Placental presentation

Description:

redlezhaniye of a placenta call its attachment in the lower uterine segment, that is on the way of the born fruit. Placental presentation increases risk of heavy bleeding, often life-threatening the pregnant woman. Distinguish three types of placental presentation. In process of development of pregnancy, smoothing and disclosure of a neck of uterus the type of placental presentation can change.

1. At full placental presentation the internal pharynx is completely closed. A kind of full presentation consider the central placental presentation when its center is over an internal pharynx.

2. At partial placental presentation only a part of an internal pharynx is closed. At the same time behind an internal pharynx along with placental fabric fetal membranes are defined.

3. At a low arrangement of a placenta its edge is located near an internal pharynx (within 2 cm).

B. Prevalence makes about 1 case on 200 pregnancies. The placental presentation found in the II trimester of pregnancy independently disappears by the end of pregnancy more than in 90% of cases. It occurs owing to growth of a trophoblast towards an uterine fundus.

Placental presentation symptoms:

1. A typical symptom — sudden painless bleeding from a genital tract. Approximately at one third of patients bleeding arises till 30th week of pregnancy, at other third — after the 36th. Among the remained cases bleeding develops on the 34th week of pregnancy more often. In most cases bleeding independently stops, later — renews.

2. In every fourth case of placental presentation bleeding develops against the background of reductions of a uterus, without its long tension.

3. At one third of patients the wrong situation and presentation are observed.

4. The IDCS arises seldom.

Placental presentation reasons:

The etiology of placental presentation is unknown. It is considered that the main role in a pathogeny is played by the changes of an endometria connected with the previous childbirth and abortions and also disturbance of blood supply of a decidua.

Treatment of Placental presentation:

1. At severe bleeding, life-threatening swear, irrespective of duration of gestation carry out the emergency delivery by Cesarean section.

2. In the absence of severe bleeding and at duration of gestation of 36 weeks and more after confirmation of a maturity of lungs of a fruit carry out delivery in a planned order. Such delivery is more preferable, than emergency.

and. Usually rodorazreshat by Cesarean section. At partial placental presentation and a mature neck of uterus childbirth in natural patrimonial ways is possible.

. If the placenta is located on a front wall of a uterus, at Cesarean section there can be severe bleeding. In this regard do a slit in the field of the lower uterine segment with transition to a body of the womb.

3. If fruit lungs unripe or duration of gestation less than 36 weeks is also absent bleeding, carry out conservative treatment. It includes the following events.

and. Restriction of physical activity.

. Abstention from sex life and syringings.

century. Maintenance of hemoglobin at the level of not less than 100 g/l.

. Introduction of anti-Rh0(D) - immunoglobulin to women with Rh-negative blood.

Tokolitichesky therapy (carry out with care). Choice drug — magnesium sulfate.

e. Preparation of blood preparations.

. Out-patient treatment is possible in the following cases.

1) The pregnant woman realizes weight of the state.

2) In house conditions observance of the above described restrictions is possible.

3) The pregnant woman is under constant supervision, there is an opportunity to quickly bring it to medical institution.

h. On reaching the 36th week of pregnancy regularly estimate a maturity of lungs of a fruit. Delivery conduct researches right after receiving a positive take.