The placenta carries oxygen and nutrients to the unborn child in the uterus. Therefore, abnormalities of the placenta can lead to complications not only during childbirth, but already during pregnancy.
Premature placenta detachment
In this very rare but dangerous pregnancy complication, part or all of the placenta detaches prematurely from the uterine wall. There is an acute risk that the child will suffer from a life-threatening lack of oxygen and the mother will suffer from severe blood loss and even shock. Signs of a placenta detachment include sudden, severe pain in the lower abdomen, vaginal bleeding, a tight abdomen, dizziness, shortness of breath, and anxiety.
Risk factors for premature placenta detachment are, for example, scars in the uterus or fibroids as well as diseases that are associated with high blood pressure in the mother (eg chronic high blood pressure, preeclampsia or HELLP syndrome).
A premature placenta detachment usually represents an obstetric emergency situation, the child is delivered immediately by caesarean section. If the placenta detaches only on a small area and the condition of mother and child is stable, a prolongation of the pregnancy can be attempted under certain circumstances.
Placenta praevia (excessive placenta, low placenta)
In rare cases, the placenta can grow so much during pregnancy that it shifts the internal cervix. The malposition of the placenta can be different – depending on whether the placenta covers only the edge of the cervix, part of it or the entire opening. The position of the placenta can be determined with an ultrasound examination.
The most common sign of placenta previa is painless bleeding, which can occur from the fifth month of pregnancy. Depending on the week of pregnancy, the severity of the bleeding and the well-being of the child, attempts are made to stop the bleeding and maintain the pregnancy for as long as possible. This requires, among other things, physical rest, close CTG monitoring and, if necessary, medication to stop the contractions. In the case of complete or partial placenta, the child is generally delivered by caesarean section.
A dangerous complication of placenta previa, placenta detachment can occur before or during birth. A risk factor for placenta previa are previous caesarean sections, multiple pregnancies and placenta previa in previous pregnancies.
One speaks of placental insufficiency when the placenta can no longer adequately supply the child. As a result, the supply of nutrients and oxygen to the child and the production of hormones by the placenta are reduced. There are two forms:
One acute placental insufficiency develops within minutes or hours. It is an emergency in which there is a sudden reduction in blood flow in the placenta, causing the child to become acutely oxygen deprived. Possible causes are, for example, a premature detachment of the placenta, bleeding from placenta previa, a severe drop in blood pressure in the mother or a rush of contractions during childbirth. Depending on the cause, sudden severe pain, a hard stomach, dizziness or nausea can occur, for example, and a decrease in the child’s movements can also be a sign. In the case of acute placental insufficiency, the pregnancy must be terminated immediately in most cases, if necessary by means of an emergency caesarean section.
One chronic placental insufficiency develops over weeks or months. Maternal diseases such as diabetes, anemia or high blood pressure are possible causes. Multiple pregnancies and the consumption of alcohol and cigarettes also increase the risk. Chronic placental insufficiency does not cause the mother any discomfort or symptoms. It is usually discovered during preventive ultrasound examinations because the child shows reduced growth. A CTG is done to make sure the child is getting enough oxygen. If the child shows a suspicious heart rate, it must be assumed that there is an insufficient supply of oxygen. In the chronic form of placental insufficiency, the underlying disorder (e.g. increased blood pressure) should be eliminated. Whether the pregnancy can be prolonged or should be terminated depends on the week of pregnancy and the well-being of mother and child.
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