Placenta previa, aging and other complications of the placenta in pregnancy

The placenta is an organ of vital importance in pregnancy. It is formed from the moment of implantation of the embryo in the uterus and is responsible for transmitting to the baby the oxygen and nutrients necessary for its growth, as well as to secrete essential hormones during pregnancy and to protect the fetus in the maternal breast by filtering harmful substances.

Can occur complications of the placenta when there are different types of anomalies or cause alterations that complicate pregnancy, childbirth and the puerperium.

There may be alterations in the implantation site, in the degree of maturity and in the form of the placenta, or premature detachment may occur or problems with the delivery.

Next we will detail four of the most frequent placenta complications: placenta previa, placental abruption, aged placenta and attached placenta.

Previous placenta

Normally the placenta is implanted towards the bottom of the uterine cavity, usually towards one of the walls of the uterus (anterior, posterior or lateral). However, when implanted over the internal cervical opening, in the lower part of the uterus, it is called placenta previa.

There are two types of placenta previa: occlusive or complete, when the placenta obstructs the cervical opening, and not occlusive or partial, when it does not obstruct it. Depending on the type of placenta previa, the delivery will be vaginal or by caesarean section.

However, it is only in the third trimester when it is diagnosed, since its growth is proportionally smaller than the size of the uterine cavity. That is, it may happen that towards the end of pregnancy, as the uterus extends, the placenta can move away from the cervical opening and allow the baby to leave.

The symptom that makes you suspect the presence of placenta previa is a hemorrhage without pain or other symptoms towards the second half of pregnancy. In case of bleeding, it should be see a doctor immediately who if diagnosing placenta previa will indicate rest, avoid sexual intercourse and any kind of effort.

Ultrasound is the way to diagnose it, so it is essential at least one ultrasound in the third trimester of pregnancy, since arriving at childbirth without knowing that there is placenta previa exposes the mother and the baby to a serious risk of death from hemorrhage.

Hemorrhage is one of the leading causes of postpartum death and the placenta previa is one of the most important.

The women with the greatest predisposition to placenta previa are those over 35 years of age, multiparous women, those who have had more than one caesarean section and a history of placenta previa.

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Placental abruption

Normally, the placenta separates from the walls of the uterus after expulsion of the baby in childbirth. As the volume of the uterus decreases sharply, the placenta begins to detach until it is expelled, constituting the last phase of labor known as delivery.

Sometimes, partial or total placental detachments occur before giving birth, prematurely during pregnancy or in labor.

Among the most frequent symptoms are: abdominal pain and hardening (even between contractions), dark vaginal bleeding and back pain.

It is a complication that puts in serious risk to the baby, since the organ that provides nutrients and oxygen to the fetus is affected. Depending on the degree of detachment there can be from a mild, severe fetal suffering or even death if the detachment is very severe.

It is a problem that cannot be prevented, only detected as soon as possible through fetal monitoring and ultrasound.

The women with greater predisposition to suffer a placental abruption are pregnant women with high blood pressure or preeclampsia, with diabetes, old age, smokers, with a high number of previous deliveries and those with a history of separation of placenta or who have suffered abdominal trauma.

In case of placental abruption, the baby should be removed from immediate form, either by vaginal delivery, if it is already advanced, or by urgent caesarean section in the case of not having started labor.

Aged placenta

Under normal conditions, the aging of the placenta occurs towards the end of pregnancy. Its function is to nourish the baby throughout the pregnancy until the time of delivery.

However, sometimes, when the delivery date is exceeded or for other causes such as hypertension or preeclampsia of the mother, placental aging occurs, decreasing its normal functioning and putting the baby's life at risk.

There are different degrees of maturity or aging of the placenta. It is important to have adequate prenatal control to control the level of maturity of the placenta through ultrasound. Sometimes calcifications can be seen in its morphology, but its presence does not always mean that the placenta is not fulfilling its function.

When a placenta occurs in grade II or III before week 34 it can be said that it is prematurely aged.

This insufficiency determines uterine malnutrition and can cause premature delivery, delayed intrauterine growth or a low birth weight baby.

There is an increased risk of aged placenta in women over 35 years old, multiparous, with preeclampsia, smoking and nutritional deficits

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Adhered placenta or placenta accreta

The placenta accreta is the one abnormally attached to the uterus. It happens when there is a penetration of the placenta beyond the endometrial surface of the uterus and can invade the uterine muscle or neighboring organs.

It can cause bleeding in the last trimester of pregnancy, but it is usually not detected until delivery when difficulties appear to detach the placenta after the birth of the baby, and can cause a uterine inversion.

Depending on the degree of penetration or adhesion of the placenta (accreta, percreta or increta) and the extent of the placenta that is attached, the doctor assess the need to remove the uterus Trying to take off the placenta could aggravate the problem.

It is one of the complications of the placenta less frequent, which occurs mainly in cases of placenta previa.

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