How to deal with placenta previa

Placenta previa happens when the placenta lies low in the uterus and covers all or part of the opening to the vagina.

If you develop the condition early in your pregnancy, it usually isn’t a problem since the placenta grows upward with the uterus during pregnancy.

If you develop the condition later in pregnancy and the birth canal is blocked it can cause serious bleeding and may prevent vaginal delivery.

Talk with your providers about ways to deal with placenta previa, which could include having a planned c-section (caesarean birth).

The placenta attaches to the wall of the womb (uterus) and supplies the baby with food and oxygen through the umbilical cord.

Placenta previa is a condition in which the placenta lies very low in the uterus and covers all or part of the opening to the cervical opening that sits at the top of the vagina.

Placenta previa happens in about 1 in 200 pregnancies. If you have placenta previa early in pregnancy, it usually isn’t a problem because it may resolve as the pregnancy grows. However, if it persists it can cause serious bleeding and other complications later in pregnancy.

Normally, the placenta grows into the upper part of the uterus wall, away from the cervix. It stays there until your baby is born. During the last stage of labor, after the baby is born the placenta separates from the wall, and your contractions help push it into the birth canal (vagina). This is also called the afterbirth.

During labor, your baby passes through the cervix into the birth canal. If you have placenta previa, when the cervix begins to thin out (efface) and open up (dilate), blood vessels connecting the placenta to the uterus may tear. This can cause severe bleeding during labor and birth, putting you and your baby in danger.

If a placenta previa is identified by ultrasound and appears to block the cervix, no vaginal exams are performed and an elective c-section is planned.

What causes placenta previa?

No one knows what causes placenta previa. However, you may be at higher risk for placenta previa if you:

  • Have had a c-section in the past.
  • Have had in vitro fertilization for infertility. .
  • Use cocaine.
  • Are 35 or older.
  • Have been pregnant before.
  • Are pregnant with twins, triplets or more.
  • Have had placenta previa in an earlier pregnancy.
  • Have had surgery on your internal reproductive organs, such as myomectomy or tissue removal from the lining of your uterus (this is also called dilation and curettage or D&C). Some people have a D&C after miscarriage.

If you’ve had placenta previa before, what are your chances of having it again?

If you’ve had placenta previa in a past pregnancy, you have a 2 to 3 in 100 (2 to 3 percent) chance of having it again.

What are the symptoms of placenta previa?

Most of the time, placenta previa has no symptoms; it is often found during a routine ultrasound test.

For those who do have symptoms, the most common is painless bleeding from the vagina during the second half of pregnancy. You also may have contractions. Call your health care provider right away if you have vaginal bleeding anytime during your pregnancy. If the bleeding is severe, go to the hospital.

Not everyone who has placenta previa has vaginal bleeding. In fact, about one-third of people with placenta previa don’t have this symptom.

How is placenta previa diagnosed?

A prenatal test that uses sound waves to show a picture of your baby in the womb (ultrasound) usually can find placenta previa and determine the placenta’s location. In some cases, your provider may do an ultrasound through the birth canal (transvaginal ultrasound) or a translabial ultrasound instead. In places where it’s available, three-dimensional ultrasound may be used.

Even if you don’t have vaginal bleeding, a routine, second trimester ultrasound may show that you have placenta previa. Don’t be too worried if this happens. Placenta previa found in the second trimester requires repeat follow-up ultrasounds to assure that the cervix is no longer blocked. If the placenta is no longer covering the cervical opening, you can usually have a vaginal delivery.

How is placenta previa treated?

Treatment depends on how far along you are in your pregnancy, the seriousness of your bleeding and the health of you and your baby. The goal is to keep you pregnant as long as possible. Your provider may recommend no vaginal exams or sex to prevent damage to the placenta and bleeding. Providers recommend c-section for nearly everyone with placenta previa to prevent severe bleeding.

If you are early in your pregnancy and have no symptoms, your provider will probably recommend no treatment, but will schedule follow-up ultrasounds to make sure everything is normal.

If you are bleeding as a result of placenta previa, you need to be closely monitored in the hospital. If tests show that you and your baby are doing well, your provider may give you treatment to try to keep you pregnant for as long as possible.

If you have a lot of bleeding, you may be treated by having new blood put into your body (blood transfusions). Your provider also may give you medicines called corticosteroids to help speed up development of your baby’s lungs and other organs in case a preterm delivery is needed.

Your provider may want you to stay in the hospital until you give birth. If the bleeding stops, you may be able to go home. If you have severe bleeding due to placenta previa at about 34 to 36 weeks of pregnancy, your provider may recommend an immediate c-section.

At 36 to 37 weeks, your provider may suggest an amniocentesis to test the amniotic fluid around your baby to see if the lungs are fully developed. If they are, your provider may recommend an immediate c-section to avoid risks of future bleeding. Nowadays, providers may use corticosteroids to help the baby lung development while you are pregnant and to help avoid an immediate c-section.

At any stage of pregnancy, an emergency c-section may be necessary if you have dangerously heavy bleeding or if you and your baby are having problems.

Is there anything you should avoid if you have placenta previa?

If you have placenta previa that doesn’t require immediate treatment, your provider may recommend that you avoid doing the following:

  • Having sex that leads to orgasm
  • Vaginal penetration or vaginal examinations
  • Moderate and strenuous exercise
  • Lifting more than 20 pounds
  • Standing for more than four hours

All of these activities could lead to contractions that could lead to bleeding.

How can you reduce your risk for complications if you have placenta previa?

Have an ultrasound in the second trimester to identify location of the placenta. You may need follow up ultrasounds to help plan for a safe birth and delivery.

Follow your providers precaution instructions to prevent bleeding or complications. Contact your provider and go to the hospital if you have bleeding at any time during your pregnancy.

We don’t know how to prevent placenta previa, but you may be able to reduce your risk by not smoking and not using cocaine.

You also may be able to lower your chances of having placenta previa in future pregnancies by having a c-section only if it’s medically necessary. If your pregnancy is healthy and there are no medical reasons for you to have a c-section, it’s best to let labor begin on its own.

Placenta previa is when a pregnant woman’s placenta blocks the opening to the cervix that allows the baby to be born. It can cause severe bleeding during pregnancy and delivery. Mothers with placenta previa are also at higher risk of delivering prematurely, before 37 weeks of pregnancy.

The placenta is an organ that grows inside the lining of your uterus during pregnancy. It connects to the umbilical cord and carries oxygen and nutrients from you to your unborn child. It also moves waste away from your baby.

Placenta previa happens when the placenta partly or completely covers the cervix, which is the opening of the uterus. Your baby passes into the cervix and through the birth canal during a vaginal delivery. Normally, the placenta attaches toward the top of the uterus, away from the cervix.

Here’s what happens with placenta previa: As your cervix opens during labor, it can cause blood vessels that connect the placenta to the uterus to tear. This can lead to bleeding and put both you and your baby at risk. Nearly all women who have this condition will have to have a C-section to keep this from happening.

Types of placenta previa

You may have different outcomes depending on the type of placenta previa you have.

  • Complete previa is when the placenta covers the entire opening of the cervix.
  • Marginal previa, also called low-lying placenta, is when the placenta is close to the opening of the cervix but doesn’t cover it. It may get better on its own before the baby is due.

Placenta Previa Symptoms

You might notice:

  • Bright red bleeding from the vagina during the second half of your pregnancy. It can range from light to heavy, and it’s often painless. along with the bleeding. You might feel the cramping or tightening that comes with contractions, or feel pressure in your back.

If you have bled too much, you may have other symptoms, such as anemia, pale skin, rapid and weak pulse, shortness of breath, or low blood pressure.

Placenta Previa Risk Factors

Placenta previa happens in about 1 out of every 200 pregnancies. You may be more likely to get it if you:

  • Smoke cigarettes or use cocaine
  • Are 35 or older
  • Have been pregnant before
  • Have had a C-section before
  • Have had other types of surgery on your uterus
  • Are pregnant with more than one baby
  • Are a person of color

Placenta Previa Diagnosis

Doctors often diagnose placenta previa during an ultrasound on one of your routine prenatal visits. The test uses sound waves to show if your placenta covers the opening from your womb to your cervix. They’ll start with a device called a transducer placed on your abdomen, but if they need a better look they’ll use a transducer that goes inside your vagina.

Placenta Previa Treatment

There’s no cure for placenta previa. The goal of treatment is to limit the bleeding so you can get as close as possible to your due date.

Your doctor could give you medicine to prevent premature labor. They may also give you corticosteroid shots to help your baby’s lungs develop faster. Once they feel that the baby can be safely delivered (by about 36 weeks of pregnancy), they’ll schedule a C-section. If your bleeding won’t stop, you’ll need an emergency C-section, even if your baby is not full term.

Treatment depends on:

  • The amount of bleeding. If it’s light, your doctor might suggest you avoid activities including sex and exercise. If it’s heavy, you may need to go to the emergency room, stay in the hospital, and get a blood transfusion.
  • How close you are to your due date
  • Your health and your baby’s health
  • The position of the placenta and the baby

When to Contact Your Doctor

Make an appointment if you have bleeding during your second or third trimester. If it’s severe, go to the hospital.

Show Sources

NHS Choices: “What Is the Placenta?”

March of Dimes: “Placenta Previa.”

Mayo Clinic: “Placenta Previa.”

Journal of Ultrasound in Medicine: “Outcomes of pregnancies with a low-lying placenta diagnosed on second-trimester sonogram.”

Med cape: “Placenta Previa.”

Sumter Health: “Labor Contractions.”

National Library of Medicine – National Institutes of Health: “Abnormalities of Pregnancy.”

How to deal with placenta previa

Placenta previa is a condition that affects a small percentage of moms-to-be. It involves the abnormal growth and positioning of the placenta, the organ that brings nutrients and oxygen to and takes away waste from the fetus. Read on to learn more about this condition and the best ways to treat and manage it.

What Is Placenta Previa?

In most pregnancies, the placenta attaches itself to the side or top part of the uterus. Placenta previa is a rare condition in which the placenta lies low in the uterus and partially or completely covers the cervix. This can cause severe bleeding upon delivery or even during pregnancy.

Many women who are diagnosed with placenta previa early in their pregnancy find that the condition resolves itself, especially in the case of marginal placenta previa, when the cervix is only partially covered by the placenta. But in the case of complete placenta previa, which is when the placenta completely covers the cervix, it’s unlikely to resolve itself before birth.

What Are the Symptoms of Placenta Previa?

The main sign of placenta previa is painless bleeding from the vagina in the second half of the pregnancy. Call your healthcare provider if you experience any vaginal bleeding in your second or third trimester or if you experience contractions or any other potential signs of preterm labor. Seek emergency medical care if bleeding is severe.

What Causes Placenta Previa?

The causes of placenta previa are not known, but some possible risk factors include if

you’ve had a baby

you’ve had surgery or another procedure that may have left a scar on your uterus, such as a cesarean section or uterine fibroid removal

you’ve had placenta previa before

you’re carrying twins, triplets, or other multiples

you’re older than 35

What Risks Are There With Placenta Previa?

It’s important that your healthcare provider monitors both you and your baby to reduce the risk of complications. The possible placenta previa risks are:

Severe bleeding. This can occur during labor, during delivery, or after delivery.

Preterm birth. Bleeding may be cause to undergo an emergency cesarean section, even before your baby is full term.

How Can I Find Out if I Have Placenta Previa?

Should you have placenta previa, it will show up during your usual prenatal checkups or a second trimester ultrasound. To be certain or to get a more thorough diagnosis, your doctor may also need to do a transvaginal ultrasound, using a wand-like device placed inside the vagina.

Should your doctor suspect or notice any signs of placenta previa, then he may do additional conventional or 3D ultrasounds to determine the precise location of the placenta and assess whether it can resolve itself over the course of your pregnancy.

However, if you experience any heavy bleeding during your pregnancy, see your doctor or go to the hospital immediately.

What Can My Doctor Do About Placenta Previa?

Placenta previa is rare, and if you do have it, the severity of the condition also depends on factors such as your and your baby’s health; how far along your pregnancy is; the position of the placenta; and to what extent it actually covers the cervix. Your doctor will monitor whether the placenta previa resolves itself, and, if it doesn’t, he will aim to get you as close to full term as possible.

If you’re late into your pregnancy and you still have placenta previa, a c-section may be required. If your placenta lies in a low position, but doesn’t cover the cervix, you may be able to have a vaginal birth, but talk this through with your doctor.

In any case, the most important thing you need to do is take care of yourself, rest as much as possible, and avoid any activities that may trigger bleeding, like exercise.

There is no need to worry about placenta previa. It’s a rare condition, and even if your doctor diagnoses you with it or you show placenta previa signs, there is a good chance it will go away by itself. And if it doesn’t resolve itself, your doctors can manage the condition so both you and your baby are safe and healthy.

During pregnancy, the placenta provides the growing baby with oxygen and nutrients from the mother’s bloodstream. Placenta previa means the placenta has implanted at the bottom of the uterus, covering the cervix.

When a baby is ready to be born, the cervix (neck of the womb) dilates (opens) to allow the baby to move out of the uterus and into the vagina. When a woman has placenta previa (the placenta has implanted at the bottom of the uterus, over the cervix or close by), the baby can’t be born vaginally. ‘Partial placenta previa’ means the cervix is partly blocked, while ‘complete placenta previa’ means the entire cervix is obstructed.

Some of the causes include scarring of the uterine lining (endometrium) and abnormalities of the placenta. Around one in every 200 pregnancies is affected.

Symptoms

The most important symptom in placenta previa is painless vaginal bleeding after 20 weeks. However, there are causes of vaginal bleeding other than placenta previa. All bleeding during pregnancy should be reported to your doctor for prompt investigation and treatment.

Why the bleeding happens

During the later stages of pregnancy, the bottom part of the uterus thins and spreads to accommodate the growing baby. If the placenta is anchored to the bottom of the uterus (as occurs with placenta previa), this thinning and spreading separates the placenta and causes bleeding.

Sexual intercourse can also cause bleeding from the placenta previa in later pregnancy. During labour, the cervix thins and dilates, which would normally allow the baby to exit into the vagina. In placenta previa, the dilation of the cervix further tears the placenta and causes bleeding.

Possible complications

Some of the complications of placenta previa include:

  • Major haemorrhage (bleeding) for the mother
  • Shock from loss of blood
  • Fetal distress from lack of oxygen
  • Premature labour or delivery
  • Health risks to the baby, if born prematurely
  • Emergency caesarean delivery
  • Hysterectomy, if the placenta fails to come away from the uterine lining
  • Blood loss for the baby
  • Death.

Causes and risk factors

Some of the possible causes and risk factors of placenta previa include:

  • Low implantation of the fertilised egg
  • Abnormalities of the uterine lining, such as fibroids
  • Scarring of the uterine lining (endometrium)
  • Abnormalities of the placenta
  • Multiple babies, such as twins
  • Multiple pregnancies – a woman who has already had six or more deliveries has a risk of one in 20.

Diagnosis methods

A pregnant woman who experiences any vaginal bleeding should be admitted to hospital and tested. Some of the tests used to diagnose placenta previa include:

  • Ultrasound scan
  • Feeling the mother’s belly to establish the baby’s position (the baby is sideways or presenting bottom-first in around one in three cases of placenta previa).

Digital vaginal examinations should be strictly avoided

It is sometimes difficult to tell the difference between placenta previa and placental abruption. Placental abruption is a condition where the placenta separates from the uterine wall. Both conditions are flagged by heavy bleeding of bright red blood.

A vaginal examination is often used to help diagnose placental abruption, but could trigger heavier bleeding in the case of placenta previa. An ultrasound scan should always be taken first, and digital (finger) vaginal examinations strictly avoided in the case of placenta previa.

The doctor may do a speculum vaginal examination very gently to make sure the bleeding is not coming from the cervix or vagina. Once the diagnosis is made, the pregnancy needs to be very carefully monitored. Placenta previa is a potentially life-threatening condition for the both the mother and her baby.

Treatment options vary

Treatment depends on a number of factors, including:

  • Whether the placenta previa is complete or partial
  • The exact location of the placenta
  • The amount of blood lost
  • The gestational age of the baby
  • The position of the baby
  • The health of the baby
  • The health of the mother.

Treatment during pregnancy

Medical treatment aims to ease the symptoms and prolong the pregnancy. Options may include:

  • Bed rest.
  • Hospitalisation.
  • Close monitoring, such as using a fetal monitor and regularly checking the mother’s vital signs (for example, blood pressure).
  • Blood transfusion for the mother.
  • Avoiding any activity that triggers uterine contractions or irritates the cervix, such as sexual intercourse or orgasms.

Delivery

Once the baby is old enough to be delivered, a caesarean section is usually performed. The baby may need to be monitored in intensive care to make sure all is well. The mother will undergo a range of tests, including tests to check her blood cell counts and the clotting ability of her blood.

Where to get help

  • Your GP (doctor)
  • Emergency department of your nearest hospital
  • Always call an ambulance in an emergency Tel. 000 . To book an appointment call SHV Melbourne CBD Clinic: (03) 9660 4700 or call SHV Box Hill Clinic: (03) 9257 0100 or (free call): 1800 013 952 . These services are youth friendly.
  • ‘Placenta praevia’ [online], in The Merck Manual of Diagnosis and Therapy, Section 18, Gynaecology and Obstetrics, Chapter 252, Abnormalities of Pregnancy. Eds R. Berkow, M. Beers, A. Fletcher & R. Bogin. Merck & Co. Inc., Whitehouse Station, NJ, USA.

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How to deal with placenta previa

Women may have painless, sometimes profuse bleeding late in the pregnancy.

Ultrasonography can usually confirm the diagnosis.

Modified activity may be all that is needed, but if bleeding continues or if the fetus or woman develop problems, cesarean delivery is done.

Pregnancy complications, such as placenta previa, are problems that occur only during pregnancy. They may affect the woman, the fetus, or both and may occur at different times during the pregnancy. However, most pregnancy complications can be effectively treated.

Normally, the placenta is located in the upper part of the uterus. In placenta previa, the placenta is located in the lower part. It covers the opening of the cervix—the entrance to the birth canal. Sometimes the placenta is located near the opening of the cervix, not over it (called a low-lying placenta).

Placenta previa occurs in about 1 of 250 deliveries. During the 2nd trimester, as many as 2% of pregnant women have placenta previa. Placenta previa may be visible on ultrasonography. However, it resolves on its own in more than 90% of women before they deliver. If it does not resolve, the placenta may detach from the uterus, depriving the baby of its blood supply. Passage of the baby through the birth canal can also tear the placenta, causing severe bleeding.

Risk factors (conditions that increase the risk of a disorder) for placenta previa include the following:

Having had more than one pregnancy

Having had a cesarean delivery

Having a structural abnormality of the uterus, such as fibroids Fibroids A fibroid is a noncancerous tumor composed of muscle and fibrous tissue. It is located in the uterus. Fibroids can cause pain, abnormal vaginal bleeding, constipation, repeated miscarriages. read more How to deal with placenta previa

Having had a procedure that involves the uterus such as removal of fibroids from the uterus (myomectomy Surgery for fibroids A fibroid is a noncancerous tumor composed of muscle and fibrous tissue. It is located in the uterus. Fibroids can cause pain, abnormal vaginal bleeding, constipation, repeated miscarriages. read more How to deal with placenta previa ) or dilation and curettage Dilation and Curettage Sometimes doctors recommend screening tests, which are tests that are done to look for disorders in people who have no symptoms. If women have symptoms related to the reproductive system (gynecologic. read more How to deal with placenta previa (D and C) done several times

Symptoms of Placenta Previa

Placenta previa can cause painless bleeding from the vagina that suddenly begins late in pregnancy. The blood may be bright red. Bleeding may become profuse, endangering the life of the woman and the fetus.

Placenta previa can cause problems for the fetus, such as the following:

If women have had a cesarean delivery, placenta previa increases the risk that the placenta will be too firmly attached to the uterus (placenta accreta Placenta Accreta Placenta accreta is a placenta with an abnormally firm attachment to the uterus. Having had both a cesarean delivery and placenta previa in a previous pregnancy greatly increases the risk of. read more ). Placenta accreta belongs to a group of disorders called the placenta accreta spectrum. These disorders differ in how firmly the placenta is attached to the uterus.

Diagnosis of Placenta Previa

Doctors suspect placenta previa in pregnant women with vaginal bleeding that starts after 20 weeks of pregnancy. Ultrasonography helps doctors identify placenta previa and distinguish it from a placenta that has detached too early (placental abruption Placental Abruption Placental abruption is the premature detachment of a normally positioned placenta from the wall of the uterus, usually after 20 weeks of pregnancy. Women may have vaginal bleeding and/or severe. read more ).

Problems With the Placenta

Normally, the placenta is located in the upper part of the uterus, firmly attached to the uterine wall until after delivery of the baby. The placenta carries oxygen and nutrients from the mother to the fetus.

In placental abruption (abruptio placentae), the placenta detaches from the uterine wall prematurely, causing the uterus to bleed and reducing the fetus’s supply of oxygen and nutrients. Women who have this complication are hospitalized, and the baby may be delivered early.

In placenta previa, the placenta is located over the cervix, in the lower part of the uterus. Placenta previa may cause painless bleeding that suddenly begins late in pregnancy. The bleeding may become profuse. The baby is usually delivered by cesarean.

How to deal with placenta previa

Placenta Previa can be a scary diagnosis. But with a little research, you can better understand it and what you can do about it.

Each OB appointment during pregnancy is a mixture of excitement and anticipation. The majority of the time, women return home with good news and sometimes a little sonogram photo. But for 1 in every 200 pregnancies, a diagnosis of Placenta Previa can turn what was supposed to be a routine appointment into an anxiety-ridden nightmare. This week we’re talking about what exactly Placenta Previa is, and ways to cope after a diagnosis.

What Is Placenta Previa?

We all know the placenta is the structure inside your uterus that provides oxygen, nutrition, and waste removal for your baby. The baby is connected through the umbilical cord, and in most pregnancies, the placenta is attached to the top or side of the uterus. Placenta Previa is diagnosed when the placenta partially or totally covers the cervix.

There are four grades of Placenta Previa:

  • Grade 1: Minor. The placenta is mainly in the upper part of the uterus, but some may extend to the lower part.
  • Grade 2: Marginal. The placenta reaches the cervix, but does not cover it.
  • Grade 3: Major. The placenta partially covers the cervix.
  • Grade 4: Major. The placenta completely covers the cervix, and is the most serious type of Placenta Previa.

PP causes severe bleeding during pregnancy and delivery. Some Placenta Previa will resolve themselves, but if not, you will need to deliver your baby via cesarean section.

What Are The Symptoms and Who Is At Risk?

Bleeding occurs in 70-80% of women with Placenta Previa, and is the primary symptom. Most bleeding begins after the 20th week of gestation. The bleeding can range from light to severe, and is usually painless, though it can be associated with uterine contractions and abdominal pain.

The general risk factors include:

  • Already having had a baby
  • Scars on the uterus from a previous surgery including cesarean deliveries, uterine fibroid removal, and dilation and curettage.
  • Having Placenta Previa previously
  • Pregnancy with more than one fetus
  • You are a smoker, or a user of cocaine
  • Are 35 years old or older

What Treatment Options Are Available?

Sadly, there are no full treatment options for Placenta Previa, only management options. Your management options depend on varying factors that include the wellbeing of the mother and fetus, the amount of blood loss, the degree of placenta previa, and the gestational age. The goal of every provider to delay delivery as long as possible without increasing risk to the fetus. During this time, your medical provider may ask you to do some of the following:

  • For Little Or No Bleeding: Avoid activities that can trigger bleeding like sex, and excessive exercise. And get PLENTY of rest. Chances of being able to deliver vaginally are higher, but you should discuss your options with your healthcare provider.
  • For Heavy Bleeding: Heavy bleeding requires immediate medical attention. In severe cases, a blood transfusion may be required. Your healthcare provider will likely plan a c-section as close to 36 weeks as possible, however you may need to deliver earlier if heavy bleeding continues.
  • Bleeding That Does Not Stop: If you can no longer control your bleeding, you will likely need an emergency c-section, even if the baby is premature.

What To Do After A Diagnosis?

If you are diagnosed with Placenta Previa, it’s okay to feel worried, scared, or confused. But, there are strategies to help cope with a diagnosis.

  • Learn all about Placenta Previa. Talk to you health care provider, and do additional research on the condition. Also, reach out to other women who’ve had the condition and find support groups online, or in person.
  • Prepare for a cesarean. Though you may not have the birth you always envisioned, keep in mind that your health and the health of your baby are the most important thing.
  • R&R is your friend. Even if you’re not on strict bedrest, remember to take it easy. Read about newborn care, plan for the arrival of the baby, and use the time for other non-taxing tasks you can knock out before the birth.
  • Self-care is important. Allow yourself to indulge in things that make you feel good. A warm bath, your favorite movie — anything that lowers your stress level and makes you feel more comfortable.

The medical professionals at Miami Center of Excellence are here to answer any questions or concerns you may have about Placenta Previa, or any other pregnancy concern. Contact us by phone or online .

The placenta is an organ that connects the developing fetus to the wall of the uterus. It gets nutrients to the fetus, gets rid of waste, and allows oxygen exchange by means of the mother’s blood supply. The placenta usually moves up and away from the cervix (opening at the bottom of the uterus) during growth of the fetus. If it doesn’t, the cervix may be blocked. Placenta previa occurs when the placenta attaches to the uterine wall in the wrong spot, close to or covering the cervix. Placenta previa affects about 1 in 200 pregnancies. It’s a major cause of bleeding during pregnancy. It can be total, partial, marginal, or low-lying. In total placenta previa, the opening is fully covered. In partial placenta previa, the opening is partly covered. In marginal placenta previa, the edge of the placenta is at the edge of the opening. In low-lying placenta previa, the placenta attaches in the lower part of the uterus and its edge is close to the edge of the opening.

What Causes Placenta Previa?

The cause is unknown. Risk factors include previous cesarean delivery, having been pregnant before, carrying twins or triplets, having had placenta previa or uterine surgery, age 35 or older, and smoking.

What Are the Signs and Symptoms of Placenta Previa?

Most often, painless vaginal bleeding, usually in the second or third trimester, occurs. Uterine contractions may or may not be present. The uterus is soft and without pain. Fetal distress doesn’t usually occur.

How Is Placenta Previa Diagnosed?

The health care provider makes a diagnosis from the medical history and physical examination. Vaginal bleeding after 24 weeks of gestation is key. The best, safest way to find the place of attachment is by using ultrasonography. This test, using sound waves, can also tell whether delivery is needed. Magnetic resonance imaging (MRI) can also help detect the condition.

How Is Placenta Previa Treated?

Treatment depends on the status of the fetus and of the mother. Fetal status and gestational age are checked by using the sonogram and continuous fetal heart rate monitoring. Outpatient treatment is possible for a fetus at less than 30 weeks of gestation, and if mother and fetus aren’t in distress. Placenta previa with a mature fetus or distress of the mother or fetus means immediate delivery. Cesarean delivery is done in almost all cases, especially for heavy bleeding. Vaginal delivery can be tried if the cervix is partly covered. Blood volume may need to be replaced to keep blood pressure normal. Blood transfusion may be done to replace lost blood. Levels of fibrinogen must be kept normal. Fibrinogen is a protein that’s important in clotting.

Krystina is a Technical Writer with a background in healthcare. She has spent the last 10 years working for an internationally recognized medical facility where she found her passion for making complicated topics easier to understand.

Monique Rainford, MD, is board-certified in obstetrics-gynecology, and currently serves as an Assistant Clinical Professor at Yale Medicine. She is the former chief of obstetrics-gynecology at Yale Health.

During pregnancy, the placenta moves as the womb stretches and grows. Early in the pregnancy, it’s common for the placenta to be low in the uterus. Normally, the placenta moves toward the top of the uterus as the pregnancy goes along.

Ideally, the placenta will be sitting at the top of the uterus by the third trimester, allowing the cervix to remain open and available for labor. However, when the placenta takes up space in the bottom of the uterus, the baby may rest with their head toward the top.

How to deal with placenta previa

vgajic / Getty Images

Risk Factors

Risk factors for placenta previa include:

  • Age: Those 35 years and older are two to three times more likely to experience placenta previa. This math works out to about one case in every 100 pregnancies.
  • Multiple pregnancies: After the first child, people are more likely to experience placenta previa. A low-lying placenta is also a risk factor for pregnancies of multiple babies—such as twins.
  • Previous surgery: With any surgery, some scarring is left behind as part of the healing process. If you’ve ever had a cesarean section or surgery on your uterus, this can increase your risk.
  • Substance abuse: Smoking cigarettes or using drugs during pregnancy increases the risk factor for many complications, including a low-lying placenta.
  • In vitro fertilization (IVF): Conceiving a baby through IVF does seem to increase the odds of complications with the placenta in general.

Symptoms

Typically, your healthcare provider will identify placenta previa on an ultrasound before any symptoms appear. Ideally, your practitioner will let you know what to expect with this condition, including symptoms you might experience, such as preterm labor.

While not everyone will experience all, or any, of these symptoms, the most common symptoms of placenta previa are:

  • Bleeding: Whenever there's a problem with the placenta, vaginal bleeding is a possibility. This bleeding is typically heavier than spotting and is often painless.
  • Contractions: Some people with placenta previa will experience sharp cramping pains or even contractions.
  • Breech position: With a textbook pregnancy, the baby will be lying with their head toward the bottom of the uterus because there is more room. However, when the placenta takes up space in the bottom of the uterus, the baby will rest with their head toward the top. This position increases the chance of the baby being in a breech position during labor.

Treatment

With all pregnancies, the goal is to make it to full term. As you get closer to your third trimester, your healthcare provider may start making recommendations to get you as close to your due date as possible.

Some of these recommendations may include:

  • Medication: In some cases, your healthcare provider might recommend a medication to prevent you from going into premature labor. While these medications don't always stop preterm labor, they will at least increase the odds of making it to the 36-week mark.
  • Pelvic rest: Sometimes, giving the pelvic area a break can help reduce the symptoms and increase the odds of a full-term pregnancy. When pelvic rest is recommended, it means avoiding putting anything into the vagina, including during menstruation (tampons), intercourse, and pelvic exams.
  • Bed rest: Since bed rest can create a whole host of other problems, strict bed rest is not often recommended. However, your healthcare provider may suggest you limit your activity level for a specific time frame. The length of time could be anywhere from a few hours each day to several days per week or longer.
  • Frequent check-ins: In some situations, the healthcare provider may increase the frequency of your appointments. These frequent check-ins allow the healthcare provider to monitor both mom and baby a little more closely until it's time for delivery.
  • Hospital stay: In more severe cases, your healthcare provider will admit you to the hospital until the baby is born. A hospital stay happens when your healthcare provider feels it is necessary to keep an eye on you and the baby around the clock.

Complications

Keep in mind that while placenta previa sounds scary, the condition itself is not dangerous for you or the baby. However, there are serious risks and potential complications from the placenta being in the wrong place. These possible complications are why your healthcare provider will monitor you a little more closely as the due date gets nearer.

Possible problems from placenta previa include:

  • Future risk: Once you’ve had placenta previa, you’re more likely to have it again in future pregnancies.
  • Preterm labor: Placenta previa increases the chance of your baby being born before the due date.
  • Hemorrhage: Placenta previa increases the risk of uncontrolled bleeding during pregnancy. Sometimes the bleeding is severe enough to result in a blood transfusion or hysterectomy.
  • Placenta accreta: Placenta accreta happens when the placenta grows more deeply in the wall of the uterus than it should. This condition can create life-threatening bleeding during labor and delivery.

A Word From Verywell

Pregnancy is an exciting, overwhelming, and nerve-racking time for many people. If you have concerns about experiencing placenta previa—or have concerns about being diagnosed with placenta previa—it’s essential to talk to your healthcare provider about them.

In many cases, just knowing how focused your healthcare provider is about your case and what their plan is for monitoring you and your baby through delivery can help ease the anxiety of a diagnosis.

Placenta previa is a pregnancy problem in which the placenta blocks the cervix . The placenta is a round, flat organ that forms on the inside wall of the uterus soon after conception. During pregnancy, it gives the baby food and oxygen from the mother.

In a normal pregnancy, the placenta is attached high up in the uterus, away from the cervix. In placenta previa, the placenta forms low in the uterus and covers all or part of the cervix.

If placenta previa is present during labour and delivery, it can cause problems for both mother and baby.

  • The mother may lose a lot of blood, which can be dangerous for both her and her baby.
  • The placenta may separate too early from the wall of the uterus. This is called abruptio placenta , and it can cause serious bleeding, too.
  • The baby may be born too early ( premature ), at a low birth weight, or with a birth defect.

What causes placenta previa?

Doctors aren’t sure what causes this problem. But some things make you more likely to have it. These are called risk factors.

You can’t control most risk factors for placenta previa. For example, you’re more likely to have it if you:

  • Have had a surgery that affected your uterus, such as a D&C or surgery to remove uterine fibroids ( myomectomy ).
  • Have had a previous C-section (caesarean delivery) .
  • Have had five or more pregnancies.
  • Are age 35 or older.
  • Have had placenta previa before.

Risk factors you can control include:

  • Smoking during pregnancy.
  • Using cocaine during pregnancy.

What are the symptoms?

Some women with placenta previa don’t have any symptoms. But others may have warning signs such as:

  • Sudden, painless vaginal bleeding. The blood is often bright red, and the bleeding can range from light to heavy.
  • Symptoms of preterm labour. These include regular contractions and aches or pains in your lower back or belly.

Call your doctor if you have:

  • Medium to heavy vaginal bleeding during the first trimester .
  • Any vaginal bleeding in the second or third trimester.

How is placenta previa diagnosed?

Most cases of placenta previa are found during the second trimester when a woman has a routine ultrasound . Or it may be found when a pregnant woman has vaginal bleeding and gets an ultrasound to find out what is causing it. Some women don’t find out that they have placenta previa until they have bleeding at the start of labour.

A pelvic examination will not be done unless you need a C-section right away. A pelvic examination could injure the placenta and cause heavier bleeding.

How is it treated?

The kind of treatment you will have depends on:

  • Whether or how much you are bleeding.
  • How the problem is affecting your health and your baby’s health.
  • How close you are to your due date.

If your doctor finds out before your 20th week of pregnancy that your placenta is low in your uterus, chances are very good that it will get better on its own. The position of the placenta can change as the uterus grows. So by the end of the pregnancy, the placenta may no longer block the cervix.

If you aren’t bleeding, you may not need to be in the hospital. But you will need to be very careful.

  • Avoid all strenuous activity, such as running or lifting.
  • Don’t have sex, and don’t put anything in your vagina.
  • Call your doctor and go to the emergency room right away if you have any vaginal bleeding.

If you are bleeding, you may have to stay in the hospital. If you are close to your due date, your baby will be delivered. Doctors always do a C-section when there is a placenta previa at the time of delivery. A vaginal delivery could disturb the placenta and cause severe bleeding.

If your bleeding can be slowed or stopped, your doctor may delay delivery and monitor you and your baby closely. The doctor may do fetal heart monitoring to check your baby’s condition.

You may be given:

  • A blood transfusion if you’ve lost a lot of blood.
  • Steroid medicines if you aren’t close to your due date. These medicines help get your baby ready for birth by speeding up lung development. to slow or stop contractions if you are in preterm labour.

If your newborn is premature, your baby may be treated in a neonatal intensive care unit, or NICU. Premature babies need to stay in the hospital until they can eat, breathe, and stay warm on their own.

Related Information

Credits

Current as of: February 11, 2020

Author: Healthwise Staff
Medical Review:
Sarah Marshall MD – Family Medicine
Kathleen Romito MD – Family Medicine
Adam Husney MD – Family Medicine
Elizabeth T. Russo MD – Internal Medicine
William Gilbert MD – Maternal and Fetal Medicine
Rebecca Sue Uranga

Current as of: February 11, 2020

Medical Review: Sarah Marshall MD – Family Medicine & Kathleen Romito MD – Family Medicine & Adam Husney MD – Family Medicine & Elizabeth T. Russo MD – Internal Medicine & William Gilbert MD – Maternal and Fetal Medicine & Rebecca Sue Uranga

Placenta previa is a problem of pregnancy in which the placenta grows in the lowest part of the womb (uterus) and covers all or part of the opening to the cervix.

The placenta grows during pregnancy and feeds the developing baby. The cervix is the opening to the birth canal.

Causes

During pregnancy, the placenta moves as the womb stretches and grows. It is very common for the placenta to be low in the womb in early pregnancy. But as the pregnancy continues, the placenta moves to the top of the womb. By the third trimester, the placenta should be near the top of the womb, so the cervix is open for delivery.

Sometimes, the placenta partly or completely covers the cervix. This is called a previa.

There are different forms of placenta previa:

  • Marginal: The placenta is next to the cervix but does not cover the opening.
  • Partial: The placenta covers part of the cervical opening.
  • Complete: The placenta covers all of the cervical opening.

Placenta previa occurs in 1 out of 200 pregnancies. It is more common in women who have:

  • An abnormally shaped uterus
  • Had many pregnancies in the past
  • Had multiple pregnancies, such as twins or triplets
  • Scarring on the lining of the uterus due to a history of surgery, C-section, or abortion
  • In vitro fertilization

Women who smoke, use cocaine, or have their children at an older age may also have an increased risk.

Symptoms

The main symptom of placenta previa is sudden bleeding from the vagina. Some women also have cramps. The bleeding often starts near the end of the second trimester or beginning of the third trimester.

Bleeding may be severe and life threatening. It may stop on its own but can start again days or weeks later.

Labor sometimes starts within several days of the heavy bleeding. Sometimes, bleeding may not occur until after labor starts.

Exams and Tests

Your health care provider can diagnose this condition with a pregnancy ultrasound.

Treatment

Your provider will carefully consider the risk of bleeding against early delivery of your baby. After 36 weeks, delivery of the baby may be the best treatment.

Nearly all women with placenta previa need a C-section. If the placenta covers all or part of the cervix, a vaginal delivery can cause severe bleeding. This can be deadly to both the mother and baby.

If the placenta is near or covering part of the cervix, your provider may recommend:

  • Reducing your activities
  • Bed rest
  • Pelvic rest, which means no sex, no tampons, and no douching

Nothing should be placed in the vagina.

You may need to stay in the hospital so your health care team can closely monitor you and your baby.

Other treatments you may receive:

  • Blood transfusions
  • Medicines to prevent early labor
  • Medicines to help pregnancy continue to at least 36 weeks
  • Shot of special medicine called Rhogam if your blood type is Rh-negative
  • Steroid shots to help the baby’s lungs mature

An emergency C-section may be done if the bleeding is heavy and cannot be controlled.

Outlook (Prognosis)

The biggest risk is severe bleeding that can be life threatening to the mother and baby. If you have severe bleeding, your baby may need to be delivered early, before major organs, such as the lungs, have developed.

When to Contact a Medical Professional

Call your provider if you have vaginal bleeding during pregnancy. Placenta previa can be dangerous to both you and your baby.

Alternative Names

Vaginal bleeding – placenta previa; Pregnancy – placenta previa

Images

  • Cesarean section
  • Ultrasound in pregnancy
  • Anatomy of a normal placenta
  • Placenta previa
  • Placenta
  • Ultrasound, normal fetus – arms and legs
  • Ultrasound, normal relaxed placenta
  • Ultrasound, color – normal umbilical cord
  • Placenta

References

Francois KE, Foley MR. Antepartum and postpartum hemorrhage. In: Landon MB, Galan HL, Jauniaux ERM, et al, eds. Gabbe’s Obstetrics: Normal and Problem Pregnancies. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 18.

Hull AD, Resnik R, Silver RM. Placenta previa and accreta, vasa previa, subchorionic hemorrhage, and abruptio placentae. In: Resnik R, Lockwood CJ, Moore TR, Greene MF, Copel JA, Silver RM, eds. Creasy and Resnik’s Maternal-Fetal Medicine: Principles and Practice. 8th ed. Philadelphia, PA: Elsevier; 2019:chap 46.

Salhi BA, Nagrani S. Acute complications of pregnancy. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 178.