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Placenta Previa

The placenta is responsible for nourishing the baby during pregnancy. At the start of pregnancy, it will be located near the lower part of the uterus. However as the pregnancy progresses the uterus grows and moves upwards typically pulling the placenta along with it. By the last trimester it should be well towards the top of the uterus and out of the way of the cervix making room for the baby to be delivered. In some cases though, the placenta stays low partially or completely obstructing the opening of the uterus. This condition is referred to as a previa.

Diagnosis

Often, during a routine sonogram the condition will be observed and diagnosed. Some women however may begin experiencing bleeding in the second half of pregnancy that is not accompanied by pain, which will be a clue for doctors.

Other symptoms include a breech baby, a baby lying sidewise or transverse or a larger than average uterus. The baby would be in an unusual position due to the placenta blocking the normal location in the uterus.

Types

- Complete: This is where the placenta covers the entire cervical opening.
- Partial: This is where the placenta covers some of the cervical opening.
- Marginal: This is where the placenta touches the cervix but doesn't obstruct it.

Risk Factors

Placenta previa occurs in approximately one out of every 200 pregnancies. However, in cases diagnosed within the second trimester, almost 90 percent will correct themselves prior to delivery. It is more commonly seen in women who smoke, use cocaine or have abnormally developed uteruses. Those who have had many pregnancies, are carrying multiples, or have uterine scarring from previous pregnancies, abortions, uterine surgery, or previous c-sections are also at increased risk. Those with large uteruses or abnormally shaped uteruses or those with endometriosis also have an increased incidence of placenta previa. Those over 35 also are at more risk for the condition.

Treatment Options

As mentioned, most cases correct themselves but for those women who are near the end of their pregnancy and still have an obstructed cervix, placenta previa usually means scheduling a cesarean section. Some women will be hospitalized to be prepared for a quick c-section once labor begins.

Treatment will depend on the severity of symptoms, particularly bleeding and the type of placenta previa.

For those without bleeding and only a marginal or partial previa, most times women will be instructed to avoid intercourse or having anything penetrate the vagina and that includes limiting pelvic exams. Bedrest may be ordered.

For those experiencing bleeding, hospitalization is more common. If heavy bleeding has occurred, blood transfusions may be necessary. Rh negative mothers will need a shot of Rho-Gam. Prior to 36 weeks of pregnancy, drugs may be administered to attempt to hold off labor. After 36 weeks, typically delivering the baby is the best option.

Cesareans are almost always necessary to protect the life of mother and baby to prevent heavy bleeding. Should the cervix be entirely obstructed or the bleeding heavy an emergency c-section may be needed to save both lives.

Coping with Placenta Previa

• Know your situation by asking questions. How much of the cervix is obstructed? When will we get another ultrasound to check on the position?
• Realize that until later in the third trimester, chances are your previa will resolve itself.
• If you must limit sexual activity, find other intimate ways to be close with your partner.
• Expect more frequent ultrasounds and hospital visits.
• Keep your travels close to home. You will probably be postponing any big trips if you are still experiencing previa in the third trimester.
• Find ways to keep from going stir-crazy if put on bedrest. Have a laptop nearby and chat with other moms on bedrest online. Have plenty of reading material or even small handcrafts to do. Catch up on all the movies you haven't seen.
• Prepare for a cesarean section. Learn all you can about the process and prepare your partner for it as well. Get a tour of where you'll deliver and find out the procedure and details at your hospital.

Realize that the odds of placenta previa becoming a serious risk to your pregnancy are still quite low. It is an easily monitored condition and the treatment is readily available. Try to relax and if you must endure some extra care at the end of the pregnancy, understand it will be for a short time and then you'll be rewarded with a healthy baby.

Article Sources:

http://www.nlm.nih.gov/medlineplus/ency/article/000900.htm
http://www.marchofdimes.com/complications_previa.html

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