating Centre for Women’s and Children’s Health. Antenatal care: routine care for the healthy pregnant woman. Clinical Guideline. London: RCOG, 2003.

26. Comstock CH,
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2004;190:1135–40.

27. Wu S,
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Placenta accreta. ACOG Committee opinion No. 266, January 2002. Obstet Gynecol.
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29. Rasmussen S,
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31. Witlin AG,
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2002;21:837–40.

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Carle.org

What Is Placenta Previa?

The placenta is an organ that connects the developing fetus to the wall of the uterus. It gets nutrients to the fetus, gets rid of waste, and allows oxygen exchange by means of the mother’s blood supply. The placenta usually moves up and away from the cervix (opening at the bottom of the uterus) during growth of the fetus. If it doesn’t, the cervix may be blocked. Placenta previa occurs when the placenta attaches to the uterine wall in the wrong spot, close to or covering the cervix. Placenta previa affects about 1 in 200 pregnancies. It’s a major cause of bleeding during pregnancy. It can be total, partial, marginal, or low-lying. In total placenta previa, the opening is fully covered. In partial placenta previa, the opening is partly covered. In marginal placenta previa, the edge of the placenta is at the edge of the opening. In low-lying placenta previa, the placenta attaches in the lower part of the uterus and its edge is close to the edge of the opening.

What Causes Placenta Previa?

The cause is unknown. Risk factors include previous cesarean delivery, having been pregnant before, carrying twins or triplets, having had placenta previa or uterine surgery, age 35 or older, and smoking.

What Are the Signs and Symptoms of Placenta Previa?

Most often, painless vaginal bleeding, usually in the second or third trimester, occurs. Uterine contractions may or may not be present. The uterus is soft and without pain. Fetal distress doesn’t usually occur.

How Is Placenta Previa Diagnosed?

The health care provider makes a diagnosis from the medical history and physical examination. Vaginal bleeding after 24 weeks of gestation is key. The best, safest way to find the place of attachment is by using ultrasonography. This test, using sound waves, can also tell whether delivery is needed. Magnetic resonance imaging (MRI) can also help detect the condition.

How Is Placenta Previa Treated?

Treatment depends on the status of the fetus and of the mother. Fetal status and gestational age are checked by using the sonogram and continuous fetal heart rate monitoring. Outpatient treatment is possible for a fetus at less than 30 weeks of gestation, and if mother and fetus aren’t in distress. Placenta previa with a mature fetus or distress of the mother or fetus means immediate delivery. Cesarean delivery is done in almost all cases, especially for heavy bleeding. Vaginal delivery can be tried if the cervix is partly covered. Blood volume may need to be replaced to keep blood pressure normal. Blood transfusion may be done to replace lost blood. Levels of fibrinogen must be kept normal. Fibrinogen is a protein that’s important in clotting.

DOs and DON’Ts in Managing Placenta Previa:

DO get plenty of rest. Avoid overexertion.

DON’T ignore symptoms. Call your health care provider if you’re pregnant and see vaginal bleeding.
DON’T use medicines (including over-the-counter drugs and herbal products) without first asking your health care provider.
DON’T smoke or use tobacco products.

FOR MORE INFORMATION

Contact the following source:

American College of Obstetricians and Gynecologists
Tel: (202) 638-5577
Website: http://www. acog.org

Placenta praevia (low-lying placenta) – HSE.ie

Placenta praevia is a complication that can happen during pregnancy. It’s also known as ‘low-lying placenta’. It is not common.

Placenta praevia happens when the placenta (afterbirth) is partially or completely blocking off your cervix (the neck of your womb). This can lead to heavy bleeding in pregnancy or during childbirth.

If you have placenta praevia, your baby will probably be delivered by caesarean section. You’ll also need to take extra care during your pregnancy.

Contact your maternity unit or hospital immediately if you have been told you have placenta praevia and have:

any vaginal bleeding
abdominal pain
contractions

How you’ll know if you have placenta praevia

The position of the placenta will be recorded at your ultrasound scan around weeks 18 to 22 of pregnancy. If you have a low-lying placenta it will be diagnosed at this stage.

For 9 in every 10 women, a low-lying placenta will move up into their womb and won’t affect them during childbirth. They will have a normal placenta by the time of their follow up scan, in the 3rd trimester.

If the placenta is still low-lying in the 3rd trimester, this is called a placenta praevia. 1 in 200 women are affected by placenta praevia at this stage.

Some women may also have a scan to check for placenta praevia if they develop signs and symptoms later in their pregnancy. These scans will look at the distance of the placenta from the entrance to the cervix.

Signs and symptoms of placenta praevia

Placenta praevia may not cause you any symptoms. But if you do have symptoms or signs they usually include:

vaginal bleeding in the second or third trimesters or after sex. You don’t usually have any pain with this bleeding but it can be heavy. This could put your baby at risk.
your baby lying in an unusual position such as breech or sideways across the womb (transverse lie)

Contact your GP, midwife or obstetrician immediately if you have any bleeding during pregnancy.

If you have placenta praevia

If you have placenta praevia you may need to take extra care during your pregnancy and the birth.

You may be advised to:

have extra ultrasound scans to see whether your placenta has moved upwards
avoid sex so as to prevent more bleeding
take an iron supplement – this is to reduce the risk of you becoming anaemic and build up your iron levels

Early hospital admission

At week 34 of your pregnancy you may need to go into hospital until you give birth. This is so you can be treated immediately if you bleed.

You may also be given steroid injections. This is to help your baby’s lung development in case they need to be delivered early.

Blood transfusions

You may need blood transfusions if you have heavy bleeding during your pregnancy or at your delivery.

If you feel you could never accept a blood transfusion, let your obstetrician, midwife and birth partner know early in your pregnancy.

Caesarean birth

You may need a caesarean section if:

your placenta is blocking your baby’s way out through the birth canal
you or your baby are at risk

Premature birth

If your baby needs to be born prematurely, they may need additional care after birth. Your baby may need to be transferred to another hospital with facilities to care for premature babies.

page last reviewed: 29/04/2021
next review due: 29/04/2024

Placenta Previa

What is placenta previa?

Bleeding can happen at any time during pregnancy. Placenta previa can cause bleeding late in pregnancy. This means after about 20 weeks.

When the placenta is attached close to the opening of the uterus (cervix) or covers the cervix, it is called placenta previa. There are 3 types of placenta previa:

Complete placenta previa. The placenta completely covers the cervix.

Partial placenta previa. The placenta is partly over the cervix.

Marginal placenta previa. The placenta is near the edge of the cervix.

What causes placenta previa?

Researchers don’t know what causes placenta previa. It is more likely to happen with certain conditions. These include:

Past pregnancies

Tumors (fibroids) in the uterus. These are not cancer.

Past uterine surgeries or cesarean deliveries

Woman who is older than 35

Woman who is African American or of another nonwhite ethnic background

Cigarette smoking

Placenta previa in a past pregnancy

Being pregnant with a boy

What are the symptoms of placenta previa?

The most common symptom of placenta previa is bright red, painless bleeding from the vagina. This is most common in the third trimester of pregnancy.

The symptoms of placenta previa may look like other health conditions. Make sure to see your healthcare provider for a diagnosis.

How is placenta previa diagnosed?

Your healthcare provider will ask about your health history. He or she will do a physical exam. The provider will also do an ultrasound. An ultrasound uses sound waves to make a picture of the organs. It can show where the placenta is and how much is covering the cervix. You may have a transvaginal ultrasound instead.

An ultrasound may show that a placenta is near the cervix in early pregnancy. But only a few women will develop true placenta previa. It is common for the placenta to move away from the cervix as the uterus grows.

How is placenta previa treated?

There is no treatment to change the position of the placenta. You may need:

More ultrasounds to track where the placenta is

Bed rest or hospital stay

Early delivery of the baby. This will be based on how much bleeding you have, how far along your baby is, and how healthy the baby is.

Cesarean section delivery

Blood transfusion for severe blood loss

What are possible complications of placenta previa?

The greatest risk of placenta previa is too much bleeding (hemorrhage). Bleeding often happens as the lower part of the uterus thins during the third trimester of pregnancy. This causes the area of the placenta over the cervix to bleed. The risk of bleeding is higher if a lot of the placenta covers the cervix. Other complications include:

Placenta doesn’t attach to the uterus as it should

Slowed growth of your baby in the uterus

Preterm birth (before 37 weeks of pregnancy)

Birth defects

When should I call my healthcare provider?

Call your healthcare provider about any bleeding you have while pregnant. Bleeding during pregnancy may not be serious. If the bleeding is moderate to severe, or you have pain, contact your healthcare provider right away.

Key points about placenta previa

Placenta previa is a cause of bleeding late in pregnancy. This is after about 20 weeks.

It causes bleeding because the placenta is close to or covers the cervix.

Bleeding with placenta previa is painless.

You may need bed rest or early delivery of your baby.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

Know the reason for your visit and what you want to happen.

Before your visit, write down questions you want answered.

Bring someone with you to help you ask questions and remember what your provider tells you.

At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.

Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.

Ask if your condition can be treated in other ways.

Know why a test or procedure is recommended and what the results could mean.

Know what to expect if you do not take the medicine or have the test or procedure.

If you have a follow-up appointment, write down the date, time, and purpose for that visit.

Know how you can contact your provider if you have questions.

Online Medical Reviewer:
Daniel N Sacks MD

Online Medical Reviewer:
Donna Freeborn PhD CNM FNP

Online Medical Reviewer:
Heather Trevino

Date Last Reviewed:
8/1/2020

90,000 MRI of the placenta in Novokuznetsk. Cost, sign up for an MRI in Magnesia

Placenta MRI is a study with a wide field of application in gynecology, has a high diagnostic value, is a non-invasive, painless method. It is performed before delivery, preferably at 34-36 weeks.

MRI uses a powerful magnetic field, radio waves and a computer to produce detailed images of the body’s internal structures. MRI does not use ionizing radiation (X-rays).Detailed MRI images allow doctors to better assess body areas and certain pathological processes that cannot be adequately assessed with other imaging techniques, such as X-rays, ultrasounds, or computed tomography (CT) scans. An MRI of the placenta is often recommended when ultrasound findings are inconclusive.

The study is carried out without the introduction of a contrast agent.

Pathologies of the placenta that can be diagnosed using MR diagnostics

placenta previa;

Placenta previa (placenta praevia) is a pathology in which the placenta is located in the region of the lower segment of the uterus, partially or completely overlapping the internal pharynx.

Classification:

I degree – low presentation – the placenta is located in the area of the cervical opening, but its edge is at least 3 cm from the pharynx;
II degree – regional presentation – the lower part of the placenta is located literally at the edge of the entrance to the cervical canal, but does not overlap it;
III degree – partial presentation – partial presentation – the lower part of the placenta overlaps the entrance to the cervical canal completely. In this case, most of the placenta is located on any one wall (front or back) of the uterus, and only a small area closes the entrance to the cervical canal;
IV degree – full or central presentation – the placenta is completely located on the lower segment of the uterus and blocks the entrance to the cervical canal with its central part. At the same time, the same parts of the placenta are located on the front and back walls of the uterus.

The gold standard in making the diagnosis is MRI in the sagittal plane, but more often the pathology is detected on ultrasound at the second (18 weeks) and third screenings (30 weeks).

placental accreta (ingrowth);

Placental ingrowth remains a major cause of maternal bleeding and obstetric hysterectomy.

An abnormally adhesive placenta is a spectrum of disorders characterized by abnormal attachment or penetration of the placenta into the uterine wall.True placental ingrowth occurs when the villi of the placenta (chorion) spread into the myometrium and beyond, that is, the invasion spreads deeply beyond the uterine serosa. The main diagnostic methods are currently considered to be an ultrasonographic method, laboratory diagnostics (an increase in human choriogonadotropin and placental lactogen), pain and a history of discharge from the genital tract. Magnetic resonance imaging is considered an auxiliary method that can determine the degree of placental ingrowth (depth of invasion).

Depending on the depth of penetration of chorionic villi into the myometrium, three variants of placental augmentation are distinguished: placenta accreta, placenta increta, and placenta percreta. In placenta accreta, the spongy layer of the basal part of the decidua is atrophied, the villi contact with the myometrium without penetrating into it and without disrupting its structure. With placenta increta, chorionic villi penetrate into the myometrium, disrupting its structure. With placenta percreta, chorionic villi sprout the myometrium throughout its entire depth, up to the visceral peritoneum.With full accretion, the placenta is fused with the myometrium along its entire length, with partial – only in certain areas.

Placental dysfunction and placental malformations;

Placental dysfunction is a common obstetric problem that complicates 5-10% of all pregnancies. It is a progressive condition in which the intrauterine supply of oxygen and nutrients is insufficient to support normal fetal growth and organ development.

Timely antenatal diagnosis of placental dysfunction and assessment of placental oxygenation leads to an improvement in neonatal outcome, as this ensures timely delivery and thereby reduces the risk of irreversible damage to the fetal organs.

Currently, screening for placental dysfunction focuses on fetal weight estimates and measurements of fetal and umbilical Doppler blood flow. However, the size of the fetus does not accurately reflect the function of the placenta, in addition, with late placental dysfunction, Doppler does not detect pathology.MRI of the placenta reveals placental dysfunction, including in late pregnancy, since intrauterine growth retardation is associated with a decrease in the exchange surface area at the villi level, which leads to a lower diffusional conductivity of the placenta.

Main indications for MRI of the placenta:

suspicion of placenta previa – if other diagnostic methods have shown controversial, inconclusive results or it is necessary to accurately diagnose the degree of previa;
The need to assess the depth of invasion of the placenta in the tissue of the uterus or bladder;
suspicion of dysfunction and abnormalities in the development of the placenta in the third trimester of the current pregnancy;
the patient is at risk of placental dysfunction: there is a scar after cesarean section, after myomectomy with opening the uterine cavity, or there are cases of placental dysfunction in the anamnesis.

Benefits of Placenta MRI in Magnesia

expert class equipment – Philips Achieva 1.5T SE high-field tomograph;
Highly informative decoding of MR images based on examination results, indicating all pathological changes;
highly qualified doctors who regularly improve their level and undergo international certification. We will hold an expert consultation absolutely free of charge to accurately describe the picture!

Contraindications to MRI of the placenta

Absolute contraindications:

artificial pacemakers (cardio, neurostimulators), fixed hearing aids, daily ECG, other implanted electronic devices;
artificial heart valves;
Ilizarov apparatus.

Relative contraindications:

tattoos with an admixture of metal – there is an itching and burning sensation at the location;
claustrophobic;

If you have claustrophobia (fear of confined spaces) or excessive anxiety, you can ask your healthcare professional to prescribe mild sedatives before your scheduled exam. Be sure to warn the staff of our Center. In such cases, we recommend that you come with one of your relatives, look at the tomograph in advance and even arrange a “test drive” – try to lie down;

sudden onset of cramps and muscle spasms, hyperkinesis, inability to remain motionless;
is in extremely serious condition.

Preparation for MRI of the placenta

You must take a referral from your attending physician, permission to conduct an MRI study and the results of ultrasound diagnostics with you for the study.

No special preparation for the study is required. Immediately before the examination, the patient needs to empty the bladder.

It is preferable to conduct the study during those hours when the fetus and mother are in the most calm state.

How is the placenta MRI procedure

The procedure is carried out on special equipment, which is a platform table, which is pushed into the tomograph, which takes pictures of the area under study. During the procedure, it is necessary to remain motionless in order to avoid distortion of the results.

The study is carried out in the supine or lateral position.

Survey results

In “Magnesia” you will receive a disc with images immediately after undergoing an MRI.The results of the examination (description and conclusion of a specialist) can be handed over to you within 60-90 minutes after the procedure. If a consultation is necessary, the description can take up to three days. If you wish, you can receive all the necessary information in electronic form.

Prices and list of services MRI placenta center “Magnesia” in Yakutsk:

No.	Magnetic resonance imaging:	Prices in rubles
4	Magnetic resonance imaging of the pelvic organs:
4. 6	Placenta	3700

It is difficult to overestimate the role of sleep in the life of every person. A full healthy rest allows you to completely restore the functioning of the nervous system, relieve tension, improve performance and increase activity. Chronic sleep deprivation is the cause of many diseases. What can we say about a woman who is at the stage of bearing a baby.During this period, she, more than ever, needs a healthy, long and full sleep. However, unfortunately, it is during this period that one can only dream of a peaceful sleep.

As soon as a woman finds out about her new position, she has to give up a lot for the health of the future baby. And you need to give up not only bad habits: alcohol, cigarettes, coffee, but also a comfortable sleep.

Insomnia can be caused by :

Anxiety;
Frequent urination;
Fears and phobias before a new stage in your life;
Nervousness and irritability;
Indigestion;
Toxicosis;
Physical discomfort;
Inconvenient position.

Good sleep is the key to the health of the future baby

During the period of bearing a child, the female body experiences an extraordinary stress, especially in the last trimester. The need for the duration of sleep increases, because the body spends much more energy. Therefore, healthy sleep and pregnancy are inextricably linked.

As soon as a woman finds out about her new position, she has to give up a lot for the health of the future baby.And you need to give up not only bad habits: alcohol, cigarettes, coffee, but also a comfortable sleep.

Let’s try to figure out how to sleep during pregnancy, so as not only not to harm the health of your unborn baby, but to sleep well.

Finding a comfortable sleeping position

Each person has their own favorite position in which they fall asleep and sleep easily. Many do not imagine a comfortable rest on their backs, accustomed to sleeping on their stomachs. This habit will have to be sacrificed, as it is unsafe for the normal development of the fetus. If in the first three months of pregnancy a woman can still sleep in the position in which she is accustomed and comfortable, then after the first trimester the growing belly will not allow to lie safely in this position. Despite the natural protection of the baby in the form of amniotic fluid, there is a high probability of injuring the baby in a dream by squeezing it. But how, then, is it correct to sleep during pregnancy?

Back Pose

Even if you are accustomed to sleeping in the Spartan position, on your back, arms outstretched wide, from the 28th week you will have to radically change your way of life.The fact is that as the fetus grows, the load on the intestines and the vena cava will significantly increase, blocking the access of oxygen to the baby.

Sleeping on your back during pregnancy can cause the following problems:

Dizziness;
Nausea
Convulsions
Limbs go numb;
Pressure drop;
Hemorrhoids;
Severity of breathing.

If you feel these symptoms or the baby gives persistent signals, it is necessary to urgently change the position, since squeezing the vena cava is fraught not only with poor health of the mother, but also with a deficiency in the supply of oxygen to the fetus.

Belly Pose

One of the most beloved positions for many people, which allows you to quickly fall asleep while hugging a pillow. Many women, as soon as they learn about the change in their lives, are interested in the question, is it possible to sleep on your stomach during pregnancy? Doctors recommend abandoning this position for the first weeks, even before the enlarged belly does not give an opportunity to fall asleep calmly.

If you are afraid during sleep, without controlling your movements, to arbitrarily roll over on your stomach, you can put a large pillow that does not allow you to change position.

Side Pose

In order to normalize your sleep and not harm your baby’s health, experts recommend sleeping on your side during pregnancy. And if at first this option seems unacceptable to many, after the second trimester, lying on its side is the only possible one. But here the question arises, on which side to sleep to ensure the safety of the fetus?

Sleeping on the right side can cause compression of the kidney, which can be dire.The ideal position is to lie on your left side. Thus, you not only do not injure the unborn baby, but also improve blood flow along with oxygen to the placenta.

But one should not ignore the individual characteristics of each organism and the position of the fetus in the uterus. When the baby is in a lateral position, choose the side where the baby’s head is. And with a breech presentation, doctors recommend changing the position several times per night.

If you still cannot improve your sleep, you feel unwell and you are tormented by insomnia, then it is better to consult a specialist. A good gynecologist will analyze the situation and help solve the problem. If necessary, he will prescribe a safe sedative that will stabilize the emotional state and help you fall asleep, resting and restoring the nervous system during sleep.

Pillow to help

Fortunately, modern manufacturers now help women get through pregnancy more comfortably by offering special pillows. They are made taking into account the physiological characteristics of a woman in this period and allow you to find a comfortable posture for rest.

You can purchase two pillows and put one under your belly and the other under your knees, looking for your best option. Or you can buy a long banana-shaped pillow that allows you to throw your leg on it during sleep, which improves your well-being and relieves the main load from the lower back and abdomen. Already in the last weeks of pregnancy, when the growing belly does not allow breathing normally, the pillow will allow you to take a comfortable half-sitting position.

Remember that pregnancy is your opportunity to gain strength and fully relax before the most crucial period in your life.Childbirth and the first weeks of caring for a baby will require a lot of energy from you, so health and good sleep!

MRI of the placenta in Novosibirsk. Cost, sign up for an MRI at the Siberian District Tomography Center

Placenta MRI is a study with a wide field of application in gynecology, has a high diagnostic value, is a non-invasive, painless method. It is performed before delivery, preferably at 34-36 weeks.

MRI uses a powerful magnetic field, radio waves and a computer to produce detailed images of the body’s internal structures.MRI does not use ionizing radiation (X-rays). Detailed MRI images allow doctors to better assess body areas and certain pathological processes that cannot be adequately assessed with other imaging techniques, such as X-rays, ultrasounds, or computed tomography (CT) scans. An MRI of the placenta is often recommended when ultrasound findings are inconclusive.

The study is carried out without the introduction of a contrast agent.

Pathologies of the placenta that can be diagnosed using MR diagnostics

placenta previa;

Placenta previa (placenta praevia) is a pathology in which the placenta is located in the region of the lower segment of the uterus, partially or completely overlapping the internal pharynx.

Classification:

I degree – low presentation – the placenta is located in the area of the cervical opening, but its edge is at least 3 cm from the pharynx;
II degree – regional presentation – the lower part of the placenta is located literally at the edge of the entrance to the cervical canal, but does not overlap it;
III degree – partial presentation – partial presentation – the lower part of the placenta overlaps the entrance to the cervical canal completely. In this case, most of the placenta is located on any one wall (front or back) of the uterus, and only a small area closes the entrance to the cervical canal;
IV degree – full or central presentation – the placenta is completely located on the lower segment of the uterus and blocks the entrance to the cervical canal with its central part. At the same time, the same parts of the placenta are located on the front and back walls of the uterus.

The gold standard in making the diagnosis is MRI in the sagittal plane, but more often the pathology is detected on ultrasound at the second (18 weeks) and third screenings (30 weeks).

placental accreta (ingrowth);

Placental ingrowth remains a major cause of maternal bleeding and obstetric hysterectomy.

Placental dysfunction and placental malformations;

Main indications for MRI of the placenta:

suspicion of placenta previa – if other diagnostic methods have shown controversial, inconclusive results or it is necessary to accurately diagnose the degree of previa;
The need to assess the depth of invasion of the placenta in the tissue of the uterus or bladder;
suspicion of dysfunction and abnormalities in the development of the placenta in the third trimester of the current pregnancy;
the patient is at risk of placental dysfunction: there is a scar after cesarean section, after myomectomy with opening the uterine cavity, or there are cases of placental dysfunction in the anamnesis.

Benefits of placenta MRI at the Siberian District Tomography Center

expert class equipment – Philips Achieva 1.5T SE high-field tomograph;
Highly informative decoding of MR images based on examination results, indicating all pathological changes;
highly qualified doctors who regularly improve their level and undergo international certification. We will hold an expert consultation absolutely free of charge to accurately describe the picture!

Contraindications to MRI of the placenta

Absolute contraindications:

artificial pacemakers (cardio, neurostimulators), fixed hearing aids, daily ECG, other implanted electronic devices;
artificial heart valves;
Ilizarov apparatus.

Relative contraindications:

tattoos with an admixture of metal – there is an itching and burning sensation at the location;
claustrophobic;

sudden onset of cramps and muscle spasms, hyperkinesis, inability to remain motionless;
is in extremely serious condition.

Preparation for MRI of the placenta

You must take a referral from your attending physician, permission to conduct an MRI study and the results of ultrasound diagnostics with you for the study.

No special preparation for the study is required. Immediately before the examination, the patient needs to empty the bladder.

It is preferable to conduct the study during those hours when the fetus and mother are in the most calm state.

How is the placenta MRI procedure

The study is carried out in the supine or lateral position.

Survey results

In the “Siberian District Tomographic Center” you will receive a disc with images immediately after the MRI scan.The results of the examination (description and conclusion of a specialist) can be handed over to you within 60-90 minutes after the procedure. If a consultation is necessary, the description can take up to three days. If you wish, you can receive all the necessary information in electronic form.

Prices and list of placental MRI services of the “Siberian District Tomographic Center” in Novosibirsk:

No.	Magnetic resonance imaging:	Prices in rubles
4	Magnetic resonance imaging of the pelvic organs:
4. 6	Placenta	3600

According to Wikipedia, spontaneous abortion ends in 15-20% of clinically established cases of pregnancy. These numbers are the lower bounds for the estimate, as in many cases the miscarriage occurs in the early stages – before the woman realizes that she is pregnant.Indeed, often the clinical signs of miscarriage are mistaken for heavy periods or for their delay.

What are the reasons for termination of pregnancy at different times? How to prepare for pregnancy after a miscarried experience? These questions were answered by the doctor obstetrician-gynecologist of the highest category of MC “Bullfinch” ALEXANDER GIL.

– Alexander Vadimovich, most miscarriages occur at the beginning of pregnancy, and many women are perplexed: why could this have happened?

– The main cause of miscarriages up to 6 weeks old is natural selection. A pregnancy is taking place with congenital malformations of an embryo that is no longer viable – thus, natural selection is carried out, in which we cannot interfere.

You will never know the exact cause of the miscarriage at this time, even if after abrasion (scraping of the uterine lining), the contents are sent for examination. As a rule, the answer comes: “short term pregnancy” and nothing else.

There is another reason for termination of pregnancy, especially if it is not the first, – Rh-conflict (when a woman has Rh-negative blood, and a man’s – Rh-positive).But in our country, effective prevention of Rh-conflict is used, so that troubles can be avoided at the stage of pregnancy planning.

In the structure of early termination of pregnancy, no one excludes infections and problems associated with hormones. At 6-8 weeks, prospective pregnancies are often interrupted due to a lack of hormones. In a normal pregnancy, a woman has a so-called corpus luteum in one of the ovaries, which produces endogenous progesterone.

Unfortunately, the functioning of the corpus luteum ends by about 7 weeks of pregnancy, and if initially there was not enough endogenous progesterone, pregnancy stops developing: the ovum is detached and the so-called frozen pregnancy occurs.

In some cases, with detachment of the ovum, pregnancy can be saved, the main thing is to contact a specialist on time. If, according to the results of an ultrasound study, the doctor sees that the embryo is still alive, pregnant women are prescribed exogenous progesterone in tablets or in suppositories. There is also this hormone in the form of injections, it is used to quickly saturate the body and prevent miscarriage.

– Agree, when a woman becomes pregnant, she cannot suspect that she lacks progesterone in her body.What should alert her? What signs indicate this?

– Any discharge from scanty dark brown to more profuse bloody is a bad sign. It is worth not hesitating to consult a gynecologist.

When spotting bleeding occurs, an ultrasound scan, a blood test for progesterone is shown.

I want to say that a lack of progesterone can cause miscarriage up to 15 weeks. At 15-16 weeks, the placenta is finally formed, which will secrete (produce) this hormone.

– Alexander Vadimovich, what problems can arise with the placenta during pregnancy?

– In the early stages, the chorion (unformed placenta) can overlap the internal pharynx, maybe its marginal location is a high risk of termination of pregnancy. In this case, the woman is admitted to the hospital and monitored for up to 16 weeks – by this time the chorion, as a rule, rises. But there remains the percentage of pregnant women in whom the placenta overlaps the pharynx of the uterus – this is called “the central location of the placenta.”To maintain pregnancy, such women, as a rule, must be in the clinic and under supervision at all times.

– What is the tactics of treating infections that appeared during pregnancy?

– Infections can appear even in those women who were thoroughly examined before pregnancy. Often this problem arises due to bloody discharge – this is a favorable environment for the development of infections.

Ectopia (erosion) of the cervix is also an infection that is a clear threat to pregnancy.Therefore, it is so important to undergo colposcopy before conception and to be treated for ectopia, if it is found.

Infection through the ascending route can penetrate intrauterinely and negatively affect the health of the fetus. There is such a complication as intrauterine pneumonia of the fetus, which is treated very poorly and occupies a large percentage in the structure of infant mortality.

And we treat infections whenever possible in any way that is prescribed in the protocol. There is such a tactic, which consists in taking antibiotics.You do not need to be afraid of them, since the doctor will prescribe only medications that are approved for pregnant women. Sometimes it is necessary to use those drugs, the benefits of which are greater than the risk of adverse reactions.

– What threats can affect mid-term pregnancy?

– Among the many reasons that lead to spontaneous miscarriages is isthmic-cervical insufficiency. This is a condition in which the isthmus and cervix cannot cope with the increasing load (growing fetus, amniotic fluid), begin to open – and the baby is born prematurely.

There are indications for the prevention of this condition – the imposition of a circular submucosal suture on the cervix. The best period is 16-17 weeks. You can do this procedure after 20 weeks, but the effect will be less.

In mid-pregnancy, a woman may experience placental abruption. In some cases, pregnancy can be saved with drugs that affect blood clotting. But often doctors are forced to resort to a small cesarean section. As a rule, childbirth before 22 weeks ends in the death of the fetus, and here we are already talking about saving the mother’s life.

I urge women in position to refrain from flying. In my medical practice, there have been several cases when a placental abruption occurred in patients during a flight. Who will provide you with qualified assistance in this case? I advise you not to risk it.

In Belarus, as in other European countries, childbirth begins at 22 weeks, but it is considered premature. Doctors are doing everything possible to preserve a promising pregnancy by any means. The main thing is to always be under the supervision of a specialist and follow all his recommendations.

– Alexander Vadimovich, unauthorized termination of a desired pregnancy is always a great psychological trauma for a woman. Nobody wants to go through this again. What are the features of preparing for the next pregnancy after a miscarriage?

– Before thinking about a second pregnancy, it is advisable for women who are experiencing mental anguish to undergo a course of psychotherapy. This is very important because mental health problems can be very serious, especially in women after unsuccessful in vitro fertilization (IVF).

The main rule is not to get pregnant after a miscarriage of 6 months. It is best to protect yourself at this time with oral contraceptives, which will be prescribed by a doctor. This is necessary in order to restore normal fertility.

A set of examinations for women who have had a miscarriage is assigned individually. But the general recommendations are as follows:

1. Diagnosis of sexually transmitted infections: mycoplasmosis, ureaplasmosis, chlamydia, herpes simplex virus, human papillomavirus (HPV).

You also need to be screened for those infections that were a possible cause of miscarriage during a previous pregnancy.

2. Test for sex hormones – if prescribed by a doctor.
3. Thyroid hormones (TSH, free T4, ATPO), ultrasound of the thyroid gland, consultation of an endocrinologist.
4. If necessary, consultation of a therapist and other specialists, blood tests for sugar, syphilis, HIV.
5. Ultrasound of the abdominal cavity and kidneys. During pregnancy, many chronic diseases are exacerbated, incl.including and kidney disease. You need to be treated before conception.
6. Colposcopy (examination of the cervix under a microscope).
7. Analysis of the partner’s spermogram.

Examination by a geneticist is indicated if, when planning a pregnancy, a woman is 36 years old, and a man is 45 years old and above. Also, this doctor needs to be visited by a couple who have had two non-developing pregnancies in a row in an early period.

– When a woman becomes pregnant after a miscarriage, should she be more closely monitored by a doctor?

– Of course, because this woman is already at risk for a certain group (miscarriage, infection, premature detachment, etc.)etc.).

Doctors recommend that women lead a more measured and calm lifestyle in such a situation, i.e. beware. It is important to protect a pregnant woman from worries, not to let her be impressed by “horror stories” about pregnancy. It is necessary to clearly tune in that this time everything will be fine.

Another advice from practice. Many women, having barely become pregnant, rush to confirm this on an ultrasound scan. Of course, there is no direct evidence that such research is harmful to the fetus, however, there is no reverse evidence that it is absolutely harmless.Since you so desire this pregnancy, you should not risk it and a competent doctor will definitely warn a woman against doing an ultrasound scan at an early stage without any special indications.

It is possible to determine pregnancy and its prospects using a blood test for hCG (human chorionic gonadotropin), or, more simply, a pregnancy hormone. It is completely harmless to pregnancy. It is advisable to donate blood at the beginning of the delay, after a week – again. If the increase in hCG is normal, then the pregnancy is promising, not ectopic – and there are no indications for ultrasound.

For the first time a woman should come for an ultrasound diagnosis at a gestational age of 11-12 weeks.

Source: infodoktor.by

The interview was given by an obstetrician-gynecologist of the highest category / ultrasound doctor of the MC “Bullfinch” Gil Alexander Vadimovich

Pain with placenta previa: Placenta Accreta and Total Placenta Previa in the 19th Week of Pregnancy

Placenta Accreta and Total Placenta Previa in the 19th Week of Pregnancy

S. Findeklee

S. D. Costa

Abstract

Abstract

Zusammenfassung

Introduction

Case Report

Medical History

Clinical Findings

Course after Admission

Discussion

Conclusion

Footnotes

References

Bleeding in Pregnancy/Placenta Previa/Placental Abruption

What complications can affect the placenta?

Low-lying placenta

Retained placenta

Placental abruption

Further information

Late Pregnancy Bleeding – American Family Physician

Carle.org

What Is Placenta Previa?

What Causes Placenta Previa?

What Are the Signs and Symptoms of Placenta Previa?

How Is Placenta Previa Diagnosed?

How Is Placenta Previa Treated?

DOs and DON’Ts in Managing Placenta Previa:

Placenta praevia (low-lying placenta) – HSE.ie

How you’ll know if you have placenta praevia

Signs and symptoms of placenta praevia

If you have placenta praevia

Early hospital admission

Blood transfusions

Caesarean birth

Premature birth

Placenta Previa

What is placenta previa?

What causes placenta previa?

What are the symptoms of placenta previa?

How is placenta previa diagnosed?

How is placenta previa treated?

What are possible complications of placenta previa?

When should I call my healthcare provider?

Key points about placenta previa

Next steps

Pathologies of the placenta that can be diagnosed using MR diagnostics

Main indications for MRI of the placenta:

Benefits of Placenta MRI in Magnesia

Contraindications to MRI of the placenta

Preparation for MRI of the placenta

How is the placenta MRI procedure

Survey results

Prices and list of services MRI placenta center “Magnesia” in Yakutsk:

Good sleep is the key to the health of the future baby

Finding a comfortable sleeping position

Back Pose

Belly Pose

Side Pose

Pillow to help

MRI of the placenta in Novosibirsk. Cost, sign up for an MRI at the Siberian District Tomography Center

Pathologies of the placenta that can be diagnosed using MR diagnostics

Main indications for MRI of the placenta:

Benefits of placenta MRI at the Siberian District Tomography Center

Contraindications to MRI of the placenta

Preparation for MRI of the placenta

How is the placenta MRI procedure

Survey results

Prices and list of placental MRI services of the “Siberian District Tomographic Center” in Novosibirsk:

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