The placenta previa

The placenta previa (placenta praevia) - wrong placentation, in which it is situated above the inner maw of the uterus. The placenta previa can be Central or full (all internal Xev closed placental tissue), and incomplete or partial (placental tissue covers part of the internal OS). In turn partial placenta previa can be side (fetal membrane lie next) or regional (at the edges of the inner throat, when opening the two "midwife" of the finger, is only the lower edge of the placenta, and in the throat palpable only shell).
The placenta previa is observed on average 1 time in 200 births.
Changes in the lining of the womb of different etiology (often after endometritis) hamper the correct attachment of the fertilized egg in addition, during its growth placenta goes on isthmic part of the uterus, approaching the interior fix.
In the second half of pregnancy with placenta previa, often after 32 weeks, bleeding occurs, in most cases with full peace of mind at night (suddenly, suddenly stopped, and, as a rule, is repeated). The midwife must remember that if the woman in the second half of pregnancy bleeding occurs, though scarce, the first thing you should consider placenta previa. Vaginal examination not to do! A woman should be sent immediately to hospital. From the hospital pregnant may not be issued before delivery, if the suspected placenta previa is not removed. Hospital vaginal examination may only doctor (when operating ready!).
Treatment. In bed, watching the function of the intestines, the use of means removing uterine contractions: papaverine 0.02 g in the candlelight, in 1 suppository 2 times a day; injection of pantopon (1 ml 2% solution) with magnesium sulfate (10 ml 10% solution). You drip blood transfusion (100-150 ml) and prevention of anemia; ascorbic acid (0.3 grams per day) and rutin (0.02 g 3 times a day); monitoring of blood loss, blood pressure and heartbeat of the fetus.
If there is bleeding in childbirth is one of the effective methods to stop bleeding is opening membranes. The last is made as a separate or pre surgery (for example, before Mithraism). After opening membranes and of rupture of membranes uterus tightly hugs the fruit, contractions increase, predlagaemaya part (head, pelvic end) pulls a loose plot placenta to the uterine wall, the bleeding stops.
Fetal bladder is recommended to break the branches bullet forceps, but not a finger to avoid further detachment of the placenta.
At partial placenta previa apply the operation Merarite (see). In these cases, you should assign the goods no more than 200-300, Suspension of cargo more weight may cause violent rupture of the cervix (up to sets), sometimes the gap continues even at the lower segment of the uterus. Metratester enter no more than 8 hours.
If there is heavy bleeding (partial placenta previa) at the head previa fruit, you can also use the method of imposing a skin-head forceps Gaussian - Ivanov. The instrument leave at the head of the fruit of not more than 6 hours, the suspended load should not exceed 200-300, early Internal rotation on the leg on the Braxton Giksu is unsafe for the mother, as is done in case of incomplete disclosure of a pharynx 2-3 finger, so it could be used in extreme cases where there are no conditions to do a caesarean section and Merarite.
When fetal pelvic presentation in combination with placenta previa shown operation relegated legs. The leg of the fruit of the display so that only has stopped the bleeding, and then hung up the cargo to the leg of a fetus weighing 200 to 300 g (not more!).
The method of choice for surgical treatment in the presence of heavy bleeding (especially when complete placenta previa is a caesarean section (see).
Very responsible period in childbirth is succession and the early postpartum period. Blood loss of more than 0.5% of the total weight of the woman, and the ongoing bleeding should start manual separation of the placenta. The operation is performed with extreme caution. Simultaneously drip blood transfusions, intravenous.

the placenta previa
The placenta previa: 1 - marginal; 2 - complete, Central; 3 - side.


The placenta previa (placenta praevia) - wrong placentation, in which it is situated above the inner maw of the uterus. The placenta previa can be Central or full (all internal Xev closed placental tissue), and incomplete or partial (placental tissue covers part of the internal OS). In turn partial placenta previa can be side (fetal membrane lie next) or regional (at the edges of the inner throat is only the lower edge of the placenta, and in the throat palpable only shell).
Type of placenta previa at small opening throat accurately determine not always possible. Estimated Central p.p. at considerable opening of the throat may be side, the latter with a small opening throat often mistaken for regional (Fig). P. p. meets, on average, 1 in every 200 to delivery, and prevails side p. P. If the edge of the placenta is less than 7 cm from the inside of the mouth, this pathology is considered as low placentation.
Causes of placenta previa or are changes in the endometrium (inflammatory processes, atrophic and dystrophic changes of the mucous membrane of the uterus after abortion pathological birth, the underdevelopment of the uterus when infantilism), or change the ovum.
Vaccination and the development of the ovum can occur in the womb, but with further growth of the placenta, enters the area of the isthmus and reaches the internal OS, there is a secondary "isthmic" placenta.
The main symptom of placenta previa - the external bleeding from kin ways arising from violations of placental attachment when the uterus and stretching the lower segment. The lower the place of placental attachment, the sooner there bleeding and the more powerful it is. At partial PP, especially regional, bleeding occurs more frequently in childbirth.
In half of the cases, usually when complete placenta previa, at least to a partial, bleeding to occur in the labor activity on the 8th month. pregnancy, rarely before. Appearing for no apparent reason, sometimes during sleep, bleeding stopped due to thrombosis revealed vessels, then repeated again and gets worse as you approach labor and especially when due. Blood loss leading to growing anemia. Bleeding that occurs for no apparent reason and without pain in late pregnancy or childbirth, above all makes us think about PP
Suspected PP causes high standing predlagay part of the fruit above the fold, sometimes incorrect position of the fetus. The palpation of the uterus is a normal consistency, the heartbeat of the fetus with moderate bleeding does not change. When vaginal examination, which should only be performed in hospital and at full readiness for rapid delivery, through the arches between exploring fingers and prelezhashie part of the fetus are defined layer testovaty consistency and unclear contours predlagay part. In an open shed finger is determined by the spongy tissue of the placenta with rough or uneven surface. Bleeding during rough palpation of the placenta is increasing. After the birth of the placenta found rupture of membranes at the edge of the placenta; low placentation rupture of membranes is located at the distance of 2-3 cm from the edge of the placenta. In the case of the head of presentation of the fetus for the purpose of diagnosis of placenta previa with a closed mouth can be used the method of rentgenoterapii during the filling of the bladder contrast or liquid oxygen.
The differential diagnosis spend with premature detachment normally
attached to the placenta (see), uterine rupture (see Childbirth, birth injuries, bleeding from the generic ways connected with tumor (cancer) and traumatic damages of the cervix and vagina, polyps and breaks varices that easily eliminated during the examination of the vagina and cervix in mirrors.
The placenta previa is severe obstetric pathology, threatening the life and health of mother and child due to blood loss. Timely hospitalization of pregnant women with PP and rational therapy help to save the lives of mothers and children; the mortality rate of mothers recently declined dramatically, and in many institutions in p.p. of deaths is not observed.
Treatment consists of compulsory hospitalization of pregnant at the first bleeding, even minor, in the maternity ward, where can be made caesarean sections and blood transfusions. In minor or moderate bleeding and premature pregnancy recommend bed rest, injections of pantopon (1 ml 2%) with solution of magnesium sulfate (10 ml 10%), repeated blood transfusion at 150-250 ml, ascorbic acid (0.3 grams per day) and rutin (0.02 g 3 times a day).
If heavy bleeding occurs and unprepared for vaginal delivery generic ways the method of choice even if the dead fetus is a cesarean section (see). At partial placenta previa, especially regional, a good effect gives rupture of membranes, leading to the termination of detachment predlagay placenta; the head of the fetus, accession to the pelvis, as if tamponiruut lower segment and stops the bleeding. In the absence of the effect of opening membranes can be used application method konovalovy forceps (see Childbirth).
Necessary for the prevention of infection (antibiotics, sulfa drugs), tools that reduce the uterus during the operation and in the postpartum period (oxytocin, pituitrin, metilargometrina and others). When severe atopic bleeding or a combination of PP with a real increment of the placenta apply a hysterectomy (see Hysterectomy).