Obstetrics and gynecology. Placenta previa (most important)

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Obstetrics and gynecology. Placenta previa (most important)

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24. Placenta previa

Placenta previa may be complete or incomplete, depending on the degree of occlusion of the internal os of the uterus by placental tissue. Placenta previa can be identified by the presence of placental tissue in the lumen of the pharynx throughout. This is complete placenta previa. When determining the placenta and membranes, presentation is considered partial. There may be a low location of the placenta, when it, located in the lower segment of the uterus, does not reach the edges of the internal os. With complete placenta previa, bleeding from the genital tract usually occurs at the end of pregnancy, with incomplete - at the beginning of labor. Bleeding occurs suddenly and is not accompanied by pain.

Diagnosis is determined by anamnestic data and the results of an objective examination. An external obstetric examination reveals a relatively high location of the presenting part. Breech presentation and transverse position of the fetus are often diagnosed. Diagnosis of presentation is specified during vaginal examination, which, due to the risk of severe bleeding, should always be carried out with extreme caution and with a deployed operating room. Behind the internal uterine pharynx, spongy tissue (full presentation) or spongy tissue with nearby fetal membranes smooth on palpation (incomplete presentation) is palpated. If the cervix is not open, then the diagnosis is based on the characteristic pastosity of the vaginal vaults and pulsation of the vessels. At the end of the examination, the cervix and vaginal vaults are examined in mirrors to exclude bleeding.

Pregnant women who are suspected of having placenta previa should be urgently taken to the clinic for examination and treatment. If the bleeding is not strong, then drugs that relax the uterus can be used during pregnancy. To relax the uterus in case of premature onset of labor, it is advisable to use beta-agonists (partusisten) and drugs that enhance blood clotting. A pregnant woman is prescribed strict bed rest to avoid severe bleeding.

The tactics of conducting childbirth depends on the obstetric situation. Abdominal caesarean section is performed with unprepared birth canal and severe bleeding. Absolute indications for operative delivery by caesarean section: complete placenta previa, partial presentation in the event of heavy bleeding. If there is an incomplete placenta previa or slight bleeding, it is recommended to open the fetal bladder. With weak labor activity, the imposition of skin-head forceps is used. With a breech presentation and a movable presenting part, it is not always possible to perform a caesarean section. In such cases, an attempt is made as carefully as possible to try to bring down the fetal leg and hang a load of up to 200 g from it. During the period of placental release and the early postpartum period, hypotonic bleeding often occurs.

Author: Ivanov A.I.

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