Placenta previa

Presentation of the placenta - its location in front of the presenting part of the fetus. The main causes are: dystrophic changes in the mucous membrane of the uterus that have arisen after abortions and labor, tumors and anomalies of the development of the uterus, infantilism, a decrease in the proteolytic properties of the trophoblast of the fetal egg, primary low nidation of the fetal egg.

Symptoms, course. Depending on the degree of closure of the internal throat of the uterus by the placental tissue, a complete and incomplete presentation of the placenta is distinguished. If at the opening of the pharynx by 4-b cm, the placental tissue is determined everywhere, then we are told of the full placenta previa; If at the same opening together with the placenta, the membranes are also defined, then the presentation is partial. In addition to the presentation, the low location of the placenta is distinguished, when it, located in the lower segment of the uterus, does not reach the edges of the internal pharynx. With complete presentation, bleeding from the genital tract is usually observed at the end of pregnancy, with incomplete-at the beginning of labor. Bleeding starts suddenly and is not accompanied by pain. Sometimes the bleeding subsides and turns into prolonged, recurring, repetitive macular bleeding. Bleeding leads to anemia, the degree of which corresponds to external blood loss. With placenta previa bleeding occurs from the vessels of the uterus; The fetus does not lose blood. However, the fetus is threatened with asphyxiation, since the detached part of the placenta does not participate in its gas exchange.

The diagnosis is based on anamnesis and objective research. Any bleeding in the last months of pregnancy and at the beginning of labor is suspicious of placenta previa. In external obstetric research, attention is drawn to the relatively high standing of the presenting part. Often, the pelvic presentation and the transverse position of the fetus are determined. The diagnosis is clarified with a vaginal examination, which, due to the danger of severe bleeding, should always be carried out with extreme caution, with strict adherence to aseptic and antiseptic rules (danger of infection) with an operating theater. Usually, behind the internal uterine pharynx palpate the spongy tissue (complete pre-lying) or spongy tissue with adjacent smooth fetal membranes (incomplete presentation). With the cervix closed, the diagnosis is made on the basis of the characteristic pastovosity of the vaginal arches and pulsations of the vessels. The study is completed by examining the cervix and vaginal walls with mirrors to prevent possible bleeding from these organs (erosion, cervical cancer, varicose veins of the vagina). From the methods of additional diagnosis, ultrasound, cysto- and vasophage are used. Differential diagnosis is performed with premature detachment of the normally located placenta and the beginning of the uterine rupture.

Treatment. Pregnant women with suspected placenta previa are urgently hospitalized for examination and treatment. With mild bleeding during pregnancy, remedies are applied to the uterus (10-20 ml of a 25% solution of magnesium sulfate v / m 2 times a day, suppositories containing 0.02 g of papaverine, 2 to 3 times a day). Recently, beta-adrenomimetic drugs (partusisten) have been used successfully for uterine relaxation in the premature development of labor. The drugs that increase blood coagulation are shown (vitamin K, 0.015 g 3 times a day, blood transfusions in small doses of 100 ml, ascorbic acid - 300 mg in 20 ml of 40% glucose solution IV). In connection with the possibility of bleeding, strict adherence to bed rest is necessary. Pregnant can not be discharged from the hospital because of the risk of bleeding.

The delivery is performed depending on the obstetric situation. With unprepared birthmarks and severe bleeding, an abdominal cesarean section is shown. Absolute indications for caesarean section are full placenta previa, as well as partial presentation, accompanied by severe bleeding. With partial presentation of the placenta and mild bleeding, a fetal bladder is opened. In case of insufficient labor, dermal head forceps are applied. With pelvic presentation and a moving presenting part, in the absence of conditions for caesarean section, it is possible to try extremely carefully to lower the leg and hang the weight to it up to 200 g. Extraction of the fetus with incomplete opening of the cervix is ​​absolutely contraindicated (rupture of the uterus!}. The postpartum and early postpartum periods are often complicated Hypotonic bleeding, therefore, it is necessary to actively maintain the 3rd stage of labor - 1 ml of intravenous oxytocin (5 units) in 20 ml of 40% glucose solution or 1 ml of methylergometrine together with 40% glucose solution. After the birth of the afterbirth, in all cases the cervix With the help of mirrors.

Prevention of placenta previa is to conduct sanitary and educational work on the harm of abortion, the early detection and treatment of infantilism and various inflammatory diseases of the uterus.