The term "chorion" is used by gynecologists to refer to the placenta in the first trimester of pregnancy. Many patients have early stages, the entry “chorion presentation” appears on the card. Like everything unknown, this definition, coupled with the word diagnosis, can seriously frighten the expectant mother.

Let's try to explain clearly what chorion presentation is. This diagnosis means that the placenta is located incorrectly. When, instead of attaching to the body of the uterus, it can capture the lower uterine segment.

Sometimes there is partial or complete overlap of the internal pharynx cervical canal, leading from the uterus. This diagnosis is most relevant for the first trimester of pregnancy. Basically, as the fetus develops, the chorion rises. But there are times when this does not happen.

Types of chorion presentation

At low presentation chorion, attachment of the fertilized egg is observed a couple of centimeters below the cervix. This occurs in only 5% of pregnant women. Such a diagnosis can only be made during an ultrasound. Low attachment is most common in the first two trimesters. In 90% of cases, the chorion rises safely to the desired position as the fetus grows. This is due to the fact that the tissues of the uterus are pulled upward and pull the placenta along with it. Thus, everything is done without drug treatment.

There are presentations on the back or front wall uterus. The first option is the most common and is considered the norm. In this case, the placenta can also move to the side walls of the uterus. There's nothing wrong with that. In the case of the chorion along the anterior wall, there is also no cause for concern. In this option, placenta migration occurs even faster.

It happens that the placenta has not risen, but there is no overlap of the internal os. In this case, the pregnant woman is recommended to rest completely and be constantly monitored by a gynecologist.

At partial presentation the placenta can cover up to two-thirds of the cervix. A variety of this type is called marginal presentation , in which the overlap of the uterine opening does not exceed one third. These options are worse, but also not hopeless. Although the risk of miscarriage increases and bleeding may occur, inpatient treatment does not apply.

The most dangerous is complete or central presentation placenta . In this case, there is a complete overlap of the internal os of the cervical canal. With this form of presentation, starting from 4 months, hospitalization is indicated. Although everything may seem fine on the outside, there is a huge risk heavy bleeding. They can develop without visible reasons, even in a state of complete rest. Therefore, in order not to risk the life of a pregnant woman, doctors observe her in a hospital.

However, in any case, you should not panic. Although in full presentation it is indicated C-section, exists real chance keep the pregnancy. Successful outcome observed in 95% of cases.

The main causes of chorion presentation

The main reason this violation counts pathology of the internal walls of the uterus , due to which the embryo cannot attach to them. Often, these pathologies arise as a result of abortion or due to sexually transmitted infections. Presentation can also develop with uterine deformation, which occurs as a result of myomectomy.

Women suffering severe forms diseases heart, kidney or liver are included in the group increased risk. This is due to congestion in the uterine cavity. Chorionic presentation often affects second-bearing women , especially over 35 years old.

This deviation may be due to pathology of the ovum , as a result of which it is impossible to fully attach the latter. It also happens that the placenta is attached too tightly and cannot separate on its own during childbirth.

It would be appropriate to note that chorionic presentation, excluding the central variant, can only be definitively diagnosed at the end of pregnancy, since the position of the placenta can always change.

Consequences of chorionic presentation

The most common complication of presentation, as well as a symptom, is bleeding . Its character depends on the degree of presentation. During complete presentation, bleeding is observed already at 2-3 months. Side shape involves bleeding after 6 months and during childbirth. The intensity of hemorrhages is also determined by the degree of presentation. It is noticed that 20% of cases occur during the second trimester.

Bloody discharge with this pathology is of a special nature.

The advantage is that the effusion always occurs outward, and avoids the formation of hematomas between the uterus and the chorion. However, this does not reduce the danger for the expectant mother and child.

A distinctive feature of these bleedings is suddenness. At the same time, the pregnant woman does not experience any pain or discomfort. This makes it possible not to confuse them with spontaneous abortion, which is always accompanied by painful spasms.

Having appeared once, bleeding tends to recur at different intervals. It is impossible to predict its intensity and abundance.

The main threat of placenta previa is miscarriage . The tone of the uterus, nagging pain in the abdomen and lower back can signal danger. Often permanent accompanying symptom is

Ultrasound examination helps diagnose certain pathologies associated with an unfavorable pregnancy. Already during the very first planned ultrasound, incomplete chorion presentation can be detected.

Many women would like to know why incomplete chorion presentation occurs, what it is and why it is dangerous. Only narrow specialists can answer this question. Chorion is outer shell embryo. It is covered with numerous villi. Over time, the chorion turns into the placenta. On early stages pregnancy, it is the villous membrane that transports nutrients to the embryo, protects the embryo, and also performs excretory and respiratory functions.

If pregnancy proceeds without pathologies, the chorion develops in the area of ​​the uterine fundus. Usually this is exactly what happens, with the placenta subsequently attaching predominantly to the posterior or anterior wall. When presenting, the chorion is located in the lower part of the uterus. The internal pharynx is partially blocked.

There are many reasons why this pathology develops. These include:

The presence of inflammatory diseases of the genital area;

Uterine fibroids;

Irregular structure of the uterus;

A large number of births in the anamnesis.

How dangerous is partial presentation? Doctors consider this a rather serious pathology, but it all depends on how severe it is. In this situation, the chorion covers only the area of ​​the internal os of the uterus. With marginal presentation, there is a chance that in the future the placenta will begin to form a little higher and the pregnancy will proceed without complications.

Central incomplete chorionic presentation usually leads to full presentation placenta. This pathology serves as an indication for cesarean section. When the internal os is blocked, natural childbirth are simply impossible.

Incomplete chorion presentation not only leads to improper formation placenta. A woman may encounter a number of complications not only during childbirth, but also during pregnancy. different stages pregnancy. The most common and very dangerous complications include:

Termination of pregnancy is spontaneous;

Hypoxia;

Intrauterine fetal death;

Bleeding;

Often, it is during partial presentation that a woman notices a scarlet discharge from the genital tract. Sexual intercourse or taking a hot bath can provoke the development of bleeding.

This diagnosis can be established only after the woman undergoes ultrasound diagnostics. Unfortunately, this pathology not treated. It is simply impossible to move the chorion to another part of the uterus. After diagnosing incomplete presentation, all efforts of doctors and the patient herself should be aimed at maintaining the pregnancy. If pain or bleeding occurs, gynecologists usually suggest to the expectant mother hospital It is very important in such a situation to strictly observe bed rest and be under medical supervision around the clock. Iron supplements may be prescribed to prevent anemia. In case of incomplete presentation of the chorion, sexual intercourse is strictly prohibited, as well as serious loads, heavy lifting and overwork. This can lead to very sad consequences.

If a woman has already had pregnancies with incomplete chorionic presentation, the risk of pathology occurring with repeat pregnancies rises. Unfortunately, it is very difficult to prevent such developments, but it is possible with a competent approach to conception planning.

Incomplete chorion presentation is quite serious and dangerous pathology. It is very important to diagnose it on time and take all measures aimed at preserving such a pregnancy. Best results can be achieved during hospital treatment.

According to statistics, up to 45% of pregnant women face such a diagnosis as marginal chorionic presentation in the early stages of pregnancy. Should I be afraid of such a medical verdict, and what to do? we'll talk in this article.

What is it?

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

At the site of attachment of the blastocyst shell, special enzymes are secreted that make the mucous membranes of the uterus more pliable and allow the fertilized egg to “grow.” A chorion is formed at the site of attachment. It is necessary to supply the fertilized egg with useful substances from the mother’s blood. A little later, the placenta appears in its place. But until 12-13 weeks we're talking about specifically about the chorion, since the placenta is still being formed and does not function.

If implantation is successful, the fertilized egg is fixed in the fundus of the uterus (this is its upper part). If for some reason pathological reasons The blastocyst failed to implant in the upper or middle part of the uterus; it may descend into the lower uterine segment. And then the chorion will form low.

Chorionic presentation is its location relative to the cervical canal - a thin passage inside the cervix connecting the uterine cavity and vagina. There is no talk of presentation 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).

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

Classification

Depending on the degree of occlusion of the cervical canal, through which the fetus will then pass during childbirth, There are also types of pathology.

• Regional chorionic presentation- the chorion is located low, its edge slightly touches the area 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. The forecasts are less optimistic, since this position of the chorion in the uterus increases the likelihood of miscarriage or bleeding due to chorion detachment.
• Full presentation- the chorion has formed low and completely covers the entrance to the cervical canal. This is a rather dangerous pathology, the prognosis for which is very unfavorable.

Any chorion presentation, but especially complete and incomplete, poses a threat of miscarriage and chorion detachment. In its place, the placenta will form, a network will develop blood vessels, 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, chorion previa can develop into another pathological condition - placenta previa, and then spontaneous childbirth naturally, most likely, will be contraindicated. The woman will have a caesarean section. Carrying the baby to term will also not be easy, since the low-lying placenta and adjacent to the exit from the uterus will create a risk of developing spontaneous bleeding at any moment.

A baby who is breech will receive less oxygen and useful substances, and this is fraught with malnutrition and hypoxia.

Causes and symptoms

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

Miscarriages and a history of frozen pregnancies also increase the likelihood of abnormal placement of the fertilized egg. An obstacle to full implantation may be a scar or several scars on the uterus from previous operations or a cesarean section.

Women who have given birth a lot cannot boast of being strong and elastic. muscle tissue reproductive organ, they also have an increased likelihood that a subsequent pregnancy may occur against the 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 “shelter” in the lower uterine segment. The reason may also be congenital anomaly structure of the uterus - bicornuate or saddle-shaped uterus. A certain sequence of such pathologies has also been noticed - if in a previous pregnancy a woman had low placentation, with a large share the likelihood of fetal attachment and chorion development during a subsequent pregnancy will also be low.

There may be no symptoms of marginal chorionic presentation in the early stages, but small short-term bleeding may appear. Usually they are always assessed correctly 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 the rupture of small blood vessels due to stretching of the uterine walls, can recur frequently, in some cases 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, you should immediately call an ambulance.

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

What to do?

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

The baby in the mother's womb is growing rapidly. To meet his needs for comfort, the uterine wall and ligamentous apparatus forced to stretch. Together with them, the placenta, which at the beginning of pregnancy was in a marginal presentation, will “crawl” upward. On the front or back wall the uterus will the placenta migrate - it doesn’t matter. It is important that in most cases it actually rises, and all the threats and risks associated with low placentation remain a thing of the past.

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

The process of placental migration is usually completed by 18-20 weeks of pregnancy. 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 classified as a risk group for premature birth and will continue to lead with increased attention and awe.

Treatment

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

The chorion is the villous membrane of the fertilized egg that ensures its growth and development. During the normal course of pregnancy, it is implanted into the inner lining of the uterine fundus, and then onto the front, back and side walls. Chorionic presentation implies its incorrect location. It is not attached to the body of the uterus, but captures its lower segment. Sometimes there is complete or partial blocking of the internal os of the cervical canal coming from the uterus. This diagnosis is most dangerous in the early stages of pregnancy. Usually, as the fetus grows, the placenta moves up, but in some cases this does not happen.

When does presentation occur?

Reasons for the development of this pathological condition have not been fully studied. However, several factors have been identified that contribute to the incorrect location of the chorion. Among them are chronic inflammatory diseases uterus, postoperative scars, fibroids, uterine developmental anomalies and large number history of childbirth.

Symptoms of improper placement of the chorion

As a rule, this pathology is diagnosed during a routine ultrasound in the absence of any complaints from the woman. There are cases when presentation is accompanied by bleeding from the genital tract against the background of complete well-being. Usually their development is facilitated by such external factors such as excessive exercise, sexual intercourse and taking a hot bath.

Possible complications

Chorionic presentation is one of the most serious obstetric problems that can lead to a number of complications for the fetus and mother. These include termination of pregnancy, intrauterine growth retardation and fetal death, severe anemia in a woman with frequently recurring bleeding.

Treatment of chorionic presentation

There is no specific treatment for this pathology. Therapeutic measures are aimed at preventing miscarriage and treatment possible complications. When diagnosing chorionic presentation during an ultrasound, a woman is offered a set of therapeutic measures in a hospital setting. She is recommended strict bed rest, ultrasound monitoring, taking medications to reduce uterine tone and vitamins for pregnant women. When discharged home, a pregnant woman should avoid physical activity, stressful situations and sexual intercourse. The appearance of bloody discharge is a reason for emergency treatment V gynecological department and the prescription of hemostatic drugs. In case of massive bleeding that threatens the woman’s condition, the pregnancy is terminated.

During the mandatory ultrasound after 12 weeks, the location of the chorion is assessed, among other things. Sometimes an ultrasound specialist diagnoses chorionic presentation. What does this mean and how dangerous is it?

What is chorionic presentation and why does it occur?

Until the placenta is formed, the embryo is surrounded by a villous membrane, which grows into the lining of the uterus. Until the 16th week of gestation, this is the chorion (from the 17th week - the placenta), which performs the following main functions:

• Nutrition of the embryo;
• Respiration - delivery of oxygen and removal of carbon dioxide;
• Isolation of metabolic products;
• Embryo protection.

During the normal course of pregnancy, the chorion attaches to the fundus of the uterus and grows along the anterior, posterior and lateral walls, but this does not always happen.

Chorion presentation is its incorrect location, in which there is complete or partial overlap of the internal os of the cervical canal.

Why this condition occurs is not completely clear. But a connection has been established with some factors:

• chronic inflammation of the uterus;
• previous operations;
• abnormal development of the uterus;
• a large number of pregnancies and births;
• low attachment of the placenta in the previous pregnancy.

Types of chorion location

Based on the attachment of the chorion relative to the internal os, presentation occurs:

• Complete - a condition in which the chorion completely covers the internal os. This will subsequently develop into placenta previa.
• Incomplete - characterized by overlap of part of the uterine os. If the villous membrane comes out up to a third, then this is called marginal presentation.
• Low - the chorion is located at a distance of 3 cm or less from the pharynx, but does not overlap it.

Chorionic presentation at 12 weeks is not the final verdict. As the uterus and fetus grow, migration may occur, and the condition will return to normal. A more favorable prognosis is noted for the posterior location of the chorion and presentation along the anterior wall.

Complete covering of the uterine pharynx by the chorion - dangerous look pathology, which threatens massive bleeding.

How is chorionic presentation manifested?

Most often, pathology is detected during ultrasound.

Bloody discharge can also be caused by breech presentation, especially if it occurred shortly before hot bath, sauna, sexual intercourse. In this case, you need to urgently consult a doctor.

Complications

The pathology is dangerous:

• premature miscarriage;
• uterine bleeding;
• intrauterine death of a child.

Chronic blood loss leads to the development of anemia and fetal hypoxia. If complete occlusion of the pharynx remains, natural childbirth is impossible.

Treatment of chorionic presentation

Partial chorionic presentation without bleeding does not require hospitalization. Isolation of any amount of blood is an indication for treatment in the hospital.

It is impossible to artificially change the location of the villous membrane, so the main task facing doctors is maintaining pregnancy. A protective treatment regime is created in the hospital:

• The woman is in a calm environment, on bed rest;
• Physical activity is limited;
• Provided balanced diet with the exception of products that strengthen or relax the stool.

Drug treatment is as follows:

• Suppositories with Papaverine, Drotaverine tablets to relieve uterine tone;
• Iron preparations, for example, Totema, Maltofer - for the prevention or treatment of anemia.

In the presence of bleeding, the hemostatic drug sodium etamsylate is additionally used. At the beginning of therapy, it is administered intravenously or intramuscularly. Then you can switch to tablets.

Massive bleeding that cannot be treated conservative ways, is an indication for termination of pregnancy.

After discharge from the hospital at home, it is necessary to adhere to a measured lifestyle, eliminate stress and increased loads. It is forbidden to have sex, because this may cause new bleeding and miscarriage.

What is the prognosis for the pathology?

Chorionic presentation at 8-14 weeks can transform into a normal location of the placenta or persist in the form of low placentation.

If the presentation does not disappear, but turns into an anomaly in the location of the placenta, then by the time of birth the baby may be transverse in the uterus or with the buttocks down. In such cases, to reduce the risk, it is recommended to deliver the child through.

Prevention

Women should take care of their reproductive health as early as possible:

• Hypothermia should be avoided and inflammatory diseases of the genital area should be treated promptly.
• Do not resort to abortion, this is not a method of family planning.
• It is important to eat properly and nutritiously and lead a measured lifestyle.

If you follow these simple rules, you don’t have to become familiar with pathologies from personal experience.

Yulia Shevchenko, obstetrician-gynecologist, especially for the site

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