Placenta previa • totalis, marginalis & partialis – 9monate.de
Placenta Praevia describes a specific location of the placenta within the womb (uterus) or on the cervix (cervix). Some pregnant women who are affected have to keep strict bed rest with this complication.
Multiparous or prolific women are just as likely to be affected as women who have had multiple scrapes. With placenta praevia there is almost always a caesarean section.
Regular seat of the placenta
Usually the placenta sits in the upper part of the uterus. From here it ensures the supply of oxygen and nutrients to the unborn child. There is enough space in the upper part of the uterus and the placenta does not obstruct the birth canal during childbirth.
A so-called deep-seated placenta is not yet a placenta praevia. However, the lower end of the mother cake protrudes a little into the lower segment of the uterus. Even if a placenta praevia is detected in early pregnancy, there is still no reason to worry. As the pregnancy progresses, the uterus grows with it, especially the lower part. As a result, the position of the placenta can change upwards over time.
With a placenta praevia, the placenta protrudes clearly into the so-called lower uterine segment, ie into the lower part of the uterus, which is close to the cervix. Here it adheres to the uterine wall and provides the unborn child with nutrients. However, this part of the uterus does not offer enough space for the placenta. Especially during childbirth it can lead to life-threatening bleeding for mother and child. Affected pregnant women are therefore under special medical observation and are often prescribed strict bed rest.
Two types of placenta previa
The placenta praevia is medically divided into two sub-forms. In the placenta Praevia totalis, the entire cervix is covered by placental tissue. Placenta Praevia marginalis means that the lower end of the placenta reaches up to the cervix. The doctor also speaks of a placenta vorvia partialis when the cervix is partially covered by the placenta.
Causes of placenta previa
There are certain risk factors that increase the risk of placenta previa. These include:
- Multiple births: Placenta previa occurs very rarely in the first pregnancy
- (Multiple) caesarean sections: The caesarean section scar on the uterus can lead to a more frequent implantation disorder of the placenta in subsequent pregnancies
- Older age of the mother: The placenta previa occurs much less frequently in under 30-year-olds than in over 40-year-olds.
- Previous operations on the uterus: Operations involving the inner lining of the uterus (eg scraping) also increase the risk of placenta previa.
- Factors affecting the placenta and its location in general: Multiple births, smoking etc.
Diagnosis of placenta previa
Placenta Praevia can already be detected during routine ultrasound examinations at the beginning of pregnancy. However, since the position of the placenta can still change, this does not have to mean anything bad. If painless vaginal bleeding occurs in women with an unfavorable placental position in the second half of pregnancy, this is referred to as warning bleeding in the context of placenta praevia, if other causes of bleeding can be ruled out.
Risks with placenta previa
There are various risks associated with placenta previa. Problems can arise during implantation, as the placenta cannot adhere properly to the wall of the uterus. As a result, there is also the risk that the umbilical cord does not run as usual and that the vessels in it run differently than intended.
In order to keep an eye on these risks, the gynecologist strictly monitors pregnant women with placenta previa totalis from the 32nd week of pregnancy, and with placenta previa marginalis / partialis from the 36th week of pregnancy. If complications occur beforehand, such as bleeding, the pregnant woman must be temporarily monitored in the hospital in order to rule out a rupture of the bladder and to ensure strict bed rest.
Treatment of placenta previa
The therapeutic measures for Placenta Praevia depend on the exact location of the placenta. The deeper it is in the uterus, the more closely the course must be observed. In order to avoid injuries to the placenta and the associated bleeding as far as possible, those affected are often prescribed strict bed rest. The location of the placenta is also crucial at birth. Placenta Praevia totalis is always delivered by caesarean section, placenta Praevia marginalis / partialis usually.
With a deep placenta, if bleeding occurs during childbirth, it can also be delivered by caesarean section. If the placenta is injured by tearing during childbirth, bleeding can occur, which can be threatening for both mother and child. In the interests of the child, the operation should only be performed from the 37th week of pregnancy if possible. In the case of early operations, the pregnant woman can be given a lung-maturing agent for the infant. For the timing of a caesarean section, however, the amount of bleeding is primarily relevant.
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