Placenta previa

Symptoms Of Placenta Previa 

The main symptom of placenta previa is sudden light to heavy bleeding from the vagina. The symptoms usually begin after 20 weeks of gestation. Any bleeding can be representative of problems with the placenta. Some of the specific symptoms include:

• Bright red-colored bleeding from the vagina during the second trimester of pregnancy 

• Bleeding after intercourse

• Mild cramping or contractions in the abdomen, belly, or back

• Uterine contractions accompany bleeding.

Note: Not everyone who has placenta previa has vaginal bleeding. About one-third of people with placenta previa don’t have this symptom.

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Types Of Placenta Previa 

The type of placenta previa depends on its location, which is determined by ultrasound imaging of the placenta's position. Common types of placenta previa include:

1. Marginal placenta previa

• This is also called a low-lying placenta. When the placenta is positioned at the end of the cervix. The placenta is touching the cervix but not covering it. 

• This type of placenta previa is more likely to resolve on its own before your baby’s due date.

2. Partial placenta previa

•  When the placenta partially covers the cervix.

3. Complete or total placenta previa

• In this type the placenta is completely covering the cervix, blocking the vagina. This type of placenta previa is less likely to correct on its own.

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Causes Of Placenta Previa 

There is no known cause of placenta previa. It may just be a random abnormality, as the placement of the placenta in the uterus varies from person to person and from pregnancy to pregnancy.

In recent studies, it has been shown that about 1% to 15% of women may have placenta previa at some point in their pregnancy. However, only 1 in 200 women are affected by it in the third trimester.

However, there are certain risk factors that can increase one’s chances of developing placenta previa.

Risk Factors For Placenta Previa

Understanding the risk factors associated with placenta previa is essential for identifying individuals who may be at higher risk of this pregnancy complication. These include:

1. Advanced age 

Women above the age of 35 years are at increased risk of developing this complication. It can be due to changes in the uterine environment.

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2. Previous history of placenta previa

These women are at a higher risk of experiencing it again in their current pregnancy and should be closely monitored during prenatal care.

3. Smoking

Smoking during pregnancy increases the risk of placenta previa by 2.6 times when compared to nonsmokers.

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4. Multiple pregnancies

Being pregnant multiple times or with more than one baby (eg. twins or triplets) can increase the risk of placenta previa.

5. Prior abortions

This may increase the risk of placenta previa by potentially causing uterine scarring or changes in the uterine environment that affect placental implantation during a subsequent pregnancy.

6. Uterine fibroids 

These are noncancerous growths on the uterus during childbearing years and can lead to placenta previa.

7. Uterine surgery

A previous C-section or a D&C (dilation and curettage) is a procedure to remove tissue from inside the uterus that can increase the chances of developing placenta previa.

8. Assisted reproductive technology (ART)

It is a medical procedure that helps individuals or couples conceive including techniques like in vitro fertilization (IVF). It may increase the risk of placenta previa due to the potential for abnormal placental implantation in the uterus after these fertility treatments.

9. Previous scars

These, if present in the uterus, create an area with lots of oxygen and collagen and can stick to these scars, which might cause the placenta to cover the cervix or grow into the uterine walls.

10. Preeclampsia

It involves high blood pressure and organ damage that can sometimes affect the placenta. 

11. Use of certain recreational drugs

Use of drugs such as cocaine during pregnancy increases the risk of placenta previa due to its adverse effects on placental development and function.

Did you know?
Certain studies have suggested that more baby boys are born among mothers with placenta previa. However, more detailed research is required in this aspect.

Diagnosis Of Placenta Previa 

Placenta previa is usually diagnosed in a routine ultrasound around 20 weeks of pregnancy. It is either diagnosed during a routine prenatal appointment or after an episode of vaginal bleeding.

The diagnosis is usually done by: 

1. Medical history

A thorough medical history is crucial for detecting placenta previa because it helps identify risk factors.

2. Physical examination

It includes speculum examination (a hinged instrument, is used to inspect the cervix and vaginal walls) to assess vaginal bleeding. Also, digital examination should be avoided to prevent massive hemorrhage due to the risk of dislodging the placenta.

3. Imaging techniques

• Ultrasound: It is the primary diagnostic tool for placenta previa because it provides non-invasive, detailed images of the placenta's position and the cervix's location.

• Transvaginal ultrasound: During this procedure, a wandlike device is placed inside the vagina to study the tissues and organs beyond it. This is crucial for diagnosing placenta previa, as it provides detailed images of the placenta's location relative to the cervix and uterine walls. 

•  Magnetic resonance imaging (MRI) scan: It can also be used to diagnose placenta previa, especially in cases where ultrasound results are inconclusive or further clarification is needed. 
  
  

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Prevention Of Placenta Previa

Placenta previa cannot be prevented, however, certain risk factors can be mitigated, such as smoking or use of recreational drugs like cocaine. 

Specialist To Visit

Doctors who can help you diagnose and manage placenta previa include:

• Obstetrician

• Gynecologist

An obstetrician is a physician who specializes in delivering babies and giving care during pregnancy and after birth. 

A gynecologist specializes in diagnosing and treating diseases of the female reproductive system. 

They can provide medical evaluation, monitoring, and surgical interventions when necessary to manage placenta previa during pregnancy.

When to see a doctor?

You should contact your doctor immediately if you have the following symptoms:

• Continuous vaginal bleeding after the second trimester 

• Cramping or contractions in the abdomen.
  
  

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Treatment Of Placenta Previa 

There's no specific treatment for placenta previa. However, the goal of management is to limit the bleeding so you can get as close as possible to your due date. 

If the placenta is near or covering just a part of the cervix and there are no evident symptoms or bleeding the doctor may recommend: 

• Reducing your activities like running, exercising, and lifting 

• Bed rest at home

• Pelvic rest involving no intercourse, no tampons, and no douching

• More hospital visits to monitor the condition 

For moderate to severe cases of placenta previa or frequent vaginal bleeding, other treatments could include:

• Bed rest at the hospital 

• Medications to prevent early labor like: 

  • Indomethacin

  • Nifedipine 

• Intravenous (IV) magnesium sulfate can be given to the pregnant woman for delaying labor

• Steroid shots of betamethasone can be given which help the baby's lungs develop faster

• Shot of special medicine called Rhogam if the mother’s blood type is Rh-negative to avoid further complications leading to Erythroblastosis fetalis (hemolytic anemia in the fetus caused by incompatibility between maternal and fetal blood groups)

• Blood transfusions in case of heavy bleeding.

Note: In a few cases, an emergency C-section may be recommended if the bleeding is heavy and cannot be controlled. 

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Home care For Placenta Previa 

Once your doctor diagnoses the condition, there are certain ways to reduce the amount of vaginal bleeding. It includes:

• Bed rest: Avoid strenuous activities and get plenty of rest to reduce the risk of bleeding.

• Pelvic rest: Abstaining from sexual intercourse and avoiding vaginal exams to prevent potential bleeding or complications.

• Monitoring: Pay attention to any signs of bleeding or contractions and report them promptly to your healthcare provider.

• Hydration: Stay well-hydrated to support your overall health during pregnancy.

Complications Of Placenta Previa 

Placenta previa can present with pregnancy complications for both the parent and baby. Let us look at some of the things that it can lead to:

Effect on the fetus 

• Premature birth: It is when a baby is born too early before 37 weeks of pregnancy has been completed. Placenta previa leads to premature birth in approximately 5% of cases.

• Intrauterine growth restriction (IUGR): This is a condition in which a baby in the womb does not grow as expected which is due to poor placental blood supply. 

• Increased risk of death: Placenta previa can increase the risk of neonatal deaths, which refers to the unfortunate loss of babies within the first 28 days of life.

Effect on the mother

• Severe bleeding: In a few cases of placenta previa, severe bleeding may occur prior to, during, or after labor and delivery requiring blood transfusions.

• Placenta accreta: It is a serious but rare condition that occurs when the placenta grows deeply into the uterine wall and causes heavy bleeding. A woman with placenta previa is at an increased risk of placenta accreta after childbirth.

• Cesarean delivery: In many cases of placenta previa a cesarean delivery is required unless the placenta moves far enough away from the cervical opening before delivery. 

Living With Placenta Previa 

In most cases of placenta previa, coping is all about being patient and kind to yourself as it is a natural phenomenon. All you can do is wait for the placenta to move to a better position till the time of delivery. Here are other things that can help:

1. Consider reaching out to a mental health counselor 

A therapist or counselor can help sort through the complicated emotions related to pregnancy. Women dealing with emotional turmoil can benefit from making an appointment with a mental health professional. 

2. Seek support from your loved ones and family 

Receiving emotional support from loved ones and family can significantly alleviate the emotional and practical challenges of dealing with placenta previa during pregnancy.

3. Talk to your doctor

Always stay in direct contact with your doctor during the slightest changes. Call your doctor if you notice any vaginal bleeding or contractions.

4. Make up your mind about a preterm delivery

Many cases of placenta previa often lead to preterm delivery. So, it’s always better to be prepared. 

5. Prepare your mind for a C-section delivery

Make up your mind emotionally and practically for cesarean delivery if the placenta doesn't move on its own at the end of the gestational phase. 

6. Keep your hospital bag ready

Prepare a hospital bag well in advance, including essentials for both you and your baby, in case of the need for an unexpected hospital stay.

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