Placenta Complications in Pregnancy and Birthby Katlyn Joy
The placenta has an important role in pregnancy, acting as the lifeline to the baby by supplying nutrients and oxygen to the growing child via the umbilical cord. However, if any abnormalities occur with the placenta, the results can be serious to both mother and baby.
This condition arises in about 1 in 200 pregnancies in the third trimester and is when the placenta is located low in the uterus, instead of higher where it should, and obstructs the cervix either partially, such as with partial previa, or completely as with complete previa. If only the edge of the cervix is affected, this is called marginal previa.
Placenta previa is most common among women who:
- Have had the condition previously.
- Are carrying multiples.
- Use cocaine.
- Smoke cigarettes.
- Are over 35 years of age.
- Have had uterine surgery.
- Are pregnant for the fourth time or more.
- Breech or transverse or side-lying baby.
- Living at a high altitude.
Frequently, the primary symptom is bleeding without pain during the third trimester. However, up to one third of those with previa don't have bleeding at all. Often the uterus measures larger than expected for gestational age. Contractions prematurely in the pregnancy often occur as well.
Often the condition is discovered during a routine sonogram, and typically those cases discovered in the middle of pregnancy or the second trimester will correct themselves. Once diagnosed, the pregnancy will be monitored. Many times mothers will be put on bed rest for the duration of labor if the case is serious enough. If bleeding, mother may be admitted to the hospital where blood transfusions may be indicated. If preterm labor is a threat, steroid shots may be administered to speed up lung development in the baby.
The baby and mother's health will be watched and if significant risk is determined, a cesarean section may be the best option. This is especially true with preterm labor after the 34th week of pregnancy.
During labor when the cervix begins dilating, the blood vessels in the placenta may tear and result in significant bleeding.
Placental abruption is when the placenta shears away from the uterine wall during pregnancy, rather than during labor. This may be a mild case or a severe one, and occurs in about 1 in every 150 pregnancies.
Who is at Risk:
- Cigarette smokers.
- Cocaine users.
- Those with uterine infection.
- Over age 35.
- Pregnant with multiples.
- Water broke before 37th week of pregnancy
- History of abruption.
- Problems with the umbilical cord or uterus.
- Abdomen trauma to mother.
- Hypertension in the mother.
- Excess fluid around baby.
Symptoms of Placental Abruption
Usually bleeding is the main symptom. Others may include abdominal pain or back pain, especially when it's sudden and severe. With rapid or excessive blood loss, a woman may go into shock as well.
Usually the diagnosis relies on your account of pain, bleeding and symptoms. An ultrasound may be done, but can miss the condition. A physical exam may be helpful in determining placental abruption.
The treatment for placental abruption is dependent on how far along you are and how severe the symptoms are. For early and mild cases, a hospital stay is usually still required. For severe cases, immediate delivery is necessary via a c-section. In serious cases where bleeding cannot be controlled, a hysterectomy may be required. Blood transfusions are also common in heavy bleeding cases.
The worst case scenario is when rapid and heavy blood loss threatens the life of both mother and infant. If baby has to be delivered early in pregnancy, the risks to baby of later growth and development problems are a concern. Stillbirth is also a risk.
While placenta problems seem like a high risk in pregnancy by the numbers, the majority of these are mild or even resolve themselves without any treatment. Women with placenta problems will often be carefully monitored during this and subsequent pregnancies. She may need to go on bed rest, avoid travel and sexual intercourse.
Other placenta problems may involve the thickness of the placenta or how deeply it imbeds in the uterus. Scar tissue may develop in the placenta or an extra lobe may grow in it. All these conditions are monitored, often through ultrasounds and physical exams. You may require extra doctor visits and bed rest may be advised.
However, with most women the problems will be caught and treated in time to prevent serious complications from ever occurring.
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