Definition of Placenta Previa

A condition of pregnancy in which the placenta is implanted

abnormally in the uterus so that it impinges on or covers the internal
os (opening) of the uterine cervix.

Description of Placenta Previa

Placenta previa is the most common cause of painless bleeding in the

third trimester of pregnancy. There are usually four degrees of this
condition: total placenta previa (the placenta covers the entire opening
to the cervix); partial placenta previa (the placenta partially
encroaches to within six centimeters of the cervical os); marginal
placenta previa (the edge of the placenta is at the edge or margin of
the opening of the cervix); and low-lying placenta or a low
implantation (the placenta is low in the uterine segment and the edge
of the placenta does not actually reach the cervical os but is very close
to it).

Placenta previa occurs when the placenta – the spongy mass of blood
vessels and tissue that forms within the uterus which supplies the
baby with nutrition via the umbilical cord – forms unusually low in the
uterus and covers part or all of the cervix.

Bleeding occurs because the lower third of the uterus stretches and
thins somewhat during the last trimester, both to make room for the
developing fetus and in preparation for birth. This stretching and
thinning often causes a low-lying placenta to tear somewhat at its
margins, causing bleeding.

If the placenta is lying partially or totally over the cervical opening,

bleeding is virtually assured at some point. As every woman comes
closer to term, the cervix begins to soften and change shape in
preparation for the birth. It shortens (effaces) and begins to open up
(dilates). Many women have some degree of these cervical changes
weeks before labor begins.

These cervical movements create a problem for the placenta in a

previa position. As the cervix starts to open up, it shears off the blood-
filled placental attachments on top of it, causing the mother to bleed,
sometimes dangerously. Nevertheless, less than one-half of one
percent of women with previa suffer fatal complications, and nine out
of ten babies survive.
There are serious problems associated with placenta previa. For the
mother, repeated or severe bleeding can result in anemiaand low
blood volume, both of which can be countered through transfusions.

For the baby, the gravest danger after birth is respiratory distress
syndrome due to premature delivery. With modern neonatal intensive
care facilities and topflight medical care, babies born with respiratory
distress do better now than ever before, but some babies do still die.
Placenta previa can also cause the baby to be small for gestational
age. This is called intrauterine growth retardation.

Babies of mothers with placenta previa seem to have a higher

incidence of jaundice at birth (readily treated by exposure to special
lights in the neonatal intensive care nursery). About 10 percent of all
babies of mothers with placenta previa lose some blood, along with the
mother, when bleeding occurs in the uterus. Sometimes the bleeding
is severe enough that the baby needs a transfusion shortly after birth.

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Causes and Risk Factors of Placenta Previa

The cause of placenta previa is not known. It is more common in

women who have already had children, older women and in women
who smoke. A previous cesarean birth or induced abortion may
increase the risk of placenta previa. A larger placenta increases the
risk of placenta previa, because it is more likely for the edge of the
placenta to lie near or over the cervical opening.
Symptoms of Placenta Previa

The first symptom is usually bright red, painless bleeding between

weeks 28 and 38 of pregnancy. The initial episode of bleeding may or
may not be followed by others.

Diagnosis of Placenta Previa

Diagnosis is made in two major ways: a sudden onset of bleeding or

discovery during an ultrasound (ordered for another reason).

Treatment of Placenta Previa

If bleeding takes place, it is essential to obtain immediate care in a

hospital Emergency Room.

There are two standard courses of treatment: immediate delivery by

cesarean or "expectant management" – strict, in-hospital bedrest and
frequent monitoring until the baby is mature enough to live without a
respirator outside the uterus.

For a women with placenta previa, pelvic or rectal exams are never to
be done unless she has been taken to a delivery room or operating
room ready for an emergency C-section.

While the actual cause of placenta previa is unknown, certain factors

increase the risk of a woman developing the condition. These factors
include:

• having abnormalities of the uterus

• being older in age
• having had other babies
• having a prior delivery by cesarean section
• smoking cigarettes