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All your pregnancy questions answered

Placenta praevia [low lying placenta]

• What is a low lying placenta or placenta praevia?

Normally in your uterus the placenta [this is where the babies umbilical cord ends into and is the structure which transfers oxygen and nutrients to your baby] is attached to the upper portion of the uterus [known as the upper segment] and the baby lies below or on the side of it.

Normal location of the placenta

If the placenta is attached to the lower 1/3rd of the uterus [lower segment] then it lies below the baby and is known as a low lying placenta or a placenta praevia.

• What causes a placenta praevia?

Usually an exact cause is difficult to pinpoint but this condition is seen more in women who

1. have scarring of the uterine wall from previous pregnancies

2. have fibroids or other abnormalities of the uterus

3. have had previous uterine surgeries or cesarean deliveries

4. are older mothers (over age 35)

5. smoke during pregnancy

6. have had a placenta praevia in a previous pregnancy

• Types of praevia

A woman could have a partial praevia or a complete placenta praevia.

           Partial placenta praevia               Complete placenta praevia  

• What are the risks if you have placenta praevia?

1. Bleeding-The greatest risk of placenta praevia is bleeding (or hemorrhage). Bleeding often occurs as the lower part of the uterus thins during the third trimester of pregnancy in preparation for labor. This causes a movement between the wall of the uterus and the surface of the placenta and this is what leads to bleeding from the area. The more of the placenta that covers the cervical os, the greater the risk for bleeding.

2. Abnormal implantation of the placenta

3. Slowed fetal growth

4. Preterm birth

5. Birth defects

6. Infection after delivery

• How is this diagnosed?

1. Bleeding-The most common symptom of placenta praevia is vaginal bleeding that is bright red and not associated with abdominal tenderness or pain, especially in the third trimester of pregnancy.

2. Ultrasound-Nowadays a placenta praevia is diagnosed usually much before a patient presents with bleeding. This is because a routine scan will be done for you at about 20 weeks and this will locate the position of the placenta. Although ultrasound may show a low-lying placenta in early pregnancy, only a few women will develop true placenta praevia. It is common for the placenta to move upwards and away from the cervix as the uterus grows, called placental migration

• How is a placenta praevia treated?

Once a placenta praevia is diagnosed you will be asked to

1. Avoid very strenuous activity

2. Avoid sexual intercourse

3. Avoid any internal examinations

as all of these could cause bleeding by disturbing the placental location.

You will also be asked to undergo serial USGs to see if the placenta has 'migrated' to the upper segment as your pregnancy advances.

There is no 'treatment' as such for a placenta praevia and if it does not 'migrate' to a higher level you will probably have to undergo delivery by caesarian section. This is because if you are allowed to go into labour the placenta will shear off before the baby is delivered and it will lead to

• loss of oxygen to the baby

• tremendous bleeding from both mother as well as baby

If you have a very mild degree of placenta praevia you may be allowed to try for a normal delivery.