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 indicate problems with the placenta. Some 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 accompanying bleeding

Note: Not everyone with placenta previa experiences vaginal bleeding. Approximately one-third of individuals with placenta previa do not have this symptom.

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.

There are certain risk factors that can increase one’s chances of developing placenta previa:

• Previous cesarean delivery
• Multiple pregnancies (twins or more)
• Advanced maternal age
• Uterine abnormalities or surgeries
• History of placenta previa in previous pregnancies
• Smoking or drug use during pregnancy

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:

• Advanced age: Women above the age of 35 years are at increased risk of developing this complication due to changes in the uterine environment.
• Previous history of placenta previa: Women with a prior history are at a higher risk of experiencing it again in their current pregnancy and should be closely monitored during prenatal care.
• Smoking: Smoking during pregnancy increases the risk of placenta previa by 2.6 times compared to nonsmokers.
• Multiple pregnancies: Being pregnant multiple times or with more than one baby (e.g., twins or triplets) can increase the risk of placenta previa.
• 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.
• Uterine fibroids: These noncancerous growths on the uterus during childbearing years can lead to placenta previa.
• Uterine surgery: A previous C-section or a D&C (dilation and curettage) can increase the chances of developing placenta previa.
• Assisted reproductive technology (ART): Medical procedures that help individuals or couples conceive, including techniques like in vitro fertilization (IVF), may increase the risk of placenta previa due to the potential for abnormal placental implantation in the uterus after these fertility treatments.
• Previous scars: Scars in the uterus can create an area with increased oxygen and collagen, which may cause the placenta to cover the cervix or grow into the uterine walls.
• Preeclampsia: This condition involves high blood pressure and organ damage that can sometimes affect the placenta.
• Use of certain recreational drugs: The use of drugs such as cocaine during pregnancy increases the risk of placenta previa due to their 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.

Placenta previa is usually diagnosed during a routine ultrasound around 20 weeks of pregnancy. It may be identified during a routine prenatal appointment or following an episode of vaginal bleeding.

The diagnosis is typically made through the following methods:

• Medical history: A thorough medical history is essential for detecting placenta previa as it helps identify risk factors.
• Physical examination: This includes a speculum examination to assess vaginal bleeding. Digital examination should be avoided to prevent massive hemorrhage due to the risk of dislodging the placenta.
• Imaging techniques:
  • Ultrasound: This is the primary diagnostic tool for placenta previa, providing non-invasive, detailed images of the placenta's position and the cervix's location.
  • Transvaginal ultrasound: In 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 offers detailed images of the placenta's location relative to the cervix and uterine walls.
  • Magnetic resonance imaging (MRI) scan: This can also be used to diagnose placenta previa, particularly in cases where ultrasound results are inconclusive or further clarification is needed.

Placenta previa cannot be prevented; however, certain risk factors can be mitigated, including:

• Smoking
• Use of recreational drugs, such as cocaine

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 activities such as running, exercising, and lifting.
• Bed rest at home.
• Pelvic rest, which involves 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, including:
• Indomethacin.
• Nifedipine.
• Intravenous (IV) magnesium sulfate to delay labor.
• Steroid shots of betamethasone to help the baby's lungs develop faster.
• A shot of special medicine called Rhogam if the mother’s blood type is Rh-negative to avoid 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 some cases, an emergency C-section may be recommended if the bleeding is heavy and cannot be controlled.

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: Abstain from sexual intercourse and avoid 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.

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 occurs 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 condition occurs when a baby in the womb does not grow as expected due to poor placental blood supply.
• Increased risk of death: Placenta previa can increase the risk of neonatal deaths, referring to the unfortunate loss of babies within the first 28 days of life.

Effect on the mother

• Severe bleeding: In some cases of placenta previa, severe bleeding may occur prior to, during, or after labor and delivery, requiring blood transfusions.
• Placenta accreta: This is a serious but rare condition that occurs when the placenta grows deeply into the uterine wall, causing 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.

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 until the time of delivery. Here are other things that can help:

• 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.
• 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.
• Talk to your doctor: Always stay in direct contact with your doctor regarding any changes. Call your doctor if you notice any vaginal bleeding or contractions.
• 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.
• Prepare your mind for a C-section delivery: Be emotionally and practically ready for a cesarean delivery if the placenta doesn't move on its own by the end of the gestational phase.
• Keep your hospital bag ready: Prepare a hospital bag well in advance, including essentials for both you and your baby, in case of an unexpected hospital stay.