Placenta Previa| Symptoms, Types and Diagnosis |Management During Pregnancy

What Is Placenta Previa ?

In Placenta previa , the placenta grows in the lowest part of the womb and covers some part or sometimes all of the cervix ( the opening to your birth canal). Due to this it can lead to severe bleeding during pregnancy and delivery.
There are three main types:

• Marginal placenta previa: The placenta is right at the border of your cervix but does not cover it. This is considered low-risk, but still requires observing because it may shift over time.

• Partial placenta previa: The placenta fractionally covers the cervical opening, but not all of your cervix. This is grouped as major previa and carries a  risk of bleeding.

• Complete placenta previa: In this placenta completely covers the Internal cervix. This is the most serious form, often requiring planned caesarean delivery.

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How Common is This Condition

Placenta previa occurrence is unusual. It affects about 1 in 200 pregnancies by the third trimester.
Some women are more likely to develop placenta previa than others due to:

• Have been pregnant before? Your risk goes up with each pregnancy

• Previous caesarean delivery or other uterine surgery

• Carrying twins, triplets, or more

• Women over 35 years of age

• Smokers

• Using cocaine

• Previous placenta previa

• Previous miscarriages or abortions

Having these risk factors doesn’t always mean you’ll develop placenta previa. But you have to be alert and do checkups with your doctor.

Signs and Symptoms to Watch For

1. Painless Vaginal Bleeding (Usually in the 2nd or 3rd Trimester) - If you notice bright red bleeding from your vagina that frequently comes and goes. It can be light or heavy. The most important thing is that it usually doesn’t hurt, which makes it easy to ignore. 

2. Bleeding After Sex - It could be a warning sign if you bleed after intercourse during pregnancy. In placenta previa, the placenta grows in the lowest part of the uterus and may easily be irritated. 

3. Bleeding Without Any Obvious Reason - If you’re in your second or third trimester and you notice blood in your underwear suddenly, without a fall, injury, or stress, it can be concerning. Simply ignoring it can be unsafe. 

4. Early Contractions or Cramping - Some women may feel mild cramps or tightening, though it’s less common. These can be mistaken for early labor pains. 

5. No Pain Doesn’t Mean No Problem - Placenta previa acts as a silent killer; it is not painful, but that doesn’t mean everything is okay. It can be dangerous if not diagnosed early.

 

 

 Diagnosis Process

1. Routine Ultrasound Scan
It is the most common method to detect placenta previa.

• The placenta previa is caught during a mid-pregnancy ultrasound (around 18–22 weeks) in most cases.

• This helps doctors see the position of the placenta in the cervix.

2. Transvaginal Ultrasound (Safe & Accurate)
Transvaginal Ultrasound involves inserting a small probe into the vagina to get accurate image of the placenta's location.

• It is safe during pregnancy and does not harm the mother and baby.

• Using this provides high-resolution images for precise diagnosis. 

3. Follow-Up Scans

• When the previa is found early, doctors usually monitor it over time, whether the placenta moves up naturally as the uterus grows.

• The additional ultrasounds in the third trimester help confirm if it has been resolved or continues.

4. Physical Exam
If you are experiencing painless vaginal bleeding:

• Doctors avoid pelvic exams if bleeding is present, as it can worsen the condition.

• They rely on imaging tests to determine if the cause is placenta previa.

Reminder: If you have vaginal bleeding during pregnancy, let your doctor know immediately. Early diagnosis makes a big difference in keeping both you and your baby safe.

Treatment Options and Management

1. Monitoring and Observation
In many cases, especially when detected early in pregnancy, the placenta may move up on its own. This is called placental migration.

• To closely monitor placenta previa go for regular ultrasounds.

• The doctor may suggest you to avoid activities that could trigger bleeding.

2. Activity Modifications
If you have verified case of placenta previa:

• Avoid heavy lifting, exhausting exercises, and sexual intercourse.

• Often advised for rest, especially in the third trimester.

• In some cases, bed rest may be suggested if bleeding occurs.

3. Medications and Hospital Care
For women experiencing vaginal bleeding, the doctor may:

• Prescribe corticosteroids to help the baby’s lungs develop if early delivery becomes necessary.

• Recommend hospitalization for close monitoring if bleeding is heavy or continued.

• Use IV fluids and blood transfusions if needed.

4. Delivery Planning
The biggest part of placenta previa management involves planning a safe delivery. The type of placenta previa resolute how your baby will be delivered:

•  Vaginal Delivery – This is possible only in marginal or low-lying placenta previa cases if the placenta moves away from the cervix.

• Cesarean Section – which is also called C-section is necessary for complete placenta previa or ongoing bleeding or complications.

• Doctors usually plan a C-section between 36 and 37 weeks to prevent emergency delivery.

5. Emergency Situations
If you are experiencing heavy vaginal bleeding, signs of labor or severe abdominal pain you may need emergency care and an immediate cesarean delivery to protect both mother and baby.

Tips for Managing Placenta Previa During Pregnancy

• Must attend all prenatal visits.

• Report immediately to the doctor if you’re facing any bleeding or cramping.

• Follow the doctor’s advice regarding any physical activity and rest.

• Create a delivery plan for placenta previa with your healthcare provider.

Impact on Pregnancy and Delivery

1. Risks During Pregnancy
Placenta previa can lead to several issues during your pregnancy, especially during the second and third trimesters.

• Vaginal Bleeding: Painless vaginal bleeding is the most common and serious symptom, often happening after 20 weeks of pregnancy. Bleeding can be light or heavy and can happen more than once.

• Early Labor (Preterm Birth): Women with placenta previa are at higher risk of preterm labor and can deliver before 37 weeks.

• Fetal Growth Restriction: In rare cases, reduced blood flow may affect the baby’s growth, leading to low birth weight or intrauterine growth restriction (IUGR).

2. Impact on Delivery
Placenta previa commonly affects how and when the baby will be delivered. In most cases of complete or partial placenta previa, a C-section delivery is important to avoid life-threatening bleeding during vaginal birth.
C-section should be planned around 36–37 weeks or may be scheduled earlier if bleeding is severe.
Attempting vaginal delivery when the placenta covers the cervix can lead to massive hemorrhage, posing risks to both mother and baby.

3. Postpartum Complications
Women with placenta previa are at higher risk of complications after birth, such as:

• Postpartum hemorrhage (heavy bleeding)

• Placenta accreta (when the placenta is abnormally attached to the uterus)

• Longer recovery time after C-section

4. Emotional and Mental Health Impact
Dealing with placenta previa can be emotionally challenging. Worries about bleeding, early delivery, and surgery can cause stress and anxiety. It becomes essential to get support from healthcare providers, family, and mental health professionals.

Future Pregnancies

If you've suffered from placenta previa before, then you're probably curious about your chances of experiencing it again. The truth is, the risk goes up too high. Women who've had placenta previa before have about a 4-8% chance of having it in future pregnancies. That's considerably higher than the general population's risk of less than 1%.
Several factors can bump up this reoccurrence risk:

• Previous cesarean deliveries

• Multiple D&C procedures

• Uterine scarring

• Having multiple babies in the past

The more c-section deliveries you've had in the past, the higher the chances of getting placenta previa. It's not something to panic about, but worth discussing with your doctor when planning another pregnancy.

 (FAQs)

1. What are the signs and symptoms of placenta previa?
The most common symptom of placenta previa is bright red, painless vaginal bleeding in the second or third trimester. Other warning signs may include bleeding after intercourse, unexplained bleeding without injury, mild cramping, or early contractions

2. Is placenta previa painful?
No, placenta previa is often not painful, which can make it more difficult to detect.

3. What causes placenta previa?
The exact cause is unknown, but certain risk factors like previous c-section, multiple pregnancies, and smoking during pregnancy increase the chances.

4. Is placenta previa dangerous for the baby and mother?
Yes, if left untreated, placenta previa can lead to severe bleeding, premature birth, or complications during delivery.

5. Can placenta previa go away on its own?
In some cases, especially if detected early in the second trimester, the placenta may move upward as the uterus grows, resolving the condition itself.

6. Can I have a normal delivery with placenta previa?
If the placenta completely or fractionally covers the cervix, a C-section delivery is usually required for safety. If the placenta is only low-lying and moves upward, vaginal delivery may still be possible but under medical supervision.
 
SOURCE:https://www.ncbi.nlm.nih.gov/books/NBK539818/