A.

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.

B. 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.

C. 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.
D. 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

E. 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

F. 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).

G. 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.

H. 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.

I. 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.