Placenta Praevia

The placenta is the pancake-shaped organ – normally located near the top of the uterus – that supplies your baby with nutrients through the umbilical cord. “Placenta Praevia” simply means a low-lying placenta, that’s closer to the mouth of the uterus. It is fairly common in the early stages of pregnancy and could move upwards as the pregnancy progresses.

Most women who develop placenta praevia have no apparent risk factors. But it has been found that placenta praevia usually occurs in women whose uterine walls have been scarred from previous pregnancies, caesareans, uterine surgery or D&Cs following miscarriage. Smoking, living at high altitudes or carrying more than one fetus also increases the probability of placenta praevia.

Women who are pregnant with twins or multiples are at a higher risk. And the more babies you’ve had and the older you are, higher the risk.

What are The Risks Of Placenta Praevia?

Placenta praevia is not usually a problem early in pregnancy. But if it persists into later pregnancy, it can cause bleeding, which may require you to deliver early or can lead to other complications. If you have placenta praevia when it’s time to deliver your baby, you’ll most probably have a
c-section. Fetuses with low-lying placentas do not usually ‘drop’ into the pelvis in preparation for delivery as the placenta blocks their way. Vaginal delivery may become impossible if the placenta blocks the cervix partially or completely.

If the placenta covers the cervix completely, it’s called a complete or total praevia. If it’s right on the border of the cervix, it’s called a marginal praevia. (You may also hear the term “partial previa,” which refers to a placenta that covers part of the cervical opening once the cervix starts to dilate.) If the edge of the placenta is within 2 centimeters of the cervix but not bordering it, it’s called a low-lying placenta. The location of your placenta will be checked during your mid-pregnancy ultrasound exam.

Bleeding In Placenta Praevia

Bleeding from a placenta praevia happens when the cervix begins to thin out or dilate (even a little) and disrupts the blood vessels in that area. It’s usually painless, can start without warning, and can range from spotting to extremely heavy bleeding. If your bleeding is severe, you may have to deliver your baby right away, even if he’s still premature. You may also need a blood transfusion.

It’s unusual for bleeding to start before late in the second trimester, and about half the time it doesn’t begin until you’re nearly full-term (37 weeks). The bleeding will often stop on its own, but it’s likely to start again at some point.

If you start bleeding or have contractions, you’ll need to be hospitalized. What happens then will depend on how far along you are in your pregnancy, how heavy the bleeding is, and how you and your baby are doing. If you are near full-term, your baby will have to be delivered by c-section right away.

If the bleeding stops, and both you and your baby are in good condition, you’ll probably be sent home. But you’ll need to return to the hospital immediately if the bleeding starts again.

I Have Placenta Praevia: What Next?

If you have been diagnosed with placenta praevia, the gravity of the situation depends on how far along you are in pregnancy.

If you are in the second trimester, and your ultrasound shows that you have placenta praevia, don’t panic. As your pregnancy progresses, your placenta is likely to “migrate” farther from your cervix and will no longer be a problem. As the placenta is implanted in the uterus, it doesn’t actually move, but it can end up farther from your cervix as your uterus expands. Usually, as the placenta grows, it’s likely to grow towards the richer blood supply in the upper part of the uterus.

It has been found that women who have been diagnosed with placenta praevia in mid-pregnancy, only about 10 per cent still have it when they deliver their baby. A placenta that completely covers the cervix is more likely to remain that way than one that is bordering it (marginal) or nearby (low-lying). Even if the placenta praevia is discovered later in pregnancy, there is a small chance that the placenta may still move away from the cervix (though this is less likely to happen).

During pregnancy, if ultrasound reveals that your placenta is still covering or is too close to your cervix, you’ll be monitored carefully, have regular ultrasounds, and need to watch for vaginal bleeding. You’ll be put on “pelvic rest,” which means no intercourse or vaginal exams for the rest of your pregnancy. And you’ll be advised to take it easy and avoid activities that might provoke bleeding, such as strenuous housework or heavy lifting.

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