Low placentation in pregnancy

Low placentation during pregnancy is a problem that often causes bleeding in late pregnancy and can cause complicated labor. This pathology is characterized by abnormal attachment of the placenta, which can develop for various reasons. Knowing the main symptoms and clinical manifestations of the disease will allow you to seek help in a timely manner and maintain your health and the health of your baby.

[ 1 ], [ 2 ], [ 3 ], [ 4 ]

Epidemiology

The epidemiology of pregnancy complications with low placentation is such that only 15% of cases can be complicated by bleeding or threat. In most women, this problem is asymptomatic and labor goes well. Among the etiological factors of low placentation, surgical interventions and frequent abortions are in first place in terms of prevalence, which must be taken into account and risk groups for this pathology must be identified.

[ 5 ], [ 6 ], [ 7 ]

Causes low placentation in pregnancy

To understand the main reasons for the development of this pathology, it is necessary to understand how placentation occurs under normal conditions. The placenta is the place where the baby “lives” and develops all its time. In its structure, the placenta is a connective tissue that contains many vessels. This is necessary for good fetal blood circulation and sufficient nutrition, since all nutrients enter the blood and then to the child. One of the main functions of the placenta is protection from external factors, since it is a very serious barrier to viruses, bacteria, toxins, and drugs. Therefore, in order for the placenta to perform all its functions normally, it must be correctly positioned. Under normal conditions, the placenta is attached to the bottom of the uterus or to its back wall. This ensures normal blood flow, the vessels are not pinched, and the child receives all the nutrients. The bottom of the uterus and the back wall have a very dense layer of endometrium, and when the placenta is attached in this place, it is very tightly fixed until the moment of birth. In this case, there is no risk of placental abruption or other complications. In any case, the placenta should attach so that it is 7 centimeters higher than the internal os. Then we are talking about normal placental attachment. If the placenta is below 7 centimeters, but does not cover the os at all, then we are talking about low placentation. Sometimes the placenta partially or completely covers the internal os, then this is placenta previa - a more complex case.

The reasons for such an abnormal location of the placenta may be different. The most common are inflammatory diseases of the internal female genital organs.

Other causes of low placentation include congenital defects of the uterus, which disrupt the entire topography of the organ and do not allow normal placentation. Very often, girls are born with congenital defects of the uterus, which are not critical and the girl can become pregnant and bear a healthy child. Such defects include a bicornuate uterus, a unicornuate uterus, and uterine hypoplasia. In this case, the normal structure of the uterus is disrupted and the fertilized egg cannot implant in one horn, since blood circulation will be disrupted as the fetus grows. Therefore, implantation occurs a little lower, where the placenta will later form, which is the cause of low placentation.

Surgical interventions on the uterus also often change the organ's topic. In certain cases, operations can be performed for myoma with partial resection of the myometrium. This leads to the fact that the placenta cannot attach normally to the bottom. Sometimes a simple suture on the uterus after a cesarean section can cause low placentation.

Uterine fibroids can be another cause of low placentation. This disease is characterized by the formation of a benign compaction in the thickness of the myometrium or the formation of a node. Such nodes can form in one horn, which directly interferes with normal placentation.

A woman's age directly affects the development of a normal pregnancy. If a woman's first pregnancy is after 35 years old, then only this can cause low placentation. After all, with age, normal blood circulation in the uterus is disrupted and this prevents normal placentation.

[ 8 ], [ 9 ], [ 10 ], [ 11 ]

Risk factors

Based on these reasons, we can identify the main risk factors for the development of low placentation in women during pregnancy, which must be taken into account for the timely prevention of complications. Such risk factors include:

1. chronic inflammatory diseases of the internal genital organs;
2. surgical interventions on the uterus;
3. uterine fibroids;
4. congenital defects of the uterus;
5. first pregnancy at an older age;
6. history of frequent abortions or miscarriages;
7. heavy physical work of the mother before pregnancy or in the early stages.

Such risk factors may not lead to low placentation, but if they exist, then such mothers must undergo thorough examinations and prevent these problems.

[ 12 ], [ 13 ], [ 14 ]

Pathogenesis

The pathogenesis of the development of such a problem in such diseases lies in the disruption of the structure of the endometrium under the influence of prolonged inflammation. If we are talking about chronic infections or acute endometritis, then inflammatory cells constantly support the pathological focus. In response to such intervention, the synthesis of connective tissue can be activated, which can cause a disruption in the structure of the endometrium. As a result, the fertilized egg cannot be implanted in the fundus area, since the connective tissue does not allow it to penetrate deep into the endometrium. Therefore, the embryo looks for a place where blood circulation is a little better and can be implanted lower, where the placenta will develop in the future. Thus, inflammatory processes in the uterus contribute to low placentation.

[ 15 ], [ 16 ], [ 17 ], [ 18 ], [ 19 ]

Symptoms low placentation in pregnancy

The first signs of low placentation may appear only in the third trimester, when the size of the fetus is such that the placenta can detach slightly. Only then may there be symptoms, or there may be no changes until the birth itself.

Low placentation in early pregnancy does not manifest itself if the woman does not have any heavy loads. At the same time, the child develops normally, has sufficient blood circulation and nutrition. When the child's weight increases, its needs also increase. It can move more actively, and if the woman makes some sudden movement or lifts something, this can disrupt the connection of the placenta with the endometrium. Then the first symptoms may appear.

Low placentation often manifests itself in vaginal bleeding. This can happen at any stage, but more often in the second half of pregnancy. Such bloody discharge appears after active walking or physical activity. The discharge is not accompanied by increased uterine tone or pain in the lower abdomen. Apart from such minor discharge, the woman may not be bothered by anything else. Blood appears because if the placenta is located low, then under a certain load it can peel off and blood is released. Its amount may be small, as well as a small area of detachment, so the discharge may stop on its own. But even in this case, you need to see a doctor.

If the detachment is significant, then severe bleeding occurs. This may cause dizziness, fatigue, headache, fainting. This is due to severe blood loss.

Low placentation during pregnancy on the back wall is more dangerous, since complications occur more often. In this case, bleeding may be internal and there may be no external signs. Blood may accumulate outside the placental abruption zone and may not come out due to compression by the fetus. Therefore, there may be no bloody discharge. But due to the accumulation of blood, there may be a feeling of pressure in the lower abdomen or minor pain. It is not pronounced, but constant and intensifies over time.

Symptoms of low placentation during pregnancy may not appear at all until the period of labor. Already during labor, during contractions, there may be a slight detachment of the placenta, since it is located low and under the influence of contractions, the fetus can move. Then, slight bleeding may occur, which requires an immediate response from doctors.

Complications and consequences

Low placentation in twin pregnancies is common, since both placentas cannot attach properly, they simply do not have enough space. In this case, complications occur less frequently, since the compression of the uterus from all sides by two fetuses does not allow the placenta to detach. Only during labor can the first symptoms appear, when one fetus has already come out and pulled the other placenta.

Bleeding with low placentation during pregnancy is the most common symptom, so you should pay attention to it regardless of the period.

Complications that can develop against the background of low placentation and which are the most threatening are placental abruption. As the child grows, its size also increases. Such a fetus can actively move and with sudden movements, especially against the background of a short umbilical cord, there may be placental abruption, since in this place it is not tightly attached to the endometrium. This is accompanied by bleeding, which threatens termination of pregnancy. Sometimes there may be no external bleeding, and then the blood accumulates behind the uterine cavity. This leads to the formation of a hematoma and the woman's condition deteriorates before our eyes, and it is difficult to determine the cause. The consequence of such a hematoma can be the formation of a Couvelaire uterus, when blood seeps through all layers of the uterus and such a myometrium can no longer contract. This threatens major bleeding, so the only treatment is removal of the uterus.

[ 20 ], [ 21 ], [ 22 ], [ 23 ], [ 24 ]

Diagnostics low placentation in pregnancy

Low placentation during pregnancy can be diagnosed definitively only in the second trimester, when the placenta is completely formed. It is important to know the concept of the significance of this pathology. Low placentation can be present in a woman throughout her pregnancy, and at the same time it does not cause any symptoms and the birth goes well. And vice versa - low placentation can cause bleeding already in the first half of pregnancy, then it is considered a significant diagnosis. Therefore, if such a pathology is established in the first half, then you just need to know that it is there and prevent complications. After all, there may be no symptoms until the end of pregnancy. And if the diagnosis is established when bleeding or other symptoms appear, then we need to talk about treatment. Therefore, the diagnostic period is not as important as the symptoms of the pathology.

In any case, routine examinations of a pregnant woman allow pathology to be detected in time. Therefore, if you do not deviate from normal pregnancy management, no special examinations are required.

If a woman complains of bloody discharge, then the woman should be carefully examined on a chair or couch. Under normal conditions, palpation does not allow reaching the edge of the placenta through the internal os. If a small part of the placenta is detected during palpation, then this may already indicate low placentation or presentation. With low placentation, the tone of the uterus is not increased and there is no pain during palpation.

The tests that need to be done are not specific. Since the placenta is located low, there is a risk of infection. Therefore, it is important to conduct a study of vaginal secretions with the exclusion of an inflammatory process of the vagina or uterus.

[ 25 ], [ 26 ], [ 27 ], [ 28 ], [ 29 ]

Differential diagnosis

Instrumental diagnostics of pathology is also very important for the purpose of differential diagnosis. The main method of diagnosing such pathology is considered to be ultrasound examination. This method allows to clarify how the placenta is located, what is the distance from the internal os, whether there is presentation. Also, with the help of ultrasound, it is possible to study the blood circulation in the placenta. If there is a suspicion of retroplacental hematoma, then the ultrasound will visualize a focus of increased echogenicity in the area of placental abruption.

After the thirtieth week, for a more accurate diagnosis of the fetus's condition, cardiotocography should be performed. This is a method that allows diagnosing fetal movements, heart rate, and uterine tone. This allows excluding premature birth as a cause of bloody discharge.

Differential diagnostics of low placentation at an early stage should be carried out primarily with the threat of termination of pregnancy. These pathologies are accompanied by identical vaginal bleeding. But unlike low placentation, the threat is also accompanied by nagging pain in the lower abdomen and increased uterine tone. This occurs due to the fact that the uterus contracts in an attempt to expel the fetus. With low placentation, both uterine tone and pain are not expressed. At a later stage and directly during labor, low placentation should be differentiated from complete or partial placenta previa. During palpation, with complete placenta previa, the internal os will be completely covered by the placenta, while low placentation is accompanied by only slight palpation of the placental tissue. These pathologies can be most accurately differentiated using ultrasound.

Low placentation should be diagnosed by ultrasound, not when symptoms appear. Only then can complications be avoided by warning the woman and prevention.

Treatment low placentation in pregnancy

Active treatment of such pathology can be used if the symptoms are pronounced or there is evidence of bleeding. Then medications are used that are aimed at stopping bleeding, improving uteroplacental circulation and maintaining pregnancy. Women with such a diagnosis definitely need a gentle regimen, it is necessary to avoid stress and long walks.

Sometimes low placentation in the late stages can cause placental abruption, then the tone of the uterus can increase and this requires taking tocolytic drugs in the acute period. Then, when the woman's condition is normalized, drugs are prescribed that improve the rheological properties of the blood and normalize uterine circulation. But it should be taken into account that such active tactics can only be used with pronounced symptoms; if clinically low placentation does not manifest itself, then external intervention is not required.

Ipradol is a drug from the group of selective sympathomimetics, which acts by binding to uterine receptors and leads to relaxation of muscle fibers. Therefore, the drug is used for low placentation, which is complicated by the threat of miscarriage and is accompanied by increased uterine tone and rhythmic contractions. The method of administration of the drug is intravenous, which allows you to quickly achieve the effect. Dosage - 10 micrograms of the drug should be administered slowly, and then switch to infusion use. Side effects are palpitations, heart rhythm disturbances, headache, feeling of heat, increased pressure, tremor, diarrhea. Precautions - the drug cannot be used at a pregnancy term earlier than 22 weeks.

Against the background of active tocolytic therapy, hemostatic therapy can be carried out in parallel if bleeding is severe.

Tranexamic acid is a systemic hemostasis agent that acts by inhibiting fibrinolysis and is widely used in gynecology. The drug can be used to treat complications of low placentation, including the formation of retroplacental hematoma. The method of administration of the drug is intravenous drip. Dosage of 100 milliliters of solution during the first hour, and then under the control of the condition and blood test. Side effects of tranexamic acid are abnormal heart rhythms, headache, tinnitus, thrombosis, nasal congestion, dizziness, convulsions. Precautions - if there is blood in the urine, use the drug with caution, as this may cause further anuria.

If a woman with low placentation had minor bleeding, but the tone of the uterus and the condition of the child are not disturbed, then a small hematoma may form, which will resolve over time. But it can be a source of infection, since blood is a good environment for the reproduction of pathogenic microorganisms. Therefore, after this, most people are inclined to the mandatory intake of an antibacterial agent that is not dangerous for the fetus. This not only prevents infection, but also acts on microorganisms that can multiply during this period of the disease. The group of cephalosporin antibiotics is considered the most acceptable for pregnant women.

Ceftibuten is a third-generation beta-lactam antibiotic, especially effective against gram-positive and gram-negative flora. The drug has a bactericidal effect on possible anaerobic pathogens, so it can be used for prophylactic purposes in gynecology. The dosage of the drug is 200 milligrams twice a day, taking into account prophylactic administration, for at least five days. Side effects are possible when affecting the stomach - colitis or dysbacteriosis develops, which is manifested by bloating, stool disorders. Precautions - the drug cannot be used if you are allergic to penicillin antibiotics, as well as with congenital enzyme deficiencies.

The use of vitamins in the treatment of low placentation is very important, since this often involves a violation of blood flow in the umbilical cord and placenta. Therefore, the use of vitamins that contain magnesium and ascorbic acid helps improve blood circulation in the uterus and placenta, which reduces the effect of insufficient oxygen on the child's brain.

Actovegin is a drug that is most often used to prevent and treat uteroplacental insufficiency. This drug is a derivative of various amino acids that normalize cellular respiration in human tissues and improve oxygen absorption. The drug is used in ampoules. For administration and complex treatment of placentation anomalies, the recommended dosage is 10 milliliters per day. The method of administration is intramuscular. Side effects can occur in the form of severe allergic reactions to foreign protein. Precautions - the injection drug can only be dissolved in saline or glucose, the drug is not used with other solvents. It is imperative to conduct a sensitivity test before using the drug, as it is allergenic.

The use of other drugs can only be symptomatic. There is no etiologic therapy for low placentation, since the drugs cannot affect the location of the placenta itself.

Physiotherapy treatment, given pregnancy, is also not recommended, since it is difficult to predict the reaction of the child and placenta to such intervention. Therefore, thermal and radiation procedures are not used in the acute period.

Folk treatment of low placentation

Traditional methods of treating low placentation can be used very widely. Such methods can be used even if there are no manifestations of the diagnosis to prevent complications. For this purpose, you can use herbs and infusions that improve uteroplacental blood circulation, because often the child may not have enough nutrients. In order to prevent detachment and the threat of premature birth, they use agents that reduce tone and sympathetic activity. Therefore, you can drink herbal infusions and treat yourself with folk remedies throughout your pregnancy right up until the birth.

1. Carrot, apple and beetroot juice is very useful to take with low placentation to normalize the structure of the vascular walls and improve blood circulation, unless of course there is an allergy. To prepare the juice, squeeze out half a liter of apple juice, add one glass of grated carrot juice and one glass of beetroot juice, mix everything thoroughly and add honey before use. Dosage - take half a glass of juice in the morning and evening.
2. Tea made from ginger, lemon juice and raspberry branches is very useful for improving the trophism of the uterus and preventing infectious complications. It tones the body of a pregnant woman well, has a calming effect and invigorates in the morning. It can be taken about two liters per day, of course, if there is no edema and hypertension. To do this, you need to brew tea from raspberry branches, boil them for a few minutes, then pour the tea into a cup and add ten grams of ginger and the juice of a quarter of a lemon. You need to drink this tea instead of plain water several times a day, then you can lie down a little, throwing your legs on an elevation to improve the blood flow to the uterus.
3. To prevent ascending infection, it is very good to use a herbal solution for washing. To do this, take oak bark and celandine grass, steam them, and wash yourself with the warm grass every day.

Herbal treatment is used very often, since many herbs have a positive effect on the tone of the uterus, local blood circulation and the condition of the fetus, while they also have a systemic effect with sedation of the body.

1. St. John's wort is a plant that normalizes the tone of the placenta vessels and improves blood circulation in the uterus, regulating nerve conduction. To prepare a medicinal tea, you need to take 50 grams of St. John's wort, boil it over low heat for five to ten minutes and then strain it. You need to drink this tea three times a day, one teaspoon at a time, up to the thirty-seventh week.
2. Especially effective in preventing complications of low placentation and the appearance of detachment is an infusion of stinging nettle. To prepare a medicinal tea, you need to take ten grams of the herb, pour half a liter of water, and then after it has been infused for twenty minutes, strain and drink. Dosage - about a liter of tea should be drunk per day, controlling other fluids in the presence of edema.
3. Calendula tincture is an excellent tocolytic agent, and besides, it also has the ability to reduce the activity of bleeding in the presence of a retroplacental hematoma. To prepare a medicinal tea, you need to take calendula flowers and fruits, pour half a liter of water, and then after it has been infused for twenty minutes, strain and drink. In the acute period, you can drink up to half a liter of tincture per day, and then you can drink a prophylactic dose of a tablespoon twice a day.
4. You need to take 100 grams of dry dandelion and plantain grass, make tea from a liter of water and drink a tablespoon three times a day. The course of treatment is four weeks. This is an excellent remedy for normalizing fetal trophism, as it dilates blood vessels and activates the flow of oxygen and nutrients to the fetus.

Homeopathy is used to treat low placentation as widely as traditional methods of treatment. And the main advantage of such methods is the possibility of their long-term use.

1. Arnica is a homeopathic remedy consisting of herbal preparations that are more effective in patients with low placentation, which is manifested by bleeding after a mechanical impact. The method of using the drug is one drop every two hours on the first and second days after the onset of symptoms, and then one drop three times a day, under the control of the heartbeat - if tachycardia occurs, the dose can be reduced. No side effects have been identified. Precautions - do not take if you are allergic to linden pollen.
2. Zincum valerianicum is an inorganic homeopathic preparation. It is used to treat low placentation, which is accompanied by nagging pain in the lower abdomen. Taking this preparation can prevent detachment if it is taken before any symptoms appear during the initial diagnosis. The method of using the preparation depends on the form. The dosage for drops is one drop per ten kilograms of body weight, and for capsules - two capsules three times a day. Side effects may include hyperemia of the skin of the hands and feet, as well as a feeling of heat. Precautions - do not use simultaneously with antispasmodics.
3. Hamamelis is the number one remedy for low placentation or placenta previa. This is a homeopathic medicine that improves blood circulation in the area of the placenta and strengthens the connection in this place, which prevents detachment. It is available in the form of drops and is used in a dosage of eight drops per dose. How to use - the solution should be dripped into 100 milliliters of boiled water and drunk half an hour before meals. The course of treatment can be started with a dosage of three drops twice a day, and then after a month you can increase the dose to five drops, as the pregnancy period increases. Side effects are rare, allergic skin reactions are possible.
4. Hydrastis is a homeopathic remedy based on the plant goldenseal, which is very effective in maintaining pregnancy due to its action, which is similar to the natural hormone progesterone. The drug normalizes blood circulation, which even with low placentation helps improve placental trophism. The drug is especially effective in the late stages of pregnancy with twins or anemia in the mother. The drug is available in granules and is dosed six granules every six hours. Taking the drug before pregnancy is not recommended.

Surgical treatment of low placentation is not used, since it is impossible to change the natural place of attachment of the placenta even with any physical exercises. As for surgical intervention in case of low placentation, it is necessary to say about the period of labor. Often, low placentation during active labor can give a slight detachment. Then, doctors determine an intact amniotic sac during palpation, which requires intervention. If an amniotomy is performed, the fetus descends lower along the birth canal and even with a slight detachment, compression occurs - this can stop bleeding and the formation of a hematoma. Thus, an intervention is performed - amniotomy, which can be considered a kind of invasive intervention in case of low placentation. In the afterbirth period, low placentation can give complications of retention of fetal membranes, then surgical intervention in the form of manual separation of the placenta is also required.

Other cases of low placentation do not require active surgical treatment.

[ 30 ], [ 31 ]

Prevention

When talking about preventing low placentation, you need to prepare for pregnancy first. If possible, the first child should be born before the age of 35, because the risk of developing such a pathology increases later. Any surgical interventions on the uterus can cause abnormal placentation, so pregnancy should be planned in such a way that the time needed for the uterus to regenerate passes after the operation. If the diagnosis has already been established, then complications need to be prevented. It is very important to lie down more, not lift heavy objects, not lead an active lifestyle, eliminate stress and eat normally. After all, any violation of the regime can lead to detachment.

[ 32 ], [ 33 ], [ 34 ], [ 35 ], [ 36 ]

Forecast

The prognosis for carrying a normal baby with low placentation is very good, since the problem is not so big and with the right actions complications can be avoided.

Low placentation during pregnancy is not such a terrible diagnosis as it seems at first glance. This is a pathology in which the placenta is attached in an atypical place. There is a risk of circulatory disorders and fetal hypoxia, or a risk of complications during childbirth. But often the pathology does not manifest itself throughout the pregnancy and everything ends well. If there are symptoms of such a pathology, then only in this case are treatment measures applied.

[ 37 ], [ 38 ], [ 39 ]