Low lying placenta is a complication of pregnancy, which is characterized by the localization of the baby’s place in the lower segment of the uterus, closer than 6 cm from its internal pharynx. The danger lies in the fact that the anomaly does not manifest itself in any way. It is possible to determine the low lying placenta only during ultrasound scanning or with the development of complications – damage, organ detachment, accompanied by pathological signs. Treatment is carried out on an outpatient basis, a therapeutic and protective regime and drug therapy are indicated. In most cases, with a low placenta location, delivery is carried out by Caesarean section.
A low placenta location is an obstetric anomaly, accompanied by incorrect attachment of the baby’s place. With this pathology, there is a risk of fetal hypoxia due to compression of the umbilical cord. Also, the low lying placenta threatens its premature detachment in late pregnancy due to fetal pressure. Women over 30 years of age are most susceptible to low placentation. When a low placenta location is detected, the prognosis is not always unfavorable. As the uterus increases in volume, there is a high probability of migration of the baby’s place and its subsequent location on the anterior or posterior wall. With this development of events, pregnancy proceeds normally, and childbirth is possible in a natural way.
As a rule, the low lying placenta is detected during ultrasound screening of the first trimester, however, closer to the 20th week, in about 70% of cases, the migration of the baby’s place occurs, and the diagnosis is removed. By the end of pregnancy, this pathology persists in only 5% of patients. If a low placenta location is detected in the third trimester, the probability of its movement is extremely small.
Scientists have not been able to definitively establish the reasons for the low lying placenta so far. However, on the basis of numerous studies, assumptions have been made that abnormal attachment of the child’s place occurs against the background of diffuse hyperplasia of chorionic villi and marginal death of individual elements of the decidual shell. Thinning of the myometrium, which has developed as a result of numerous abortions, curettage and other gynecological manipulations, can cause such changes and lead to a low lying placenta. The risk of obstetric abnormality increases against the background of previous miscarriages, inflammatory and infectious diseases of the reproductive organs.
A low placenta location is often diagnosed after cesarean section as a result of the formation of a scar on the uterus. Pathology is more likely to develop during multiple pregnancies if a woman has had a history of 3 or more births, against the background of benign diseases, for example, fibroids. Congenital uterine anomalies, in particular, a two-horned or saddle-shaped uterus, the presence of partitions in the organ cavity, also increase the possibility of a low placenta location. The high-risk group includes patients prone to bad habits, prone to stress, performing heavy physical work.
In obstetrics, a low lying placenta of two types is diagnosed, depending on the localization of the embryonic organ in relation to the uterus itself. Based on this criterion, the prognosis of pregnancy may also be different. The following forms of anomaly are distinguished:
- Low lying placenta along the back wall of the uterus. This is a more favorable option for the development of pathology. As the uterus increases in size, migration of the baby’s place often occurs. Accordingly, space is freed up for the child, childbirth is highly likely to take place through natural paths.
- Low lying placenta on the anterior wall of the uterus. It is diagnosed quite rarely, but has an unfavorable prognosis. If, when the child’s place is localized on the back wall, it tends to move upwards, then in this case, as the uterus increases, the placenta will “move” downwards. At the same time, there is a threat of partial or complete overlap of the uterine pharynx. The anterior low lying placenta often causes umbilical cord entanglement, fetal hypoxia, and premature placental abruption.
Clinically, the low lying placenta in most cases does not manifest itself. Usually women feel well, and it is possible to detect abnormal attachment of the baby’s place during a planned obstetric ultrasound. The low lying placenta may be accompanied by pathological symptoms if complications have begun to develop against its background. With premature detachment, pulling pains in the abdomen, sacrum, and bleeding are possible. Extremely rarely, this diagnosis contributes to the development of late toxicosis. In addition, the low lying placenta in late gestation can lead to fetal hypoxia. Oxygen deficiency is manifested by a decrease in the child’s motor activity, rapid or slow heartbeat.
Diagnosis and treatment
It is possible to identify the low lying placenta during ultrasound screening of the I, II or III trimester of pregnancy, which are prescribed by an obstetrician-gynecologist routinely to all patients at 12, 20 and 30 weeks, respectively. Determining the abnormal attachment of the baby’s place in the early stages is not critical, since closer to the middle of gestation it migrates and takes the right position without risk to the health of the woman or fetus. Ultrasound at a low location shows not only its exact localization, but also the thickness, the level of blood flow in the vessels, the condition of the fetus. Evaluation of these parameters allows us to suspect more serious complications, in particular, hypoxia, entanglement, and the onset of detachment.
Treatment of a low lying placenta depends on the gestation period, as well as the general condition of the woman and fetus. The detection of an anomaly in the first trimester does not require additional therapy, it is enough to limit physical activity. With a high probability, the baby’s place migrates as the uterus increases in volume. Hospitalization with a low placenta location is indicated with the threat of premature detachment, severe fetal hypoxia, or closer to delivery in the period of 35-36 weeks to examine the patient and determine the delivery plan.
Low lying placenta requires correction of the daily routine. The patient should rest as much as possible. It is important to completely exclude psychoemotional and physical exertion, sexual contacts, as all this can provoke complications in the form of detachment. With a low lying placenta, you should walk less, refuse to travel by public transport. It is recommended to rest in a supine position, while lifting the leg end to increase blood flow to the pelvic organs, in particular, to the uterus and placenta.
Drug treatment with a low placenta location is not prescribed. Pregnancy management at the same time requires more careful monitoring, most likely, an obstetrician-gynecologist’s consultation will be prescribed more often than usual. Correction of the patient’s or fetus’s condition is carried out only when there is a threat or development of complications against the background of abnormal attachment. With the onset of placental abruption, the use of drugs that improve blood flow in the vessels of the umbilical cord, vitamin complexes is shown. If uterine hypertonicity is present against the background of a low placenta location, tocolytics are used.
With a low placenta location, delivery is possible both through the natural genital tract and by caesarean section. The first option is possible when placing a baby’s place no lower than 5-6 cm from the inner throat of the uterus, as well as a good condition of the mother and fetus, sufficient maturity of the cervix and active labor. A planned caesarean section is performed when a low placenta location is accompanied by the threat of premature detachment, with severe fetal hypoxia.
Prognosis and prevention
The vast majority of pregnancies occurring with a low placenta location have a favorable outcome. In 70% of patients with this diagnosis, closer to childbirth, the baby’s place occupies the correct position on the anterior or posterior wall of the uterus. In other cases, timely diagnosis and the appointment of a protective regime make it possible to avoid complications, carry pregnancy to 38 weeks and give birth to an absolutely healthy child. In 40% of women with a low placenta location, childbirth is carried out by cesarean section. In other cases, children are born through the natural birth canal. Sometimes there are signs of intrauterine hypoxia on the part of the fetus.
Prevention of low placenta location consists in early diagnosis and treatment of gynecological abnormalities that contribute to thinning of the uterine mucosa. Also, women should avoid abortions, timely register for pregnancy with an obstetrician-gynecologist. To reduce the likelihood of developing a low placenta location will help to eliminate stress, physical exertion after conception. You should also avoid working at harmful enterprises, give up harmful habits, rest more and ensure sufficient intake of nutrients into the body of the expectant mother. Walking in the fresh air has a positive effect on the health of a woman and a fetus. Each patient should follow all the recommendations of an obstetrician-gynecologist, take the necessary tests and conduct screening studies in order to detect the low lying placenta as early as possible and begin therapy.