What is the marginal chorionic presentation and what does it affect?

According to statistics, up to 45% of pregnant women in the early stages of bearing a baby face such a diagnosis as the regional presentation of the chorion. Is it worth fearing such a medical verdict, and what to do, will be discussed in this article.

What it is?

Chorion is a temporary organ that performs the functions of a pharmacist. It is formed from the moment of implantation of the ovum from the fallopian tube, where the meeting of the egg and sperm took place, into the uterine cavity. As soon as the blastocyst (it is into it by 8-9 days after ovulation the fertilized egg turns into) reaches the uterine cavity, it seeks to gain a foothold in it. It is this process that is called implantation.

In the place of attachment of the blastocyst membrane, special enzymes are secreted, which make the mucous membranes of the uterus more pliable and allow the ovum to "grow". A chorion is formed at the attachment site. It is necessary for the nutrition of the ovum with useful substances from the mother's blood. In its place a little later, the placenta appears. But until 12-13 weeks it is about the chorion, since the placenta is still being formed and does not function.

If the implantation was successful, the ovum is fixed in the area of the fundus of the uterus (this is its upper part). If, for some pathological reason, the blastocyst could not be implanted in the upper or middle part of the uterus, it can descend into the lower uterine segment. And then the chorion will form low.

Chorionic presentation is called its location relative to the cervical canal - a thin passage inside the cervix that connects the uterine cavity and the vagina. The presentation of speech is not only if the chorion has formed in the area of the fundus of the uterus or in its middle part (in the body of the uterus).

If the chorion is located low, there are several types of presentation.

Classification

Depending on the degree of overlap of the cervical canal, through which the fetus will then pass during labor, there are also varieties of pathology.

Chorionic presentation - the chorion is located low, its edge slightly touches the region of the cervical canal with one edge. This presentation is considered the most favorable, in terms of prognosis, for further pregnancy and childbirth.
Incomplete presentation - the chorion is located low and covers the entrance to the cervical canal by about two-thirds. Predictions are less optimistic, since such a position of the chorion in the uterus increases the likelihood of miscarriage or bleeding due to chorionic detachment.
Full presentation - the chorion has formed low and completely closes the entrance to the cervical canal. This is a rather dangerous pathology, the prognosis for which is very unfavorable.

Any chorionic presentation, but especially complete and incomplete, creates a threat of miscarriage, chorionic detachment. In its place, the placenta will form, a network of blood vessels will develop, and this is dangerous if the vessels grow into the lower part of the uterus, which, according to the laws of nature, should open and release the baby out when the due date comes.

Often, chorionic presentation can go into another pathological condition - placenta previa, and then independent birth in a natural way is likely to be contraindicated. The woman will have a caesarean section. It will also be difficult to bring the baby to the due date, since the placenta that is low and adjacent to the exit from the uterus will create the risk of spontaneous bleeding at any time.

During presentation, the child will receive less oxygen and nutrients, and this is fraught with hypotrophy and hypoxia.

Causes and symptoms

The main reason for the marginal presentation is internal prerequisites that prevented the ovum from implanting normally and into a more suitable fundus of the uterus. Such prerequisites include violations of the state of the endometrium of the uterus. It is usually observed in women who have had several abortions or have undergone diagnostic curettage.

Miscarriages, a history of frozen pregnancies also increase the likelihood of misalignment of the ovum. An obstacle to a full-fledged implantation may be a scar or several scars on the uterus from previous operations or cesarean section.

Women who have given birth a lot cannot boast of strong and elastic muscle tissues of the reproductive organ, they also have an increased likelihood that a subsequent pregnancy may occur against a background of low placentation.

The presence of fibroids, fibroids and other formations in the upper part of the uterus also creates obstacles for the attachment of the blastocyst, and it is forced to descend in search of a "haven" in the lower uterine segment. The cause may also be a congenital anomaly in the structure of the uterus - a two-horned or saddle-shaped uterus. A certain sequence of such pathologies has also been noticed - if a woman had low placentation in a previous pregnancy, it is very likely that the fetal attachment and the development of chorion during subsequent pregnancy will also be low.

Symptoms of the marginal presentation of the chorion in the early stages may not be, or small short-term spotting may appear. Usually they are always correctly assessed by a woman - as a threat to the preservation of the child.

If the chorion, and subsequently the placenta, does not migrate, such bleeding, associated with rupture of small blood vessels due to stretching of the walls of the uterus, can be repeated often, in some - until the very birth. Because of them, a woman begins to suffer from anemia, she chronically lacks iron, and her blood contains a small amount of hemoglobin. Be that as it may, when bloody discharge from the genital tract of a pregnant woman appears, an ambulance should be called immediately.

With timely hospitalization, with the help of conservative treatment, it is possible to save up to 90% of all babies who grow in the mother's womb against the background of the marginal presentation of the chorion, placenta and even the umbilical cord.

What to do?

As already mentioned, the regional chorionic presentation is diagnosed in about 4-5 women out of ten pregnant up to 12 weeks. However, not all of them immediately fall into the risk group and the lists of patients for a planned cesarean section. The forecasts are favorable, and in 90% of cases the chorion, and then the placenta, which forms in its place, migrates higher simultaneously with the growth of the uterus.

The baby in the womb is growing rapidly. To meet his needs for comfort, the walls of the uterus and ligaments are forced to stretch. Together with them, the placenta, which at the beginning of pregnancy was in the marginal presentation, will "creep" upward. The placenta will migrate along the front or back wall of the uterus - it does not matter. It is important that in most cases it really rises, and all the threats and risks associated with low placentation remain in the past.

Medicine cannot influence the migration process, accelerate it or stimulate it. A woman diagnosed with marginal chorionic presentation should follow all the recommendations of her attending physician, exclude physical activity, lifting weights, jumping, sudden movements, and squats. She will have to visit her doctor more often, do an ultrasound scan in order to monitor the process of chorionic (placenta) migration. Sex with marginal presentation is prohibited, since orgasm associated with contraction of the uterine muscles can contribute to rapid traumatic chorionic detachment and severe bleeding, in which the child can die in utero, and the woman can lose a lot of blood and die from this.

Placental migration is usually completed by 18-20 weeks of gestation. By this time or a little later (by 35-28 weeks), the true state of affairs becomes clear - if the placenta has risen, the restrictions will be lifted, if not, the pregnant woman will be referred to the risk group for premature birth and will be carried on with increased attention and trepidation.

Treatment

It is impossible to speed up migration, but treatment for a woman with a marginal chorionic presentation is likely to be prescribed. Only it will not be directed at the chorion itself, but at relaxing the muscles of the uterus, so as not to allow its tone and not to provoke new detachments and bleeding. Depending on the degree of presentation, treatment can be carried out in a hospital, or they can be allowed to take the necessary medications at home. The doctor leaves this question to his own discretion.

A woman is shown bed or semi-bed rest, complete sexual and psychological rest. Of the medicines, antispasmodics "Papaverin" and "No-shpa" are considered effective, hemostatics - "Ditsinon", vitamins of group B, "Magne B 6", vitamin E in large doses.

In a hospital, a woman is injected with magnesia with novocaine, hormonal drugs are often recommended at home, for example, "Duphaston", but only if it is proved that the woman has a deficiency of certain pregnancy hormones.

For better nutrition of the baby, drugs are recommended that improve uteroplacental blood flow - "Kurantil", "Actovegin". Medicines should be taken regularly, without skipping or forgetting.

The courses of treatment are usually quite long - up to the moment when it is possible to establish on an ultrasound that the placenta has risen and there is no more danger, or until the very birth, if the placenta does not rise higher.

Childbirth

In the overwhelming majority of cases, in the absence of placenta migration before 35-36 weeks of pregnancy, a decision is made to perform a caesarean section. Even the marginal presentation can be dangerous, from the point of view of the development of profuse, massive bleeding during childbirth, dangerous for both the mother and the fetus. Rapid placental abruption before the baby is born also leads to acute hypoxia and can be fatal for him.