Placenta previa

Description

Placenta previa (pluh-SEN-tuh PREH-vee-uh) is a problem during the pregnancy, when the placenta completely or partially covers the opening of the uterus (cervix).

The placenta is an organ that develops inside your uterus during pregnancy. It works to provide oxygen and nutrients to the baby and to remove the residue. The placenta connects to your baby through the umbilical cord. Normally, the placenta is attached to the top or side of the inner wall of the uterus.

With placenta previa, the placenta attaches lower in the uterus. This results in a part of the tissue of the placenta covers the cervix. Can result in bleeding during pregnancy or during or after delivery.

Changes in the uterus and placenta during pregnancy can lead to correct the problem on your own. If not, the baby is born by cesarean section (c-section).

Symptoms

The main sign of placenta previa is bright red vaginal bleeding, usually without pain, after 20 weeks of pregnancy. Sometimes, when you see that happens before an event with more blood loss.

The bleeding can occur with prelabor contractions of the uterus that causes the pain. The bleeding may also be triggered by sex, or during a medical examination. For some women, the bleeding may not occur until the workmanship. Often it is not clear the event that leads to bleeding.

When to see a doctor

If you have vaginal bleeding during your second or third trimester, call your health care provider immediately. If the bleeding is severe, seek emergency medical attention.

Causes

The exact cause of placenta previa is unknown.

Risk factors

Placenta previa is more common among women who:

  • Have you had a baby
  • Have had a previous cesarean delivery
  • Has scars in the uterus from a previous surgery or procedure
  • I had placenta previa with a previous pregnancy
  • You are pregnant after having an assisted reproductive technology (ART) procedure for the treatment of infertility
  • Are carrying more than one fetus
  • Are 35 years of age or older
  • Smoke
  • The use of cocaine

Complications

If you have placenta previa, your doctor will monitor you and your baby to reduce the risk of these serious complications:

  • The bleeding. Serious, life-threatening vaginal bleeding (hemorrhage) can occur during pregnancy, at birth or in the first hours after birth.
  • The preterm birth. Severe bleeding can lead to an emergency c-section before your baby is full-term.
  • Placenta accreta spectrum. Placenta previa is associated with a group of conditions called placenta accreta spectrum. With these conditions, the placenta grows into or through the wall of the uterus. Placenta accreta has a high risk of bleeding during the pregnancy or during and after delivery.

Placenta previa

Diagnosis

Placenta previa is diagnosed through ultrasound, either during a routine prenatal appointment or after an episode of vaginal bleeding. Most cases of placenta previa are diagnosed during a second trimester ultrasound exam.

The initial diagnosis can be done with an ultrasound device in the abdomen. For more precise image, you may also need a transvaginal ultrasound, which uses a wandlike device placed inside your vagina. Your health care provider with the position of the device in order not to disturb the placenta or cause bleeding.

Treatment

If the placenta previa are diagnosed during a routine examination, it is likely that you have more frequent ultrasound examinations to monitor any changes in the placenta.

In many women with a diagnosis of placenta previa at the start of pregnancy, the condition resolves on its own. As the uterus grows, the distance between the neck of the uterus and the placenta may be increased. Also, the direction of growth of the placenta may be increased in the uterus, and the edges of the tissue of the placenta, close to the cervix that can reduce the size.

If the placenta previa resolved, you may be able to plan a vaginal birth. If not resolved, going for a birth plan for c-section.

Treatment of bleeding

Vaginal bleeding after 20 weeks is treated as a medical emergency. You may be admitted to the hospital, the labor and delivery unit. You and your baby will be monitored, and you may need a blood transfusion to replace the blood loss.

If you are 36 weeks of pregnancy, it is likely to have a cesarean section to give birth to the baby. If you have extreme loss of blood, or there is a risk to the health of you or the baby, an emergency cesarean section may be necessary prior to 36 weeks.

If this was the first time that I have had bleeding and the bleeding has stopped for at least 48 hours, then you may be sent home from the hospital. If you continue to have episodes of major bleeding, your health care team may recommend that you stay at the hospital.

The treatment with no bleeding

When there is bleeding, the goal of treatment is to reduce the risk of possible bleeding and to get as close to your delivery date as possible. Your doctor will probably recommend avoiding the following:

  • Sexual intercourse or sexual activity that could lead to the orgasm
  • Moderate or vigorous exercise
  • Moderate or heavy lifting
  • Standing for long periods of time

If you are sent home from the hospital, after a first episode of bleeding, it is expected that you follow these same recommendations for reducing the risk of a second episode.

You will be advised to seek emergency medical care if you have vaginal bleeding or contractions. Your doctor may ask whether you have in-home support that allows the transport to a nearby hospital.

Planned c-section delivery

Even if you have not had any bleeding during pregnancy due to placenta previa, or without bleeding from the first episode — is likely to have a cesarean delivery is scheduled sometime between 36 and 37 weeks.

If your delivery is scheduled before 37 weeks, your health care provider will offer corticosteroids to help your baby's lungs to develop.

Coping and support

If you are diagnosed with placenta previa, you may worry about how your condition will affect you, your baby and your family. Some of these strategies may help you cope:

  • Learn as much as you can about the disease.
  • Find a support group through your clinic, hospital or other community organizations.
  • Identify people who can assist with daily activities in the home or provide emotional support.
  • Be specific about the ways in which people can help if they offer assistance.
  • Perform a transportation or child care plan in the event that you need emergency services.

Preparing for your appointment

Placenta previa are diagnosed during a routine ultrasound exam, or after an episode of vaginal bleeding. So you may not have time to prepare for a quote about placenta previa, as can be typical prenatal care appointments.

If you do not need immediate medical attention or are being sent home after treatment for vaginal bleeding, it is important to understand the plan for ongoing care and management.

The questions that you can ask your provider after a diagnosis or in follow-up examinations include:

  • What are the signs or symptoms should prompt me to call you?
  • What are the signs or symptoms should cause me to go to the hospital?
  • When I need my next ultrasound?
  • What other follow-up care will I need?
  • What activities should I stop or limit?
  • What type of exercise do you recommend?
  • There is a possibility that the placenta previa resolve on its own?
  • In what time will we be likely to know if I can have a vaginal birth?
  • If you need a plan for a cesarean section, when it is recommended that the programming of the same?
  • Do you have additional information about placenta previa?
  • Do you have information about support groups or services for women with placenta previa?

What to expect from your doctor

Your health care provider is likely to ask a series of questions, with regard to their ability to manage care in the home, especially if you've already had an episode of bleeding. These include:

  • Do you live in the hospital?
  • How much time does it take to get to the hospital in case of an emergency, including the time to arrange child care and transportation?
  • Do you have someone that could take care of you or help with daily activities, so that you can restrict your activities or rest?
Symptoms and treatment of Placenta previa