Placenta praevia: role, risk of detachment, expulsion …

Placenta praevia : rôle, risque de décollement, expulsion...

The placenta is simply vital during pregnancy: it establishes the link between mother and child. How is it formed? What are the possible complications? What to do in case of placental abruption? Anna Roy, midwife, answers our questions about this organ, which is essential for baby’s development.

For future parents, the placenta is quite mysterious: we know that it is essential and that doctors watch because it can provide valuable information, but we sometimes ignore What is his role. From her development to post-birth exams, including potential complications, Anna Roy, midwife and author of several books, including We talk about my perineum? (Leduc editions), we says everything about this vital organ.

The placenta forms from the start of pregnancy and will play an essential role during the nine months. “It is a part of the embryo, which separates from it in the first days of gestation. It will grow and develop little by little, to play an interface role between the baby and the mother “says Anna Roy. If it is created in the first days, it takes several months to develop. “It will grow, differentiate, change anatomically, and it operates on its own from the 4th month of pregnancy. Afterwards, just like the fetus which, at 5 months of pregnancy, only grows and matures, the placenta will continue to widen until delivery, says the midwife.

One of the main functions of the placentais to allow exchanges between mother and fetus, so that it is nourished thanks to what contains the blood of the future mother. Without this organ, there is no oxygen exchange, no nutrient exchange, recalls Anna Roy. The midwife also explains that the placenta has a very important protective function. “It is a filtration organ, like the liver. It will filter out viruses and molecules that are not good for the baby. ” Unfortunately, the placenta cannot filter everything, and it is for this reason that doctors recommend that pregnant women pay attention to their lifestyle. “It is an almost perfect organ, but it has faults. For example, placental barrier can let tiny viruses pass, like toxoplasmosis, but also cigarettes, alcohol, or drugs “, says Anna Roy.

The placenta having an essential role during pregnancy, when he has complications, these can be quite severe. For example, it may not fit properly. This is what happens when there is a placenta praevia : he goes on or near the cervix. This makes childbirth by track bass impossible “says Anna Roy. In other cases, it can be inserted too much inside the uterine lining. “This is called a placenta accreta. We can’t differentiate it from the uterine lining, and that can cause big problems after childbirth “, decrypts the specialist. In other cases, the problem caused by the placenta is that it no longer ensures the proper exchange of oxygen and nutrients. The specialist explains that this can be caused by many factors, including poor genetic compatibility between the two parents. Finally, thee placenta can come off prematurely, “this is called a retro-placental hematoma ((HRP). In this case, the medical teams must act urgently to save the future baby.Finally, “it can be at the origin of diseases like pre-eclampsia, hypertension of pregnancy”.

Chorioamniotitis means a infection of the placenta and amniotic fluid. It is mainly characterized by fever and abdominal pain. It occurs especially in women whose pouch has ruptured prematurely or who have already had a premature delivery. Smoking is also a risk factor. Once the diagnosis is confirmed, cesarean delivery should take place as soon as possible to protect the mother and her baby. Antibiotic therapy should then be started.

In case of detachment of the placenta, the signs that can alert the expectant mother are bleeding, and very severe abdominal pain. The retro-placental hematoma can be more or less serious, depending on the stage of pregnancy and the size of the area taken off. If detachment is early, at the beginning of pregnancy, it is not necessarily very serious. The woman will bleed a little. It may just be a small area that is affected, and in many cases it sticks together “, would like to reassure Anna Roy. However, it is not the same thing if placental abruption occurs in late pregnancy. According to our midwife, in this scenario, “we must have a caesarean in an emergency and hope that the medical profession has not arrived too late”.

A future mother who has past the term of her pregnancy will have to have regular checkups to make sure her unborn baby is okay, especially if the placenta is still normal and functional. Anna Roy says it’s because “of an organ that has an expiration date, to put it simply. At the end of pregnancy, we will check that it is not expired by doing an ultrasound, and in particular by looking at the level of amniotic fluid. ” If the placenta is still functioning normally, doctors may allow the pregnancy to continue for up to five days after the due date, always by monitoring the placenta. However, “if we see that this is not the case and that it no longer fulfills the exchanges correctly, we will trigger childbirth”.

At the time of delivery, the placenta must imperatively be expelled, after the baby. “It is the cause of many deaths around the world, for example due to the hsevere bleeding from postpartum. This is a problem that is taken very seriously and that is why, in France, we often do a so-called “directed” delivery of the placenta. We are going to inject a product when the baby comes out of the shoulders, so that it will peel off easily within 5 to 15 minutes after birth. We are going to be very demanding on the release time “, explains Anna Roy. However, during more natural deliveries, for example in birthing centers, “there will be no directed deliverance”. In this case, the time allowed by the medical profession to the placenta to be expelled is 30 minutes maximum. “There are often some contractions that resume and we can ask the patient to push a little bit”, adds the midwife.

Nevertheless, it may happen that the placenta is not expelled, or that a lump remains in the womb. In this case, “we can do a uterine revision. The doctor or midwife will fetch the placenta or the part of the organ that remains inside with his or her hand “. If the medical profession systematically performs this step when the placenta is not expelled, it is because, if it remains in the uterus, it can lead to serious health problems. “The number one danger is hemorrhage. The second is the risk of infection, because if we leave a piece of placenta inside the uterus, it will eventually become infected “, explains the midwife. In some pregnancies, we can know in advance that the expulsion of the placenta will be difficult, and in particular in the event of a placenta accreta, since it will then be very nested in the uterine lining. Exams carried out by the pregnant woman will make it possible to know at what stage it is, “depending on the stage which has been determined, the patient will give birth in a maternity of a higher or lower level, because we may have to perform an operation, or even remove the uterus (which is fortunately rare), in the aftermath of childbirth, and in this case you need a specialized doctor “.

“We examine the placenta after birth to see if it is complete. We will also look at its anatomical features (size, defect, split in two, odor …)says Anna Roy. In case of suspicion, the midwife or obstetrician who helped the patient to give birth may request that it be analyzed for the presence of germs or viruses, and whether it has deteriorated prematurely. Observe the placenta can also collect important information. “For the health of the newborn, it does not necessarily imply much, but Those are things that may be of interest for a future pregnancy. For example, during a second pregnancy, we can advise aspirin to fluidify the exchanges between mother and fetus “, explains Anna Roy. Likewise, in the event of late mowing or the birth of a stillborn baby, examining the placenta may help to understand the cause.

In the United States, in the United Kingdom, and even in France, many women report eating their placenta.In some developing countries, countries that are sometimes extremely poor, women have access to nothing but their placenta, which they are forced to cook. In Europe and North America, some have said that, if they did, it was because it was very good for health “, explains Anna Roy. But it’s abouta received idea, she insists since it is a filtration organ. “It is completely false. It is true that the placenta is very rich in iron in particular, but it also contains all the bad substances, chemical pollutants, toxins, viruses, etc. In addition, the placenta, unlike the liver, does not eliminate these products, “she said.

“Keeping your placenta to bury it is not possible in France”. In other cases, the mother may want to keep the placenta for cultural and traditional reasons. “For example, in Africa families love very much bury it at the foot of a fruit tree, because they see him as part of the baby, which is the case, so they feel that he owes him respect, and want to keep this memory that will nourish the tree. I don’t mind, but it’s not possible in France “, says Anna Roy. On this subject, in fact, French law is very clear: the placenta, like all other human waste, cannot be recovered by the patient. Anna Roy explains that “The medical teams risk a prison sentence if they let a woman go with her placenta, for whatever reason. So unanimously, nobody does it in the hospital anymore, and the trend has calmed down a bit. But that remains a bit in the home births. Normally, the midwife has to take the placenta and put it in the infectious waste, but some do not. “

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