The skin becomes pigmented in pregnancy. This condition is undoubtedly due to hormone changes. The same skin change happens to non• pregnant women who take similar hormones in birth control pills. After pregnancy the pigmentation gradually hides until eventually little or none is noticeable. The mask of pregnancy is a very light brown. blotchy discoloration of the skin over the forehead and cheekbones.
Other pigmented areas of the body become darker. The skirt around the nipple (creole of the breast) becomes darker. The !iota alba, that little line down the middle of the abdomen, becomes darkened and is then known as the Linea nigra. Pigmented moles become darker. This change is not cause for concern and does not make removal of the moles necessary. No treatment is effective or necessary for this pigmentation. If unsightly, the pigmented areas can be covered up with cosmetics.
In placenta previa the placenta is implanted too close to the neck of the womb. Ordinarily the placenta implants high up in the uterine body. No one knows why or how the ovum first decides on a particular place to attach itself, but if this point is close to the cervix, a placenta previa results at the end of pregnancy. This is not a common complication. It Genus in only about one of every hundred deliveries. It is a good deal more common in women who have had several children than in the pregnant for the first time.
It is uncommon (although not unheard.of) for a woman to have placenta previa in more than one pregnancy. As pregnancy draws to a close, the neck of the womb gradually thins out and dilates in anticipation of the changes that will occur when labor ensues. If the placenta lies too close to the uterine cervix (neck of the womb), the attachment of the placenta to the womb’s lining is disturbed. Bleeding to a lesser or greater degree follows, depending on how much of the placenta is detached. The bleeding is painless and, in the usual case, intermittent. After the initial episode, which often produces no more than a few teaspoonsful, days or even weeks may pass before another occurrence. The recurrent incidents of bleeding are more profuse, and if these warning symptoms are ignored, in some cases a truly alarming hemorrhage can result.
There are several methods for locating the site of the placenta. The placenta can often be seen in an X•ray picture. but this method is far from accurate. In another method, radioactively tagged albumin is injected into the mother’s bloodstream. It collects in the placenta and can then be detected by sensitive counters. This method is more accurate than the X-ray picture and, surprisingly, subjects the infant to considerably less radiation than he would get from a standard X-ray exposure.
There are also accurate ultrasound techniques. When the placenta is implanted in the lower part of the uterus, it prevents the baby’s head from entering the pelvis. Consequently, the fetus often assumes a transverse or oblique orientation in relation to the axis of the birth canal. Such abnormal positions are a common accompaniment of placenta previa. With rare exceptions. significant bleeding in the latter part of pregnancy is due either to placenta previa or premature separation of the normally implanted placenta.
Both of these are serious conditions that can endanger the mother and the infant. When bleeding occurs in the final month of pregnancy, diagnosis and proper treatment should be undertaken without delay if the condition of the baby and mother is good. At this time the infant will be mature enough to do well. Procrastination may result in more serious hemorrhage. Prior to the last month, it may be wise to withhold treatment in hope that a more
mature infant will be delivered. Selection of the proper time to institute treatment requires expert critical judgment depending on many factors. In spite of the several diagnostic tools available. the differential diagnosis between placenta previa and premature separation of the placenta must be made by internal examination. IF the physician can feel the placenta at the opening of the womb, the patient has a placenta previa.
If not. he can safely assume that the bleeding comes from a separated placenta. This examination is heat conducted in the operating room under anesthesia with preparations made for immediate Caesarean section. The operation must sometimes be done with a minimum of delay if a placenta previa is discovered. Most women with placenta previa will require Caesarean section, but most of those with premature separation of the placenta can safely be delivered vaginally.