Προδρομικός πλακούντας

Συμβαίνει όταν ο πλακούντας ενός μωρού καλύπτει τον τράχηλο της μητέρας μερικώς ή εντελώς – τη δίοδο μεταξύ της μήτρας και του κόλπου. Ο προδρομικός πλακούντας μπορεί να προκαλέσει σοβαρή αιμορραγία πριν ή κατά τον τοκετό.

Ο πλακούντας παρέχει οξυγόνο και θρεπτικά συστατικά για την ανάπτυξη του μωρού σας και απομακρύνει τα προϊόντα αποβλήτων από το αίμα του μωρού. Συνδέεται με το τοίχωμα της μήτρας σας, και τον ομφάλιο λώρο του μωρού σας. Στις περισσότερες εγκυμοσύνες, ο πλακούντας εμφυτεύεται στην κορυφή ή στην πλευρά της μήτρας. Στον προδρομικό πλακούντα, ο πλακούντας εμφυτεύεται με το κατώτερο τμήμα της μήτρας.

Συμπτώματα
Ανώδυνη, ζωηρή κόκκινη κολπική αιμορραγία κατά το δεύτερο ήμισυ της εγκυμοσύνης είναι το κύριο σημάδι του προδρομικού πλακούντα.  Η ποσότητα της αιμορραγίας μπορεί να κυμαίνεται από ελαφρά έως βαριά. Η αιμορραγία σταματά συνήθως χωρίς θεραπεία, αλλά σχεδόν πάντα επαναλαμβάνεται ημέρες ή εβδομάδες αργότερα.

Πότε πρέπει να δείτε ένα γιατρό
Εάν αντιμετωπίσετε οποιαδήποτε κολπική αιμορραγία κατά το δεύτερο ή τρίτο τρίμηνο σας, καλέστε τον γιατρό σας αμέσως. Εάν η αιμορραγία είναι σοβαρή, αναζητήστε επείγουσα ιατρική φροντίδα.

Παράγοντες κινδύνου
Οι γυναίκες διατρέχουν μεγαλύτερο κίνδυνο για προδρομικό πλακούντα, εάν είχαν προηγούμενες χειρουργικές επεμβάσεις στη μήτρα, όπως:

  • Η καισαρική τομή
  • Χειρουργική επέμβαση για αφαίρεση ινομυωμάτων
  • Διαστολή και απόξεση ( D & C)

Ο προδρομικός πλακούντας είναι επίσης πιο συχνός στις γυναίκες που:

  • Είναι πολύτοκες
  • Είχαν προδρομικό πλακούντα σε προηγούμενη εγκυμοσύνη
  • Κυοφορούν πολύδημες κυήσεις
  • Είναι ηλικίας 35 ετών και άνω
  • Είναι Ασιάτισες
  • Είναι καπνίστριες

Επιπλοκές
Αν έχετε προδρομικό πλακούντα, θα χρειαστείτε τακτική παρακολούθηση από το γιατρό σας, για να μειωθεί ο κίνδυνος από αυτές τις σοβαρές επιπλοκές:

  • Αιμορραγία
    Μία από τις μεγαλύτερες ανησυχίες είναι ο κίνδυνος σοβαρής κολπικής αιμορραγίας κατά τη διάρκεια της κύησης, του τοκετού ή τις πρώτες ώρες μετά τον τοκετό. Η αιμορραγία μπορεί να είναι αρκετά σοβαρή για να είναι απειλητική για τη ζωή.
  • Πρόωρος τοκετός
    Σοβαρή αιμορραγία μπορεί να απαιτεί επείγουσα καισαρική τομή πριν το έμβρυο να είναι τελειόμηνο.

Διάγνωση
Ο προδρομικός πλακούντας μπορεί να  διαγνωστεί μέσω υπερήχων, είτε κατά τη διάρκεια ενός υπερηχογραφήματος ρουτίνας ή μετά από ένα επεισόδιο κολπικής αιμορραγίας.
Ο πλακούντας σε ένα ποσοστό της τάξεως του 10-15% στον υπερηχογραφικό έλεγχο ρουτίνας στις 22 εβδομάδες μπορεί να βρίσκεται κοντά στον τράχηλο της μήτρας και ονομάζεται πλακούντας χαμηλης πρόσφυσης.

Φυσιολογικά ο πλακούντας θεωρείται φυσιολογικός, όταν απέχει περισσότερο από 2,5cm από το έσω τραχηλικό στόμιο.

Ένας πλακούντας ονομάζεται προδρομικός εφόσος παραμένει χαμηλός μετά τις 28 εβδομάδες κύησης. Σε ένα ποσοστό της τάξεως του 95% περίπου, οι χαμηλής πρόσφυσης πλακούντες στις 22 εβδομάδες, μεταναστεύουν προς τα επάνω καθώς η κύηση προχωράει.

Εάν ο γιατρός σας υποψιάζεται ότι μπορεί να έχετε προδρομικό πλακούντα, θα αποφευχθεί η δακτυλική εξέταση ρουτίνας για να μειώσει τον κίνδυνο της έντονης αιμορραγίας. Μπορεί να χρειαστείτε επιπλέον υπερήχους για να καθοριστεί η ακριβής θέση του πλακούντα σας πριν από τον τοκετό.

Η θεραπεία για τον προδρομικό πλακούντα εξαρτάται από διάφορους παράγοντες, όπως οι εξής:

  • Το ποσό της κολπικής αιμορραγίας
  • Το αν η αιμορραγία έχει σταματήσει
  • Την ηλικία κύησης
  • Την υγεία του μωρού σας
  • Τη θέση του πλακούντα και του μωρού

Για μικρή ή καθόλου αιμορραγία:

  • Αν έχετε λίγη ή καθόλου αιμορραγία, ο γιατρός σας μπορεί να συστήσει ξεκούραση στο κρεβάτι στο σπίτι. Θα πρέπει να αποφεύγετε το σεξ, το οποίο μπορεί να προκαλέσει αιμορραγία. Να είστε έτοιμες να αναζητήσετε ιατρική φροντίδα έκτακτης ανάγκης , αν αρχίσετε να αιμορραγείτε.
  • Εάν ο πλακούντας δεν καλύπτει πλήρως τον τράχηλό σας , μπορεί να σας επιτραπεί να επιχειρήσει κολπικό τοκετό. Αν αρχίσετε να αιμορραγείτε σε μεγάλο βαθμό, μπορεί να χρειαστείτε επείγουσα καισαρική τομή.

Για βαριά αιμορραγία

Εάν η αιμορραγία είναι σοβαρή, μπορεί να χρειαστείτε μετάγγιση αίματος για να αντικαταστήσει το αίμα που έχετε χάσει.

Ο γιατρός σας θα προγραμματίσει πιθανώς μια καισαρική τομή το συντομότερο, ιδανικά μετά από τις 36 εβδομάδες κύησης . Αν δεν είναι δυνατό να περιμένει, θα χρειαστείτε μια προηγούμενη καισαρική τομή. Σε αυτήν την περίπτωση, μπορεί να χορηγηθούν κορτικοστεροειδή για να επιταχύνθει η ανάπτυξη των πνευμόνων του μωρού σας.

Για την αιμορραγία που δεν θα σταματήσει

Εάν η αιμορραγία σας δεν μπορεί να ελεγχθεί ή το μωρό σας είναι σε κίνδυνο, μπορεί να χρειαστείτε μια επείγουσα καισαρική τομή – ακόμη και αν το μωρό είναι πρόωρο.

 

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