Placenta previa

Placenta previa is a complication of pregnancy in which the placenta grows in the lowest
part of the womb (uterus) and covers all or part of the opening to the cervix.

The placenta is the organ that nourishes the developing baby in the womb.

Causes, incidence, and risk factors

During pregnancy, the placenta moves as the uterus stretches and grows. In early
pregnancy, a low-lying placenta is very common. But as the pregnancy progresses, the
growing uterus should "pull" the placenta toward the top of the womb. By the third
trimester, the placenta should be near the top of the uterus, leaving the opening of the
cervix clear for the delivery.

Sometimes, though, the placenta remains in the lower portion of the uterus, partly or
completely covering this opening. This is called a previa.

There are different forms of placenta previa:

 Marginal: The placenta is against the cervix but does not cover the opening.
 Partial: The placenta covers part of the cervical opening.
 Complete: The placenta completely covers the cervical opening.

Placenta previa occurs in 1 out of 200 pregnancies. It is more common in women who have:

 Abnormally developed uterus

 Many previous pregnancies
 Multiple pregnancy (twins, triplets, etc.)
 Scarring of the uterine wall caused by previous pregnancies, cesareans, uterine
surgery, or abortions

Women who smoke or have their children at an older age may also have an increased risk.
Possible causes of placenta previa include:

 Abnormal formation of the placenta

 Abnormal uterus
 Large placenta
 Scarred lining of the uterus (endometrium)

Symptoms

The main symptom of placenta previa is sudden, painless vaginal bleeding that often occurs
near the end of the second trimester or beginning of the third trimester. In some cases,
there is severe bleeding, or hemorrhage. The bleeding may stop on its own but can start
again days or weeks later.

There may be uterine cramping with the bleeding. Labor sometimes starts within several
days after heavy vaginal bleeding. However, in some cases, bleeding may not occur until
after labor starts.

See: Vaginal bleeding in pregnancy

Signs and tests

Your health care provider can diagnose placenta previa with an ultrasound exam. Most
cases of placenta previa are identified by routine ultrasound during pregnancy.

Treatment

Treatment depends on various factors:

 How much bleeding you had

 Whether the baby is developed enough to survive outside the uterus
 How much of the placenta is covering the cervix
 The position of the baby
 The number of previous births you have had
 Whether you are in labor

Many times the placenta moves away from the cervical opening before delivery.

If the placenta is near the cervix or is covering a portion of it, you may need to reduce
activities and stay on bed rest. Your doctor will order pelvic rest, which means no
intercourse, no tampons, and no douching. Nothing should be placed in the vagina.

If there is bleeding, however, you will most likely be admitted to a hospital for careful
monitoring.

If you have lost a lot of blood, blood transfusions may be given. You may receive medicines
to prevent premature labor and help the pregnancy continue to at least 36 weeks. Beyond
36 weeks, delivery of the baby may be the best treatment.

If your blood type is Rh-negative, you will be given anti-D immunoglobulin injections.

Your health care providers will carefully weigh your risk of ongoing bleeding against the
risk of an early delivery for your baby.
Women with placenta previa most likely need to deliver the baby by cesarean section. This
helps prevent death to the mother and baby. An emergency c-section may be done if the
placenta actually covers the cervix and the bleeding is heavy or very life threatening.

Expectations (prognosis)

Placenta previa is most often diagnosed before bleeding occurs. Careful monitoring of the
mother and unborn baby can prevent many of the significant dangers.

The biggest risk is that severe bleeding will require your baby to be delivered early, before
major organs, such as the lungs, have developed.

Most complications can be avoided by hospitalizing a mother who is having symptoms, and
delivering by C-section.

Complications

Risks to the mother include:

 Death
 Major bleeding (hemorrhage)
 Shock

There is also an increased risk for infection, blood clots, and necessary blood transfusions.

Prematurity (infant is less than 36 weeks gestation) causes most infant deaths in cases of
placenta previa. The baby may lose blood if the placenta separates from the wall of the
uterus during labor. The baby also can lose blood when the uterus is opened during a C-
section delivery.

Calling your health care provider

Call your health care provider if you have bleeding from the vagina at any point in your
pregnancy. Placenta previa can be dangerous to both you and your baby.

Prevention

This condition is not preventable.

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001902

Placenta previa

Definition
Placenta previa is an uncommon pregnancy complication that can cause excessive bleeding
before or during delivery.

Soon after conception, the placenta begins to form. This oval, flat organ provides oxygen
and nutrients to your growing baby and removes waste products from your baby's blood. It
attaches to the wall of your uterus, and your baby's umbilical cord arises from it, forming a
vital connection between you and your baby.

Placenta previa occurs when the placenta attaches to the lower part of your uterine wall,
partially or totally covering your cervix. When the cervix starts to open in preparation for
labor, the placenta is detached, which can trigger severe vaginal bleeding. Thankfully,
placenta previa is nearly always detected before a woman or her baby is in significant
danger.

Symptoms

Painless, bright red vaginal bleeding in the second half of pregnancy is the main sign of
placenta previa.

Although some women have light bleeding or spotting during the first trimester or early
second trimester, bleeding associated with placenta previa usually occurs near the end of
the second trimester or the beginning of the third. The amount of bleeding may range from
light to heavy. And it usually stops, but it nearly always recurs days or weeks later. Some
women who have placenta previa experience contractions with the bleeding.

Types of placenta previa

There are three specific types of placenta previa:

 Total placenta previa. In total placenta previa, the placenta completely covers the
cervix.
 Partial placenta previa. In partial placenta previa, the placenta partly covers the
cervix.
 Marginal placenta previa. In marginal placenta previa, the placenta approaches
the edge of the cervix.

Low-lying placenta is a term used to describe a placenta that lies low in the uterus but isn't
quite close enough to the cervix to qualify as marginal placenta previa. This condition
usually doesn't cause signs or symptoms during pregnancy, but it may cause bleeding after
delivery.

When to see a doctor

If you're pregnant, seek regular prenatal care. If you experience any vaginal bleeding
during your second or third trimester, call your health care provider right away. Your
health care provider will likely do an ultrasound to determine the source of the bleeding.
If you've been diagnosed with placenta previa, make sure that any health care provider you
see during pregnancy is aware of the condition. Examining the cervix can lead to heavy
bleeding. Sex is also off-limits for the rest of the pregnancy.

Causes

Early in pregnancy, the placenta may implant in the lower part of the uterus. As the uterus
grows, the placenta usually moves up and away from the opening of the uterus (cervix). If it
doesn't, the cervix may be blocked. This is placenta previa.

Placenta previa is associated with:

 Scars in the lining of the uterus (endometrium)

 A large placenta, such as with a multiple pregnancy
 An abnormally shaped uterus

Risk factors

Placenta previa is more common among women who:

 Have already delivered at least one baby

 Had a previous C-section
 Had placenta previa with a previous pregnancy
 Are age 35 or older
 Are Asian
 Smoke
 Are carrying twins, triplets or other multiples
 Have had a previous uterine surgery, such as myomectomy to remove uterine
fibroids or dilation and curettage (D and C) to scrape the uterine lining

Complications

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

 Bleeding. One of the biggest concerns with placenta previa is the risk of severe
vaginal bleeding (hemorrhage) during labor, delivery or the first few hours after
delivery. The bleeding can be heavy enough to cause maternal shock or even death.
 Premature birth. Severe bleeding may prompt an emergency C-section before your
baby is full term.
 Placenta accreta. If the placenta implants too deeply and firmly into the uterine
wall, the placenta may not spontaneously detach from the uterus after delivery —
an uncommon condition known as placenta accreta. This can result in severe
bleeding and, often, the need for surgical removal of the uterus (hysterectomy).
Tests and diagnosis

Placenta previa is diagnosed through ultrasound, either during a routine prenatal

appointment or after an episode of vaginal bleeding. Placenta previa is nearly always
detected before a woman or her baby is in significant danger.

Diagnosis before 20 weeks of pregnancy

It's not unusual to detect a low-lying placenta or to see the placenta covering the cervix
during a routine midpregnancy ultrasound. Most of these cases resolve on their own before
delivery, as the uterus grows and the placenta migrates away from the cervix. You may
need additional ultrasounds to track the position of your placenta. The longer placenta
previa persists, the more likely it will be present at delivery.

Diagnosis after 20 weeks of pregnancy

Your health care provider may detect placenta previa later in pregnancy during an
ultrasound for an unrelated reason. At this stage of pregnancy, however, vaginal bleeding is
usually the tip-off.

If you experience vaginal bleeding during the second or third trimester, call your health
care provider right away. You'll likely need to go to your doctor's office or the hospital to
determine the cause of the bleeding. In most cases, your health care provider can use an
abdominal ultrasound to quickly confirm or rule out placenta previa.

A definitive diagnosis may require a combination of abdominal ultrasound and

transvaginal ultrasound, which is done through a wand-like device (transducer) placed
inside your vagina. Your health care provider will closely monitor the location of the
transducer in your vagina to prevent any bleeding. Rarely, magnetic resonance imaging
(MRI) may be used to diagnose placenta previa.

If your health care provider suspects that you may have placenta previa, he or she will
avoid routine vaginal exams to reduce the risk of heavy bleeding. You may need additional
ultrasounds or, rarely, an MRI to determine the exact location of your placenta before
delivery. Your baby's heartbeat may be tracked as well.

Related conditions

Two uncommon conditions are often grouped with placenta previa because they can cause
vaginal bleeding in the late second or third trimester. If you have vaginal bleeding late in
your pregnancy, your health care provider will also consider these conditions before
making a diagnosis:

 Placental abruption. Rarely, the placenta separates from the uterus before birth.
This can deprive the baby of oxygen and nutrients and cause heavy bleeding that
may be dangerous for both mother and baby.
  Vasa previa. The umbilical cord usually develops in the center of the placenta. If the
umbilical cord attaches to the placenta in an unusual way, a portion of the blood
vessels normally inside the umbilical cord may be left unprotected. If these
unprotected blood vessels cross the cervix, it's known as vasa previa. If these blood
vessels rupture, the baby faces life-threatening bleeding.

Treatments and drugs

Treatment for placenta previa depends on various factors, including:

 The amount of vaginal bleeding

 Whether the bleeding has stopped
 Your baby's gestational age
 Your health
 Your baby's health
 The position of the placenta and the baby

For little or no bleeding

If you have marginal placenta previa or another form of placenta previa but little or no
bleeding, your health care provider may recommend bed rest at home. Depending on the
circumstances, you may need to lie in bed most of the time —sitting and standing only
when necessary. You'll need to avoid sex and vaginal exams, which can trigger bleeding.
Exercise is usually off-limits, too. Discuss the do's and don'ts with your health care provider
— and be prepared to seek emergency medical care if you begin to bleed.

If your placenta doesn't cover your cervix, you may be allowed to attempt a vaginal
delivery. If you begin to bleed heavily, you may need an emergency C-section.

For heavy bleeding

If you're bleeding, you may need bed rest in the hospital. If the bleeding is severe, you may
need a blood transfusion to replace lost blood. You may also benefit from medications to
prevent premature labor.

Your health care provider will likely plan a C-section as soon as the baby can be safely
delivered, ideally after 36 weeks of pregnancy. If it's not possible to wait, you will need an
earlier C-section. In this case, you may be given corticosteroids to speed your baby's lung
development. In as little as 48 hours, these potent medications can help your baby's lungs
prepare for life outside the uterus.

For bleeding that won't stop

If your bleeding can't be controlled or your baby is in distress, you may need an emergency
C-section — even if the baby is premature.
Coping and support

Pregnancy is supposed to be a time of awe and anticipation. If you're diagnosed with

placenta previa, you're sure to be worried about how your condition will affect your baby.
Some of these strategies may help:

 Learn about placenta previa. Gathering information about your condition may
help you feel less scared. Talk to your health care provider, do some research on
your own and connect with other women who've had placenta previa.
 Prepare for a C-section. Placenta previa may prevent you from delivering your
baby vaginally. Ask your health care provider every C-section question that comes
to mind. If you're disappointed that you may not have a vaginal birth, remind
yourself that your baby's health and your health are more important than the
method of delivery.
 Make the best of bed rest. If your health care provider recommends bed rest, fill
your days by planning for your baby's arrival. Read about newborn care or purchase
newborn necessities, either online or from catalogs. Or use the time to balance your
checkbook, organize old photo albums or catch up on thank-you notes.
 Take care of yourself. Surround yourself with things that bring you comfort, such
as a good book or a favorite pair of pajamas. Give your partner, friends and loved
ones concrete suggestions for ways to help, such as bringing a favorite food or
simply stopping by for a visit.

A condition that could cause excessive bleeding before or during delivery isn't part of any
mother's vision of the perfect pregnancy. Yet most women who have placenta previa go on
to deliver a healthy baby — which is far better than a perfect pregnancy.

http://www.mayoclinic.com/health/placenta-previa/DS00588