Que es la placenta posterior: Dónde se sitúa la placenta en un embarazo con y sin riesgo

Que es la placenta posterior: Dónde se sitúa la placenta en un embarazo con y sin riesgo

Dónde se sitúa la placenta en un embarazo con y sin riesgo

21 May 2018

Embarazo con problemas

La situación de la placenta en el útero puede condicionar el parto, sobre todo cuando se trata de una placenta previa. Por eso, en consulta muchas veces me preguntan las pacientes, al informarles sobre la situación de la placenta dentro del útero, si se trata de algo normal o supone un riesgo para su embarazo y el parto.

  • Descubre cuándo está previsto que des a luz y conozcas a tu bebé.

En la gran mayoría de los casos no hay problema: se trata de un embarazo único y la placenta suele insertarse de forma normal en una pared del útero. Y según sea su localización, hablamos de placenta de cara anterior, posterior o fúndica. ¿Qué significa esta clasificación? Pasamos a explicarlo con detalle.

Cómo es la placenta en embarazos normales

🔹 La placenta anterior quiere decir que se encuentra insertada en la cara uterina más próxima al ombligo de la madre. Es la cara que habitualmente las mujeres acaricia y a través de la cual se hacen las ecografías de seguimiento del embarazo

🔹 La placenta de cara posterior es la que se inserta justo al contrario, en la cara uterina que se encuentra más próxima a la espalda de la embarazada.

🔹 La placenta fúndica es aquella que se inserta en la parte más alta del útero.

Cualquiera de estas tres posiciones de la placenta es considerada como normal durante el embarazo y no conlleva ningún control especial. Y tampoco riesgos específicos. Es decir, una placenta posterior no indica que la mujer vaya a tener más dolor de espalda, y una placenta anterior no implica más riesgo de traumatismos, por ejemplo.

  • La placenta es un órgano creado para alimentar a tu bebé. Conoce cómo es

La única posible repercusión es que la placenta anterior puede hacer que las mujeres comiencen a percibir movimientos fetales de forma más tardía. En estos casos la placenta funcionaría como una especie de amortiguador de estos movimientos, como una almohada. En cuyo caso, hasta que estos no son más intensos, no son percibidos por la futura mamá.

Ojo, las placentas bajas son las peligrosas

Por otro lado, estarían lo que llamamos las placentas de localización baja. Estas placentas no se considerarían normales y precisan un seguimiento especial. Las placentas bajas son aquellas que pueden tapar el orificio del cuello uterino y que por lo tanto pueden dificultar o impedir el proceso del parto normal.

Hablamos de complicaciones de la placenta en estos casos: placenta previa parcial o marginal, y placenta previa total.

🔹 Placenta previa parcial o marginal. Se encuentran cerca del cuello del útero, que pueden en algún momento del embarazo tapar el orificio cervical interno. Pero conforme va aumentando la gestación y el útero se hace más grande, suelen ir alejándose de este orificio cervical interno. Por lo tanto no suelen impedir el parto, aunque sí se recomienda una estrecha vigilancia del mismo porque suele haber mayor posibilidad de sangrado.

🔹 Placenta previa total. Son las que se insertan sobre el cuello del útero y que impiden de forma completa el parto normal. Estás placentas pueden producir sangrados durante el embarazo o si se desencadena el parto. Normalmente se necesita realizar una cesárea para asegurar el bienestar del bebé.

 

Placenta posterior en el embarazo: ¿qué significa?

Si tu ginecólogo te ha dicho que tienes placenta posterior, o bien lo has leído en algún informe y el médico no te ha hecho ningún comentario al respecto, puedes estar tranquila. Tener placenta posterior no significa que exista un problema necesariamente. Veamos qué implica y cuáles son los casos de mayor riesgo.

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  • ¿Qué es la placenta posterior?
  • ¿Qué es mejor, tener la placenta anterior o posterior?
  • ¿Qué es la placenta posterior marginal?
  • ¿Qué quiere decir placenta posterior normoinserta?
  • Placenta posterior: ¿hay diferencia si es niño o niña?
  • Placenta posterior: ¿dificulta los movimientos bebé?
  • Placenta posterior alta

¿Te han dicho que tienes placenta posterior y no sabes qué significa? La placenta es el órgano que alimenta al feto durante el embarazo.

La placenta es un órgano muy especial, ya que se crea con el único objetivo del embarazo, y solo existe durante este período. Su desarrollo empieza con la implantación del embrión, cuando se establece una conexión única entre el organismo de la madre y el del futuro bebé.

Una vez implantada y bien sujeta en la pared uterina, la placenta no se mueve, pero puede cambiar de ubicación dentro del útero durante la gestación.

La placenta suministra nutrientes y oxígeno de la sangre de la madre a la sangre del feto. Está unida al útero de la madre, y también al bebé, a través del cordón umbilical.

Imagen de una placenta real, unida al cordón umbilical

¿Qué es la placenta posterior?

La placenta posterior se da cuando la placenta se adhiere al útero en su pared posterior. 

Se considera placenta posterior cuando el útero se posiciona entre los huesos de la pelvis de la madre. A medida que el bebé comienza a crecer, también lo hace el útero. Como hemos visto, la placenta puede cambiar de localización durante la gestación, a medida que el útero se agranda. Cuando se adhiere a la parte posterior, se considera una placenta posterior.

¿Qué es mejor, tener la placenta anterior o posterior?

El ginecólogo que sigue el embarazo de la futura mamá puede comunicarle que tiene una placenta posterio o anterior. ¿Qué diferencia hay?

  • La placenta posterior está situada más bien en la parte trasera del útero, a una mayor o menor altura.
  • La placenta anterior se sitúa, por el contrario, en la parte del abdomen, la que da a la tripa de la mamá, como se puede observar en la ilustración, más abajo.
  • Cuando la embarazada tiene placenta anterior, al estar la placenta por delante del feto, la mamá suele notar los movimientos del bebé más tarde, ya que están más atenuados.
  • Algunos estudios van en la dirección de que la placenta anterior es más susceptible de provocar complicaciones que la placenta posterior, pero dependerá de cada caso concreto.
  • El ginecólogo realizará el seguimiento oportuno y tendrá en cuenta la localización de la placenta, así que ¡no te preocupes!

Fuente: Medicalnewstoday.com

¿Qué es la placenta posterior marginal?

Las placentas de localización baja son las más problemáticas de cara al parto. Este tipo de placentas requieren de un seguimiento específico. Las placentas de inserción baja pueden obstaculizar el cuello del útero e impedir la salida del bebé en el momento del parto, si la obstruyen totalmente, como en el caso de la placenta previa total. Se puede observar en la siguiente ilustración.

Los tipos de placentas más conflictivos son: placenta previa, parcial o marginal, y placenta previa total. 

La placenta posterior marginal es un tipo de placenta localizada de tal manera que cubriría parte del orificio del cuello del útero, pero sin llegar a cubrirlo por completo. Esto representa una complicación de cara al parto, pero no es tan grave como una placenta previa total. El ginecólogo decidirá cómo proceder de cara al nacimiento del bebé, con el fin de que no se produzcan complicaciones.

¿Qué quiere decir placenta posterior normoinserta?

Una placenta posterior normoinserta es una placenta situada en la parte posterior del útero de la futura mamá. La placenta inserta en cara posterior es una de las posiciones normales de la placenta y, si no se prolonga hacia la parte inferior del cuello, no condiciona en nada el parto normal. 

Placenta normoinserta significa que está en una posición normal, y que no resulta problemática en cuanto a la posibilidad de causar complicaciones en el embarazo o en el parto.

Placenta normoinserta

Placenta posterior: ¿hay diferencia si es niño o niña?

Popularmente, se suele decir que cuando la placenta es posterior, el bebé será niño, y que cuando es anterior, será una niña. Pero, ¿qué hay de cierto?

  • Más alla de la ubicación de la placenta posterior o anterior, en cuyo caso no queda tan claro desde el punto de vista científico, la ubicación más clara para saber si se trata de un niño o una niña es si el órgano se sitúa a la derecha o a la izquierda del útero.
  • El llamado «Método Ramzi» está basado en la ubicación de la placenta y en el emplazamiento de las vellosidades coriónicas

    , que forman parte del tejido que conforma la placenta. El hecho de que estas vellosidades estén lateralizadas se relaciona con el desarrollo del sexo del bebé, desde un punto de vista científico.
  • Si, en la ecografía, se observa que las vellosidades del corion se encuentran situadas a la derecha de la imagen, el embrión tiene muchísimas posibilidades de tener cromosomas XY, es decir, es un niño.
  • Por el contrario, si las vellosidades coriónicas y la placenta se sitúan a la izquierda, el embrión sería una niña, es decir, cromosomas XX.

Placenta posterior: ¿dificulta los movimientos bebé?

  • En principio, el hecho de que la placenta esté ubicada en la pared posterior del útero no tiene por qué dificultar los movimientos del feto.
  • La placenta posterior tampoco dificulta que la futura mamá note los movimientos y pataditas del bebé, ni que lo haga más tarde de lo que se esperaría por su tiempo de gestación.
  • En cambio, si la placenta es anterior, la capacidad de notar los movimientos del feto claramente puede resultar obstaculizada por la situación de la placenta, que «amortiguaría» los movimientos. Es decir, el bebé se movería como cuaquier otro, pero la mamá no lo notaría igual.
  • En caso de que la futura mamá sufra un sobrepeso importante, los movimientos del feto también pueden apreciarse en menor medida que en un embarazo sin sobrepeso ni obesidad.

(Te interesa: TEST ¿Cuánto sabes sobre embarazo y sobrepeso?)

Placenta posterior alta

  • Si la placenta posterior es alta, es decir, si está ubicada en una zona de la pared posterior del útero, pero alejada del cuello uterino, no debe producirse ninguna complicación de cara al parto debida a este hecho.
  • La razón es muy simple: si la placenta está lejos del orificio de salida del bebé cuando llegue el momento del nacimiento, no obstaculiza el parto y, por tanto, el embarazo no tiene por qué acabar en cesárea necesariamente, al menos, no por la ubicación de la placenta.
  • Las que sí son peligrosas de cara al parto son las placentas de inserción baja. Como hemos visto, las placentas previas, totales, parciales o marginales. En todos estos casos, el ginecólogo detectará el problema y realizará el seguimiento oportuno durante todo el embarazo.

. …….. 

¿Sabés cuál es la ubicación de tu placenta? ¿Te han dicho que tienes una placenta posterior? Comparte tus experiencias con otras futuras mamás. ¡Déjanos tu comentario!

Low placenta

Home / Gynecologist / Low placenta

Placenta is a temporary organ that is formed in the body of a pregnant woman in order to maintain a connection between her body and the fetus. She filters the blood , which the unborn baby feeds on, cleansing it of toxins and other harmful substances.

This pathology can be very dangerous in some cases, while in others it goes away without any treatment and does not bring problems.

Types of location of the placenta

Usually the placenta is attached to the posterior wall of the uterus closer to its bottom . It is worth noting that the uterus is an inverted vessel, and its bottom is located on top. This is the best option for the location of the placenta. However, this does not always work out. In some cases, the placenta is attached to the anterior wall. Which is also not a pathology.

The low position of the placenta during pregnancy is much more dangerous. If the placenta is located low, it is subjected to stronger pressure from the fetus, and even with any external influence, the risk is damage to the placenta or its detachment increases. In addition, in the later stages, an actively moving baby can also damage the placenta, or squeeze the umbilical cord.

A placenta is said to be low when there is less than 6 cm between its lower edge and the os of the uterus. The anterior wall has a greater tendency to stretch, and migration is also characteristic of it, however, the direction of migration is opposite: usually the placenta moves in the opposite direction, down to the cervix.

An even more complex and dangerous pathology of the location of the placenta is its partial or complete presentation . Previa is a condition when the placenta partially or completely obscures the cervix of the uterus.

Causes of low placenta

Many causes of low placenta are due to internal factors — diseases during pregnancy and the condition of the female genital organs . They can be:

  • damage to the mucous membrane of the uterus;
  • inflammatory processes;
  • infections;
  • previous abortions;
  • miscarriages in the past;
  • cesarean section;
  • various gynecological operations;
  • pathology of the structure, development, functioning of the uterus;
  • multiple pregnancy;
  • unhealthy lifestyle: active smoking, excessive alcohol consumption;
  • previous diseases of the uterus: endometritis, fibroids;
  • parity — many births in the past;
  • the woman’s age is over 35 years.

Curettage of the uterus in the past is the main cause of this pathology. Damage to the mucosa prevents the fetal egg from gaining a foothold in the upper segment of this organ, and it remains below, at the neck.

Symptoms of low placenta

The danger of this pathology is that it practically does not manifest itself. Usually, signs that not everything is in order with the placenta are the result of already running and irreversible processes — for example, its detachment. It can be:

  • drawing pains, feeling of heaviness in the abdomen;
  • bloody discharge with a low location of the placenta is an alarm signal that it is necessary to call an ambulance;
  • freezing of the fetus in the womb for a long time, or, conversely, its too violent activity — this is caused by hypoxia;
  • on ultrasound with such a pathology in 50% of cases is the wrong presentation of the fetus;
  • in 30% of cases, women suffer from severe toxicosis.

A pregnant woman herself cannot suspect that she has a low placenta. This can only be seen on planned ultrasounds, which must be passed by everyone. After an ultrasound examination, they can not only clarify or refute the diagnosis, but also determine the type of pathology.

Treatment and prevention of low placentation

Management of pregnancy with low placentation is always very careful. A woman will have to undergo ultrasound many times, limit physical activity and stop sexual activity. For a long time, increased uterine tone can provoke detachment of an improperly located placenta, from there bleeding, and possible death of the fetus as a result of acute hypoxia, if placental abruption is large. Bleeding can even provoke a gynecological examination of the cervix, therefore, for no particular reason, doctors try not to conduct examinations on the chair.

Listen to the doctors and hope for the best. Many women give birth on their own or by caesarean section of healthy babies with low placenta previa.

If you need help from an experienced gynecologist, sign up for a consultation by calling 8 (49244) 9-32-49, 8 (910) 174-77-72.

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O. • Placenta previa

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In the normal course of pregnancy, the placenta is usually located in the fundus or body of the uterus, along the back wall, with the transition to the side walls, i.e. in those areas where the walls of the uterus are best supplied with blood. On the anterior wall, the placenta is located somewhat less frequently, since the anterior wall of the uterus undergoes significantly more changes than the posterior one. In addition, the location of the placenta on the back wall protects it from accidental injury.

Placenta previa is a pathology in which the placenta is located in the lower parts of the uterus along any wall, partially or completely blocking the area of ​​the internal os. The incidence of placenta previa averages from 0. 1% to 1% of the total number of births.

If the placenta only partially covers the area of ​​the internal pharynx, then this is an incomplete presentation, which occurs with a frequency of 70-80% of the total number of presentations. If the placenta completely covers the area of ​​​​the internal os, then this is a complete placenta previa. This option occurs with a frequency of 20-30%.

There is also a low location of the placenta, when its edge is at a lower level than it should be in the norm, but does not cover the area of ​​the internal os.

Causes of low or low placenta

There are several causes of low or low placenta. The most common causes are pathological changes in the inner layer of the uterus (endometrium) due to inflammation, surgical interventions (curettage, caesarean section, removal of myomatous nodes, etc.), multiple complicated births. In addition, violations of the attachment of the placenta can be caused by uterine fibroids, endometriosis, underdevelopment of the uterus, isthmicocervical insufficiency, inflammation of the cervix, multiple pregnancy. It should be noted that placenta previa is more common in re-pregnant women than in primiparas. Due to these factors, the fetal egg that enters the uterine cavity after fertilization cannot be implanted in the upper sections of the uterus in a timely manner, and this process is carried out only when the fetal egg has already descended into its lower sections.

The most common manifestation in placenta previa is recurrent bleeding from the genital tract. Bleeding can occur during various periods of pregnancy, starting from its earliest terms. However, most often they are observed already in the second half of pregnancy due to the formation of the lower segment of the uterus. In the last weeks of pregnancy, when uterine contractions become more intense, bleeding may increase.

Bleeding is caused by repeated abruption of the placenta, which is unable to stretch following the stretching of the uterine wall as pregnancy progresses or labor begins. In this case, the placenta partially exfoliates, and bleeding occurs from the vessels of the uterus. The fetus does not shed blood. However, he is threatened by oxygen starvation, since the exfoliated part of the placenta is not involved in gas exchange.

Provoking factors for bleeding during pregnancy can be: physical activity, sudden coughing, vaginal examination, sexual intercourse, increased intra-abdominal pressure with constipation, thermal procedures (hot bath, sauna).

With complete placenta previa, bleeding often occurs suddenly, without pain, and can be very heavy. Bleeding may stop, but reappear after some time, or may continue in the form of scanty discharge. In the last weeks of pregnancy, bleeding resumes and / or increases.

With incomplete placenta previa, bleeding may begin at the very end of pregnancy. However, more often it occurs at the beginning of labor. The amount of bleeding depends on the size of the placenta previa. The more placental tissue is present, the earlier and more bleeding begins.

Recurrent bleeding during pregnancy complicated by placenta previa in most cases leads to the development of anemia.

Pregnancy with placenta previa is often complicated by the threat of miscarriage, which is due to the same reasons as the occurrence of an incorrect location of the placenta. Preterm labor most often occurs in patients with complete placenta previa.

Pregnant women with placenta previa are characterized by low blood pressure, which occurs in 25%-34% of cases.

Preeclampsia (nephropathy, late toxicosis) is also no exception for pregnant women with placenta previa. This complication, which occurs against the background of dysfunction of a number of organs and systems, as well as with symptoms of blood clotting disorders, significantly worsens the nature of recurrent bleeding.

Placenta previa is often accompanied by fetal placental insufficiency, lack of oxygen for the fetus and delayed development. The exfoliated part of the placenta is switched off from the general system of the uteroplacental circulation and does not participate in gas exchange. With placenta previa, an incorrect position of the fetus (oblique, transverse) or breech presentation is often formed, which in turn are accompanied by certain complications.

In obstetric practice, the term «migration of the placenta» is widely rooted, which, in fact, does not reflect the real essence of what is happening. The change in the location of the placenta is carried out due to a change in the structure of the lower segment of the uterus during pregnancy and the direction of growth of the placenta towards a better blood supply to the sections of the uterine wall (towards the bottom of the uterus) compared to its lower sections. A more favorable prognosis in terms of placental migration is noted when it is located on the anterior wall of the uterus. Usually the process of «migration of the placenta occurs within 6-10 weeks and is completed by the middle of 33-34 weeks of pregnancy.

Diagnosis of placenta previa

Placenta previa is not difficult to identify. The presence of placenta previa may be indicated by complaints of a pregnant woman about bleeding. In this case, recurrent bleeding from the second half of pregnancy, as a rule, is associated with complete placenta previa. Bleeding at the end of pregnancy or at the beginning of labor is more often associated with incomplete placenta previa.

In the presence of bleeding, carefully examine the walls of the vagina and cervix using speculums to exclude trauma or pathology of the cervix, which may also be accompanied by the presence of bloody discharge.

A vaginal examination of a pregnant woman also easily reveals clear diagnostic signs indicating an abnormal location of the placenta. However, such a study must be performed as carefully as possible, in compliance with all the necessary rules to prevent possible bleeding.

Currently, the most objective and safest method for diagnosing placenta previa is ultrasound, which allows you to establish the fact of placenta previa and the variant of placenta previa (complete, incomplete), determine the size, structure and area of ​​the placenta, assess the degree of detachment, as well as get an accurate picture of the migration of the placenta.

If the ultrasound revealed a complete placenta previa, then a vaginal examination should not be performed at all. The criterion for the low location of the placenta in the III trimester of pregnancy (28 — 40 weeks) is the distance from the edge of the placenta to the area of ​​​​the internal os 5 cm or less. Placenta previa is indicated by the presence of placental tissue in the area of ​​the internal os.

The nature of the localization of the placenta in the II and III trimesters of pregnancy (up to 27 weeks) is judged by the ratio of the distance from the edge of the placenta to the area of ​​the internal os, with the diameter value (BDP) of the fetal head.

If an abnormal location of the placenta is detected, a dynamic study should be carried out to monitor its «migration». For these purposes, it is advisable to perform at least three echographic controls during pregnancy at 16, 24-26 and 34-36 weeks.

Ultrasound should be done when the bladder is moderately full. With the help of ultrasound, it is also possible to determine the presence of an accumulation of blood (hematoma) between the placenta and the wall of the uterus during placental abruption (in the event that there was no outflow of blood from the uterine cavity). If the site of placental abruption occupies no more than 1/4 of the area of ​​the placenta, then the prognosis for the fetus is relatively favorable. In the event that the hematoma occupies more than 1/3 of the area of ​​the placenta, then most often this leads to the death of the fetus.

Medical support for pregnant women with placenta previa

The nature of management and treatment of pregnant women with placenta previa depends on the severity of bleeding and the amount of blood loss.

In the first half of pregnancy, if there are no blood discharges, then the pregnant woman can be at home under outpatient control in compliance with the regime that excludes the action of provoking factors that can cause bleeding (restriction of physical activity, sexual activity, stressful situations, etc. )

Observation and treatment for more than 24 weeks of pregnancy is carried out only in an obstetric hospital.

Treatment aimed at continuing the pregnancy up to 37-38 weeks is possible if the bleeding is not heavy, and the general condition of the pregnant woman and the fetus is satisfactory. Even despite the cessation of bloody discharge from the genital tract, pregnant women with placenta previa can under no circumstances be discharged from the hospital before delivery.

Management of pregnant women in an obstetric hospital provides for: observance of strict bed rest; the use of drugs that ensure the optimization of the normalization of contractile activity; treatment of anemia and fetal placental insufficiency.

Emergency caesarean section, regardless of gestational age, is indicated for: recurrent bleeding; a combination of small blood loss with anemia and a decrease in blood pressure; simultaneous profuse blood loss; complete placenta previa and bleeding.

The operation is performed according to vital indications on the part of the mother, regardless of the duration of pregnancy and the condition of the fetus.

In the event that the pregnancy has been carried to 37-38 weeks and placenta previa persists, depending on the situation, the most optimal method of delivery is chosen on an individual basis.

The absolute indication for elective caesarean section is placenta previa. Childbirth through the natural birth canal in this situation is impossible, since the placenta that covers the internal os does not allow the presenting part of the fetus (fetal head or pelvic end) to be inserted into the pelvic inlet. In addition, in the process of increasing uterine contractions, the placenta will exfoliate more and more, and the bleeding will increase significantly.

In case of incomplete placenta previa and in the presence of concomitant complications (breech presentation, incorrect position of the fetus, scar on the uterus, multiple pregnancy, severe polyhydramnios, narrow pelvis, age of the primiparous over 30 years, etc. ), a caesarean section should also be performed in a planned manner.

If the above associated complications are absent and there is no blood discharge, then you can wait until the onset of spontaneous labor activity, followed by early opening of the fetal bladder. In the event that after opening the fetal bladder, bleeding nevertheless began, then it is necessary to resolve the issue of performing a caesarean section.

If, with incomplete placenta previa, bleeding occurs before the onset of labor, then the fetal bladder is opened. The necessity and expediency of this procedure is due to the fact that when the membranes are opened, the fetal head is inserted into the entrance to the pelvis and presses the exfoliated part of the placenta against the wall of the uterus and pelvis, which helps to stop further placental abruption and stop bleeding. If bleeding after opening the fetal bladder continues and / or the cervix is ​​immature, then a caesarean section is performed. In the case of stopping bleeding, it is possible to conduct labor through the natural birth canal (with a favorable obstetric situation).

Bleeding can also begin in the early stages of labor, from the moment of the first contractions. In this case, early opening of the fetal bladder is also shown.

Thus, the management of childbirth with incomplete placenta previa through the natural birth canal is possible if: the bleeding stopped after opening the fetal bladder; mature cervix; labor activity is good; there is a cephalic presentation of the fetus.

However, caesarean section is one of the most frequently chosen methods of delivery by obstetricians in placenta previa and is performed with a frequency of 70% -80% in this pathology.

Other typical complications in childbirth with incomplete placenta previa are weakness of labor and insufficient oxygen supply to the fetus (fetal hypoxia). A prerequisite for conducting labor through the natural birth canal is constant monitoring of the condition of the fetus and the contractile activity of the uterus.

After the birth of a child, bleeding may resume due to a violation of the process of separation of the placenta, since the placental site is located in the lower sections of the uterus, the contractility of which is reduced.

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