The degree of aging of the placenta by week is normal. Premature aging of the placenta: causes, treatment, prognosis. What are the dangers of premature aging of the placenta?

Pregnancy is a wonderful and emotionally intense time in the life of any woman. However, this period is accompanied not only by inexhaustible joy, but also by exciting moments. Basically, all worries arise about the health of the unborn baby. And today we will tell you about the degree of maturity of the placenta by week in the table.

What do the words “degree of maturity of the placenta” mean?

First you need to understand what a placenta is. This is a temporary organ that appears exclusively during pregnancy and connects mother and child. It is the placenta that is vital for the baby. She gives him oxygen, destroys toxins and all the necessary nutrients pass through her. Therefore, it is so important that the placenta is normal and performs its tasks well.

Like any other organ, the placenta develops, changes occur in it, which are called the degree of maturity of the placenta. Development means an increase in the thickness of the organ and the appearance of new vessels. It is possible to see these changes only with the help of an ultrasound examination, which must be carried out by a specialist to make sure that the mother does not have any abnormalities and that the child’s life is not in danger.

4 degrees of maturity of the placental layer

Today, the thickness of the placenta is determined by the weeks of pregnancy and there are 4 degrees of placental maturity. It is very important that the degree corresponds to the required period, which means that everything is normal.

This table will help expectant mothers figure out on their own what degree of maturity should be in a particular week:

It must be said that the younger the placenta (less its degree of maturity), the more functions it performs. Already before the birth of a child, her reserve of possibilities is limited, the placenta becomes old, and this means dense. Therefore, if the degree of maturity of the placenta is ahead of the pregnancy period, then this becomes dangerous for the child, since the early aging organ cannot provide the baby with the required amount of nutrients and oxygen.

However, such a diagnosis does not always necessarily entail placental insufficiency; before you panic, listen carefully to the conclusion of your gynecologist.

What happens at each stage of placental maturation?

As a rule, expectant mothers want to know everything in the smallest detail about what is happening with their baby, so the question is: placenta maturity level 2, what does this mean? - occurs very often in the doctor's office.

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Let's look at the processes accompanying each degree in order.

The zero degree should be before the 30th week, at which time (starting from the 12th week) the placenta begins to grow and gain strength. Its structure is completely even and smooth, the placenta fully performs all the tasks assigned to it. However, the mother does not always give the grade 0; it happens that the doctor sets it to 0-1, which means premature aging of the placenta. You can see such a picture on an ultrasound examination thanks to the waves and inclusions on the placenta, indicating its maturation. With such a history, the gynecologist will prescribe treatment for you.

Stage 1 should accompany you until 34 weeks, which will indicate that this organ is developing at the right pace. If the mother is given grade 2 or even 3, then there is no need to panic; the gynecologist will conduct the necessary studies and prescribe treatment if the situation requires it.

Sometimes the early maturity of the placenta does not threaten the child in any way, and in this case, the actions of the doctor and yours will be aimed at normalizing blood circulation. And this can be done with the help of a balanced diet, walks in the fresh air, vitamins and medications. If the diagnosis is accompanied by the word “hypoxia,” then, most likely, you will have to stay in the hospital under observation, where doctors will try to keep you and your baby healthy. Only when the procedures do not produce positive results will it be necessary to resort to premature birth.

From 34 to 39 weeks of pregnancy, the degree of maturity of the placenta should be equal to 2, at this time the organ has a relief structure, there are more inclusions, the convolutions become more pronounced.

Grade 3 is a normal diagnosis immediately before the birth itself, which means that the placenta played a role in bearing the child. It has become old, as evidenced by its structure: deposited salts, deep waves, a large number of inclusions. The placenta performs the smallest number of functions at a given time.

Why does premature maturity of this organ occur?

This question is asked by all mothers who have been diagnosed with this. And experts answer it like this:

• A pregnant woman does not take care of her health, which also affects the child. Neglect can be expressed in smoking or systematic consumption of alcoholic beverages;
• The mother does not have enough nutrients, therefore, the child does not receive enough of them;
• The pregnant woman has late toxicosis;
• Diseases that are caused by viruses and bacteria can also lead to the fact that the degree of maturity of the placenta does not correspond to the norm;
• If the mother is expecting several children;
• Damage that is observed in the uterus;
• There were abortions or unsuccessful pregnancies (miscarriages);
• Chronic diseases of the endocrine system;
• Individual characteristics of the body.

However, this is an open list of reasons; there are a lot of them, and yours specifically can be found out only after a complete and professional examination.

The mother's womb is a small house of the future baby, in which its formation, development and growth take place. To do this, first of all, breathing and nutrition are necessary. The placenta is precisely the organ that supports the vital functions of the developing baby, protects it from infections and harmful substances that enter the maternal bloodstream.

A temporary organ, like the human body, goes through several stages of development - formation, maturation and aging. The afterbirth is formed by the end of the first trimester (week 12) and leaves the mother’s body with the birth of the child.

Placenta maturity

During pregnancy, the “baby spot” changes (in thickness and structure), especially starting from the end of the second trimester. The gradual aging of the placenta affects its functioning, so it is very important that it does not begin prematurely. The degree of maturity of the placenta is determined during ultrasound monitoring:

• The thickness and echographic density of the placenta are determined.
• As the baby's place matures, a change in the appearance of the border between it and the uterus is noted.
• The ability to reflect ultrasound changes.
• With the onset of aging of the placenta, deposits of salts and calcium appear (in the form of white inclusions).

An indicator of the maturity of the placenta can help predict the onset of labor and promptly draw attention to the threat of premature birth. There are 4 stages of maturation of the “baby place”: zero, first, second and third, indicating full readiness for childbirth.

Placenta maturity by week

Each stage of organ maturation is characterized by changes in its size and structure that occur at certain stages of pregnancy.

Maturity level 0

The stages of maturation of the “children’s place” begin with degree 0, which persists from the moment of organ formation and up to 30 weeks. During this period, the organ grows and increases in thickness. The afterbirth has a homogeneous structure, the membrane is smooth. In some cases, starting from week 27, maturity can be defined as 0-1. The transition to degree 1 at this time requires additional attention, since it is somewhat ahead of schedule. If deviations are detected, then treatment is prescribed to help normalize the functioning of the organ and placental flow.

1 degree of maturity of placenta

The growth of the organ stops, its tissues thicken - this is an illustration of the next stage of maturation of the placenta. 1 degree of maturity of the placenta is the norm for pregnancy from 30 to 34 weeks. The chorionic tissues are slightly wavy; isolated echogenic inclusions are noted in the structure.

2nd degree of placenta maturity

In the case of a normal pregnancy, the second degree of organ maturity is typical for the period from the end of 34 to 37 weeks. The undulation takes on relief, and numerous echogenic zones are visualized in the form of lines. If this degree of placenta maturity is detected at 32 weeks, additional examination is required, since the development of the organ is ahead of schedule. If a serious pathology is detected that threatens the health and life of the child, the issue of premature delivery is decided.

Placenta 3 degrees of maturity

This stage of maturation of the placenta is characteristic of full-term pregnancy (starts at 37-38 weeks). During this period, the functioning of the organ declines, it prepares for the end of pregnancy and rejection, and its natural aging begins. Pronounced depressions in the membrane reach the basal layer, the “baby spot” has a lobular structure. The placenta has large echogenic zones (salt deposits), merging into irregularly shaped spots, its vessels dilate.

Norms of placenta maturity

The maturation of the “baby place” and its functioning has a direct connection with the development of the baby and its condition in the womb. Therefore, it is very important that this process proceeds in accordance with the course of pregnancy.

Early maturation of the placenta

Aging of an organ ahead of time determined by nature is dangerous because the likelihood of the baby not receiving enough oxygen and nutrients increases. This condition is fraught with intrauterine growth retardation, malnutrition, low birth weight, and hypoxia. Oxygen starvation is especially dangerous, as it can lead to death.

Among the reasons that increase the likelihood of early ripening of the placenta are the following:

• Bad habits of a pregnant woman - smoking, alcohol.
• Thyroid diseases.
• Presentation, placental abruption.
• Diabetes mellitus.
• Hypertension.
• Late toxicosis (gestosis).
• Rhesus conflict.
• Multiple pregnancy.

If the maturity of the placenta has the second degree for up to 32 weeks or the third degree for up to 36 weeks, we are talking about premature aging of the “baby place”. At the same time, the advance of the development of the placenta is not always identical to placental insufficiency. Such a condition may be an individual characteristic of the body. To help the baby be born healthy and on time, it is necessary to undergo additional examinations, during which the condition of the fetus is clarified - CTG of the fetus and the functionality of the placenta are performed - uteroplacental blood flow is checked. If deviations are detected, you must strictly follow the doctor's prescriptions.

Late maturation of the placenta

This pathology is much less common than early maturation. However, it poses no less a threat to the developing fetus. A delay in the development of the placenta leads to the fact that it does not sufficiently cope with its functions and the child’s development is delayed. The most common causes of late maturation of the “children’s place” are chronic diseases of the mother, genetic disorders (may be reflected in the developmental defects of the child).

Placenta maturity table

The placenta maturity table clearly illustrates the periods of organ maturation during pregnancy.

The maturity of the placenta is one of the determining indicators of the course of pregnancy. Timely therapy will help restore organ function and safely carry the baby.

Today, many mothers know far more about pregnancy than our parents knew. Therefore, many women during pregnancy worry about the state of their health, and are very worried if the doctor talks about the condition of such an important organ during pregnancy as the placenta. This organ performs the most important functions, and without it it is impossible to carry a pregnancy to term.

Deviations in the structure or functioning of the placenta can lead to complications for the mother or fetus, and certain measures must be taken in a timely manner to correct everything. But what can happen to the placenta, and how can it be dangerous? Let's figure it out together.

What is the placenta?

The term “placenta” itself comes from the Greek language and is translated by the simple word “cake”. Indeed, in appearance the placenta resembles a large and voluminous cake with a “tail” extending from it in the form of an umbilical cord. But this cake is extremely important for every woman carrying a baby; it is due to the existence of the placenta that it is possible to carry and give birth to a child normally.

In terms of structure, the placenta, or, as it may be called differently in the literature, “baby place,” is a complex organ. The beginning of its formation occurs at the time of implantation of the embryo into the wall of the uterus (from the moment the embryo attaches to one of the walls of the uterus).

How does the placenta work?

The main part of the placenta is special villi, which branch in it and form from the beginning of pregnancy, resembling the branches of centuries-old trees. The baby’s blood circulates inside the villi, and outside the villi are actively washed by the blood coming from the mother. That is, the placenta combines two circulatory systems at once - the maternal one from the uterus, and the fetal one from the amniotic membranes and the baby. According to this, the sides of the placenta are also different - smooth, covered with membranes, with an emerging umbilical cord - on the fetal side, and uneven lobulated - on the mother's side.

What is the placental barrier?

It is in the area of ​​the villi that an active and constant exchange of substances occurs between the baby and his mother. From the mother's blood, oxygen and all the necessary nutrients for growth and development flow to the fetus, and the baby gives the mother metabolic products and carbon dioxide, which the mother removes from the body for two. And the most important thing is that the blood of the mother and fetus does not mix in any part of the placenta. The two vascular systems - the fetus and the mother - are separated by a unique membrane that is capable of selectively allowing some substances to pass through and retaining other, harmful substances. This membrane is called the placental barrier.

Gradually forming and developing along with the fetus, the placenta begins to fully function by approximately twelve weeks of pregnancy. The placenta retains bacteria and viruses penetrating into the maternal blood, as well as special maternal antibodies that can be produced in the presence of Rh conflict, but at the same time the placenta easily allows the nutrients and oxygen necessary for the child to pass through. The placental barrier has the property of special selectivity; different substances coming from different sides of the placental barrier penetrate the membrane to varying degrees. Thus, many minerals actively penetrate from the mother to the fetus, but practically do not penetrate from the fetus to the mother. And also, many toxic substances actively penetrate from the baby to the mother, but practically do not pass back from her.

Hormonal function of the placenta

In addition to the excretory function, fetal breathing (since the placenta temporarily replaces the baby's lungs), and many other functions, the placenta has another function that is important for pregnancy as a whole - hormonal. Once the placenta begins to fully function, it can produce up to 15 different hormones that perform various functions during pregnancy. The very first of these are sexual functions, which help in maintaining and prolonging pregnancy. Therefore, gynecologists, if there is a threat of early pregnancy termination, always wait 12-14 weeks, helping in the early weeks of pregnancy with external hormones (duphaston or utrozhestan). Then the placenta begins to actively work and the threat disappears.

The functions of the placenta are so great that in the initial stages the placenta grows and develops even faster than your baby grows. And this is not without reason, by the time of 12 weeks the fetus weighs about 5 grams, and the placenta is up to 30 grams, by the end of pregnancy, at the time of birth, the size of the placenta will be about 15-18 cm, and the thickness will be up to 3 cm, with a weight of about 500 -600 grams.

Umbilical cord

The placenta on the fetal side is connected to the baby by a special strong cord - the umbilical cord, inside which there are two arteries and one vein. The umbilical cord can attach to the placenta in several ways. The first and most common is the central umbilical cord attachment, but lateral or marginal umbilical cord attachment may also occur. The umbilical cord functions are not affected in any way by the method of attachment. A very rare option for attaching the umbilical cord may be attachment not to the placenta itself, but to its fetal membranes, and this type of attachment is called membrane.

Problems with the placenta

Most often, the placenta and umbilical cord system work harmoniously and supply the baby with oxygen and nutrition. But sometimes malfunctions may occur in the placenta due to the influence of various factors - external or internal. There are various kinds of developmental disorders or problems with the functioning of the placenta. Such changes in the placenta do not go unnoticed for the mother and fetus; often problems with the placenta can have serious consequences. We will talk about the main abnormalities in the development and functioning of the placenta and how to identify and treat them.

Placental hypoplasia

Reducing the size or thinning of the placenta in medical language is called “placental hypoplasia.” You should not be afraid of this diagnosis, because... it occurs quite often. The fetus is affected only by a significant decrease in the diameter and thickness of the placenta.

A significantly reduced placenta, a small baby's place, is uncommon. This diagnosis is made if the reduction in size is significant compared to the lower limit of normal for the size of the placenta at a given stage of pregnancy. The causes of this type of pathology have not yet been clarified, but according to statistics, usually a small placenta is associated with the development of severe genetic abnormalities in the fetus.

I would like to immediately make a reservation that the diagnosis of “placental hypoplasia” is not made based on a single ultrasound; it can only be made as a result of long-term observation of a pregnant woman. In addition, it is always worth remembering that there may be individual deviations in the size of the placenta from standard, generally accepted normal values, which will not be considered a pathology for each specific pregnant woman in each of her pregnancies. So, for a small and slender woman, the placenta should be smaller in size than for a large and tall woman. In addition, there is no absolute proof of the relationship between placental hypoplasia and the presence of genetic disorders in the fetus. But when a diagnosis of placental hypoplasia is made, parents will be advised to undergo medical genetic counseling.

During pregnancy, a secondary reduction in size of the placenta may occur, which may be associated with exposure to various unfavorable factors during pregnancy. This could be chronic stress or fasting, drinking alcohol or smoking, or drug addiction. Also, the causes of underdevelopment of the placenta during pregnancy can be hypertension in the mother, a sharp exacerbation of chronic pathology, or the development of some acute infections during pregnancy. But in the first place when the placenta is underdeveloped, there is gestosis with the development of severe edema, high blood pressure and the appearance of protein in the urine.

Changes in the thickness of the placenta occur. A placenta is considered thin if it has insufficient mass but is of a size that is quite normal for its age. Often, such thin placentas occur with congenital defects of the fetus, and children are born with manifestations, which causes serious problems with the health of the newborn. But unlike a primary hypoplastic placenta, such children are not associated with the risk of developing dementia.

Sometimes a membranous placenta is formed - it is very wide and very thin, measuring up to 40 cm in diameter, almost twice as large as normal. Typically, the cause of the development of such a problem is a chronic inflammatory process in the endometrium, which leads to dystrophy (depletion) of the endometrium.

Placental hyperplasia

In contrast, a very large, giant placenta occurs, which usually occurs in cases of severe gestational diabetes. Enlargement (hyperplasia) of the placenta also occurs in diseases of pregnant women such as toxoplasmosis or syphilis, but this is not common. An increase in the size of the placenta may be the result of kidney pathology in the unborn baby, if present, when the fetal red blood cells with Rh protein begin to attack the mother's antibodies. The placenta can increase significantly in case of thrombosis of its vessels, if one of the vessels is blocked, as well as in case of pathological growth of small vessels inside the villi.

An increase in the thickness of the placenta more than normal may be associated with its premature aging. Thickening of the placenta is also caused by pathologies such as Rh conflict, hydrops fetalis, diabetes mellitus in pregnancy, gestosis, viral or infectious diseases suffered during pregnancy, placental abruption. Thickening of the placenta is normal in multiple pregnancies.

In the first and second trimesters, an enlarged placenta usually indicates a previous viral disease (or latent carriage of the virus). In this case, the placenta grows to prevent disease in the fetus.

The rapid growth of the placenta leads to its premature maturation and, consequently, aging. The structure of the placenta becomes lobular, calcifications form on its surface, and the placenta gradually ceases to provide the fetus with the necessary amount of oxygen and nutrients. The hormonal function of the placenta also suffers, which leads to premature birth.

Treatment for placental hyperplasia usually involves careful monitoring of the fetus.

What is dangerous about changing the size of the placenta?

Why are doctors so worried about significant changes in placenta size? Usually, if the size of the placenta changes, functional insufficiency in the functioning of the placenta may also develop, that is, so-called feto-placental insufficiency (FPI), problems with the supply of oxygen and nutrition to the fetus, will form. The presence of FPN may mean that the placenta cannot fully cope with the tasks assigned to it, and the child experiences a chronic lack of oxygen and the supply of nutrients for growth. In this case, problems can grow like a snowball, the child’s body will suffer from a lack of nutrients, as a result, it will begin to lag behind in development and IUGR (intrauterine growth retardation in the fetus) or fetal growth restriction syndrome (FGR) will form.

To prevent this from happening, it is best to engage in advance prevention of such conditions, treatment of chronic pathology even before pregnancy, so that exacerbations do not occur during pregnancy. During pregnancy, it is important to control blood pressure, blood glucose levels and protect the pregnant woman as much as possible from any infectious diseases. You also need a good diet with enough proteins and vitamins.

When diagnosing “placental hypoplasia” or “placental hyperplasia”, careful monitoring of the course of pregnancy and the condition of the fetus is first required. The placenta cannot be cured or corrected, but there are a number of medications prescribed by a doctor to help the placenta perform its functions.

In the treatment of emerging feto-placental insufficiency, special drugs are used - Trental, Actovegin or Curantil, which can improve blood circulation in the placental system on both the maternal and fetal sides. In addition to these medications, intravenous infusions of drugs can be prescribed - rheopolyglucin with glucose and ascorbic acid, saline solutions. The development of FPN can have varying degrees of severity and should not be self-medicated; this can lead to the loss of the child. Therefore, it is necessary to follow all the appointments of the obstetrician-gynecologist.

Changes in the structure of the placenta

The normal placenta has a lobular structure; it is divided into approximately 15-20 lobules of equal size and volume. Each of the lobules is formed from villi and a special tissue that is located between them, and the lobules themselves are separated from each other by partitions, however, not complete ones. If changes occur in the formation of the placenta, new variants of the structure of the lobules may arise. Thus, the placenta can be bilobed, consisting of two equal parts that are connected to each other by special placental tissue; a double or triple placenta can also be formed, the umbilical cord will be attached to one of the parts. Also, a small additional lobule may be formed in a normal placenta. Even less commonly, a so-called “fenestrated” placenta may occur, which has areas covered with a membrane and resembling windows.

There can be many reasons for such deviations in the structure of the placenta. Most often this is a genetically determined structure, or a consequence of problems with the uterine mucosa. Prevention of such problems with the placenta can be the active treatment of inflammatory processes in the uterine cavity even before pregnancy, during the planning period. Although deviations in the structure of the placenta do not have such a strong effect on the child during pregnancy, and almost never affect its development. But during childbirth, such a placenta can cause a lot of trouble for doctors - such a placenta can be very difficult to separate from the wall of the uterus after the baby is born. In some cases, separation of the placenta requires manual control of the uterus under anesthesia. Treatment for the abnormal structure of the placenta during pregnancy is not required, but during childbirth you must remind the doctor about this so that all parts of the placenta are born and no pieces of the placenta remain in the uterus. This is dangerous due to bleeding and infection.

Degree of maturity of the placenta

During its existence, the placenta goes through four successive stages of maturation:

Degree of placenta maturity 0- normally lasts up to 27-30 weeks. Sometimes at these stages of pregnancy there is 1 degree of placental maturity, which can be caused by smoking or drinking alcohol during pregnancy, as well as by previous infection.

Placenta maturity level 1- from 30 to 34 weeks of pregnancy. During this period, the placenta stops growing and its tissues thicken. This is a crucial period when any deviations can pose a danger to the health of the fetus.

Degree of placenta maturity 2- lasts from 34 to 39 weeks of pregnancy. This is a stable period when some advance in the maturity of the placenta should not cause concern.

Degree of placenta maturity 3- can normally be diagnosed starting from the 37th week of pregnancy. This is a stage of natural aging of the placenta, but if it is combined with fetal hypoxia, the doctor may recommend a cesarean section.

Disorders in placental maturation

For each stage of placenta formation, there are normal periods in weeks of pregnancy. Too fast or slow passage of certain stages by the placenta is a deviation. The process of premature (accelerated) maturation of the placenta can be uniform and uneven. Typically, expectant mothers with underweight face uniform premature aging of the placenta. Therefore, it is important to remember that pregnancy is not the time to follow various diets, since their consequences can be premature birth and the birth of a weak baby. The placenta will mature unevenly if there are problems with blood circulation in some of its zones. Typically, such complications occur in overweight women with prolonged late toxicosis of pregnancy. Uneven maturation of the placenta occurs more often with repeated pregnancies.

Treatment, as with feto-placental insufficiency, is aimed at improving blood circulation and metabolism in the placenta. To prevent premature aging of the placenta, it is necessary to take measures to prevent pathologies and gestosis.

But delays in the maturation of the placenta occur much less frequently, and the most common reasons for this may be the presence of diabetes mellitus in the pregnant woman, alcohol consumption and smoking. Therefore, it is worth giving up bad habits while carrying a baby.

Placental calcifications

The normal placenta has a spongy structure, but by the end of pregnancy some of its areas may become stone; such areas are called petrificates or placental calcifications. Hardened areas of the placenta are not able to perform their functions, but usually the remaining parts of the placenta do an excellent job with the task assigned to them. As a rule, calcifications occur with premature aging of the placenta or postterm pregnancy. In such cases, the doctor will closely monitor the pregnant woman to exclude the development of fetal hypoxia. But usually such a placenta functions quite normally.

Low attachment and placenta previa

Ideally, the placenta should be located in the upper part of the uterus. But there are a number of factors that prevent the normal location of the placenta in the uterine cavity. These could be uterine fibroids, tumors of the uterine wall, malformations, multiple pregnancies in the past, inflammatory processes in the uterus, or abortions.

Requires more careful observation. It usually tends to rise during pregnancy. In this case, there will be no obstacles to natural childbirth. But it happens that the edge of the placenta, part of it, or the entire placenta blocks the internal os of the uterus. If the placenta partially or completely covers the uterine pharynx, natural childbirth is impossible. Usually, if the placenta is abnormally located, a caesarean section is performed. Such abnormal positions of the placenta are called incomplete and complete placenta previa.

During pregnancy, a woman may experience bleeding from the genital tract, which leads to anemia and fetal hypoxia. The most dangerous is partial or complete placental abruption, which leads to the death of the fetus and a threat to the life of the mother. , including sexual, you cannot exercise, swim in the pool, walk a lot and work.

What is placental abruption?

What is premature placental abruption? This is a condition when the placenta (normally or abnormally located) leaves its place of attachment before its due date, that is. In case of placental abruption, an emergency cesarean section is necessary to save the life of the mother and fetus. If the placenta has separated in small areas, then doctors try to stop this process, maintaining the pregnancy. But even with minor placental abruption and slight bleeding, the risk of repeated episodes of abruption remains until childbirth, and the woman is carefully monitored.

The causes of placental abruption can be injuries or blows to the abdomen, the presence of chronic pathologies in a woman, which leads to problems with blood circulation, defects in the formation of the placenta. Premature placental abruption can be caused by complications during pregnancy - most often gestosis with increased pressure, protein in the urine and edema, which affects all organs and systems of the mother and fetus. It is important to remember that premature placental abruption is the most dangerous complication of pregnancy!

Placental abruption
Rice. 1 - complete placenta previa;
Rice. 2 - marginal placenta previa;
Rice. 3 - partial placenta previa
1 - cervical canal; 2 - placenta; 3 - umbilical cord; 4 - amniotic sac

Dense attachment and placenta accreta

Sometimes anomalies occur not only in the location, but also in the method of attachment of the placenta to the wall of the uterus. A very dangerous and serious pathology is placenta accreta, in which the placental villi are attached not only to the endometrium (the inner layer of the uterus, which peels off during childbirth), but also grow deep into the tissues of the uterus, into its muscular layer.

There are three degrees of severity of placenta accreta, depending on the depth of villous germination. In the most severe, third degree, villi grow into the uterus to its full thickness and can even lead to uterine rupture. The cause of placenta accreta is the inferiority of the endometrium due to congenital defects of the uterus or acquired problems.

The main risk factors for placenta accreta are frequent abortions, cesarean sections, fibroids, as well as intrauterine infections and uterine malformations. Low placentation may also play a certain role, since in the area of ​​the lower segments the growth of villi into the deeper layers of the uterus is more likely.

With true placenta accreta, in the vast majority of cases, removal of the uterus with placenta accreta is required.

An easier case is the dense attachment of the placenta, from the accreta, differing in the depth of penetration of the villi. Tight attachment occurs when the placenta is low or previa. The main difficulty with such attachment of the placenta is the delay in its birth or the complete impossibility of spontaneous passage of the placenta in the third stage of labor. If the attachment is tight, they resort to manual separation of the placenta under anesthesia.

Diseases of the placenta

The placenta, like any organ, can hurt. It can become infected, infarctions (areas deprived of blood circulation) can develop in it, blood clots can form inside the vessels of the placenta, and the placenta itself can even undergo tumor degeneration. But this, fortunately, does not happen often.

Infectious damage to placental tissue (placentitis) is caused by various microbes that can penetrate the placenta in various ways. So, they can be brought with the bloodstream, penetrate from the fallopian tubes, ascending from the vagina, or from the uterine cavity. The inflammation process can be spread throughout the entire thickness of the placenta or occur in its individual areas. In this case, treatment must be specific, and it depends on the type of pathogen. Of all the possible drugs, the one that is acceptable for pregnant women at this stage will be selected. And for the purpose of prevention before pregnancy, it is necessary to carry out comprehensive therapy for chronic infections, especially in the genital tract.

Placental infarction usually develops, like any other, as a result of prolonged ischemia (spasm of placental vessels), and then the areas of the placenta that receive blood from these vessels die as a result of oxygen deficiency. Typically, infarctions in the placenta occur as a result of severe gestosis or the development of hypertension in the pregnant woman. Placentitis and placental infarction can cause FPN and problems with fetal development.

Sometimes, as a result of inflammation or damage to the vascular wall, when blood viscosity is disrupted, or due to sudden movements of the fetus, blood clots form inside the placenta. But small blood clots do not affect the course of pregnancy in any way.

The maturation of the placenta during pregnancy largely determines the degree of fetal development. The placenta itself is a unique organ that creates an isolated place for the long-term presence and growth of the embryo. In order to monitor pregnancy, the maturation of the placenta must be constantly monitored.

Various abnormalities in this temporary organ can cause serious problems. When the degree of placenta maturity is determined by week, the table makes it possible to compare real results with the norm and take timely measures if there are deviations.

What does the organ consist of?

The placenta is a temporary embryonic organ that begins to form immediately after implantation of a fertilized egg and is rejected after childbirth. It matures, as a rule, on the posterior uterine wall, but can also develop normally on the anterior wall. Such an organ is formed on the mucous membrane from the endometrium and cytotrophoblast.

The placenta, as it develops, increases in size, consisting of the following layers: decidual tissue, formed by transformation of the endometrium; fibrinoid layer of Langhans; trophoblast, covering the lacunae and fused to the arterial walls; lacunae with blood mass; syncytiotrophoblast; cytotrophoblast; stroma in the form of connective tissue with vessels; amnion for the synthesis and adsorption of amniotic fluid. The connection between the embryo and the placenta is carried out by the umbilical cord.

In terms of their structure, there are differences between the fetal and maternal surfaces of the placenta. The surface adjacent to the embryo is formed by amnions and has the appearance of a smooth gray shell. In the middle part, the umbilical cord approaches, from the junction with which numerous vessels run in different directions. The surface facing the maternal organ has a dark brown tint and is divided into 18-21 lobules (cotyledons).

The blood of the fetus enters the capillaries from the arteries of the umbilical cord, and oxygen from the maternal blood spreads through the capillaries of the embryo, and carbon dioxide from its blood returns to the maternal blood. To prevent direct mixing of maternal and fetal blood there is a placental barrier.

What functions does the placenta perform?

The placenta performs a number of important functions, without which the preservation and development of the fetus is impossible. The following main functions are distinguished:

• gas exchange (respiratory function): supply of oxygen and removal of carbon dioxide;
• nutrition and removal of harmful substances: supply through the placenta of water, vitamins, electrolytes, essential microelements and removal (transportation) of metabolic products;
• protection: transporting maternal antibodies to the embryo that provide immune protection; the placenta regulates the development of the immune system and prevents immune contradictions between maternal cells and embryonic cells as foreign elements;
• hormonal role: the placenta performs the functions of the endocrine system, producing gonadotropin, prolactin, progesterone, estrogens and some other hormones.

Principles of placenta development

The mechanism of placenta formation is a complex physiological process. After fertilization, a cavity (lacuna) appears in the uterine wall, filled with the mother’s blood. The embryo is fixed in this cavity, which receives the necessary nutrition directly from the tissues of the female body. Cytotrophoblasts located around the embryo, through rapid division, create a branched membrane with a network of lacunae. The vascular system of the embryo grows into the branches of this membrane, which provides a connection between the blood system of the mother and the embryo. In this case, there is no direct exchange of blood, and communication is ensured in a diffuse manner. As a result of the primary process, the placenta is born, which is an organ that belongs to both the woman and the child.

Already 3 weeks after conception, the placenta begins to perform its respiratory function, but until 12-13 weeks its structure is not considered fully formed and does not have clear boundaries. Until 6-7 weeks, this formation is called chorion, and only then does real placentation begin. An important indicator of development is the degree of maturity of the placenta. In the second trimester of pregnancy, it is the maturity of the placenta that already makes it possible to assess physiological and pathological processes. In general, the maturity of the placenta is divided into 4 degrees by week.

Stages of organ maturation

The degree of maturity of the placenta is 0, i.e. The initial stage of organ formation normally occurs within 30 weeks after conception. During this period, the placenta has a fairly homogeneous structure and develops from a fuzzy amorphous system to the first signs of maturation. The main functional development is observed starting from 11-12 weeks, when the growth of the placenta and thickening of the membrane are actually observed. One of the main indicators of the zero stage is surface smoothness.

Degree of placental maturity 1 begins with the appearance of signs of maturation on the placenta, expressed in a violation of the smoothness of the surface - slight waviness, inclusions. Ultrasound reveals individual zones of echogenicity. The normal course of pregnancy involves the development of this stage in the period 27-34 weeks.

The degree of maturity of the placenta 2 is characterized by the appearance of a noticeable relief on the surface of the organ, obvious convolutions of the membrane are recorded, ultrasound shows the presence of numerous changes in echogenicity. The average duration of this period is 34-39 weeks.

The placenta of the 3rd degree of maturity is a finally matured organ that has performed all the necessary functions and is preparing for childbirth. The transition stage to this degree normally begins at 38 weeks of pregnancy.

The main external characteristic is the appearance of a pronounced lobular structure and significant tortuosity of the membrane. This period expresses the natural aging of the placenta. This degree of maturity indicates that the fetus is actually mature, and therefore childbirth after 37 weeks of pregnancy is considered completely acceptable. Premature onset of stage 3 placenta maturity is very dangerous and is fraught with premature birth and insufficient development of the child.

An important characteristic of the maturation of the placenta is its thickness. It is this parameter that is often used to monitor placental development. The table shows the norms for this parameter by week of pregnancy.

What anomalies occur during development

As the placenta matures, some abnormalities may be detected that may affect the health of the pregnant woman, the development of the child, or the course of future births. Such disturbances may be revealed in the location of the placenta, its size or timing of maturation.

A fairly important indicator is the location of the placenta attachment site in the uterine cavity. So, for many women, in the early weeks of pregnancy this place is located almost at the uterine outlet, but as the size of the uterus increases, the placenta rises higher. However, some women may experience excessively low attachment of the placenta even in the 3rd trimester, which is dangerous due to its premature detachment.

The presence of the so-called placenta previa, when it is located near the internal os, and sometimes overlaps it, causes great concern. This phenomenon can be caused by previous abnormal births, abortions, tumor formations, and abnormal uterine structure. The danger of the anomaly is the risk of bleeding and premature birth. The situation requires constant monitoring using ultrasound.

Quite rarely, but still there are cases of placental villi growing into the muscular structure of the uterus or uterine walls (placenta accreta). Such placental remnants are not removed from the uterus with menstruation and can cause serious bleeding in the postpartum period. Treatment in such cases involves surgical intervention. Similar problems are caused by excessively tight attachment of the placenta to the uterine wall.

The anomalies discussed above may contribute to such a pathology. It can occur in early labor or at any stage of pregnancy. When pathology appears, the woman needs urgent hospitalization, and the measures taken depend on blood loss and the area of ​​detachment.

Placenta (“baby place”) is an embryonic, temporarily existing organ that carries out communication and metabolism between the mother’s body and the fetus.

In appearance, it resembles a flatbread, hence its name (Latin placenta - flatbread). In the “baby place” there are two sides: the maternal side (facing the uterus) and the fetal side, from which the umbilical cord extends. The placenta has a lobular structure: it consists of lobules (cotyledons) separated from each other by partitions (septa).

Its formation begins already in the second week of pregnancy, when the embryo implants into the wall of the uterus. During 3-6 weeks, the placenta develops intensively, and by 12-16 weeks of pregnancy it is already formed and begins to perform its functions.

Functions

The functions of the placenta are diverse:

1. Respiratory(ensures the supply of oxygen to the fetus and the removal of carbon dioxide).
2. Trophic. Transfers nutrients to the fetus: proteins, fats, glucose, water, vitamins, enzymes, electrolytes.
3. Endocrine. Provides the transfer of maternal hormones to the fetus (sex hormones, thyroid and adrenal hormones). In addition, the placenta itself begins to produce a number of hormones necessary for the normal development of the fetus and the course of pregnancy (human chorionic gonadotropin, placental lactogen, prolactin, estrogens, progesterone, cortisol).
4. Protective (barrier). The placental barrier protects the fetus from harmful factors, but the protective properties do not affect all substances. Many drugs, alcohol, and nicotine can penetrate the placenta, thereby having a negative effect on the development and growth of the fetus.
5. Immune protection. Forms an immune barrier between two foreign organisms (mother and fetus), due to which an immune conflict does not occur.

Location

During physiological pregnancy, the placenta develops in the body of the uterus, most often along its posterior wall, transitioning to the sides. This is due to the fact that the posterior wall is less subject to changes during pregnancy and is better protected from the effects of accidental injuries. Less commonly, the placenta is located in the fundus of the uterus.

Normally, it should be located high, not reaching the internal os of the cervix by 7 cm or more. If the placenta’s lower edge reaches the pharynx and partially or completely covers it, then this is (one of the most serious types of obstetric pathology).

A final idea of ​​the location of the placenta can be obtained only after 32-34 weeks; before that, due to the growth and change in the shape of the uterus, the location may change.

Maturity

Maturation of the placenta- This is a natural process associated with the need to ensure the development of the fetus in a timely and complete manner.

Ultrasound examination evaluates the nature of the changes and their correspondence to the gestational age.

There are five degrees of placental maturity:

• 0 degree(corresponds to a period of up to 30 weeks);
• 1st degree(gestational age is from 30 to 34 weeks, it is possible to determine this degree as early as 27-28 weeks);
• 2nd degree(from 34 to 37-38 weeks);
• 3rd degree(from 37 weeks);
• 4th degree(at the end of pregnancy, before childbirth). This degree characterizes the physiological aging of the placenta.

When diagnosing premature or late maturation of the placenta, additional examination and treatment of the woman is required (preferably in a hospital setting).

Information Disruption of the placenta leads to serious complications for the development of the fetus: oxygen starvation (hypoxia) develops and.

Thickness

During an ultrasound examination, not only the structure, but also the thickness of the placenta is studied.

Normal placental thickness