Definition

Placenta previa is the most common cause of painless bleeding in the later stages of
pregnancy (after the 20th week). The placenta is a temporary organ that joins the mother and
fetus and transfers oxygen and nutrients from the mother to the fetus. The placenta is disk-
shaped and at full term measures about seven inches in diameter. The placenta attaches to the
wall of the uterus. Placenta previa is a complication that results from the placenta implanting
either near to, or overlying, the outlet of the uterus (womb).

Because the placenta is rich in blood vessels, if it is implanted near the outlet of the uterus (the
opening of the cervix), bleeding can occur when the cervix dilates or stretches.

What are the types of placenta previa?

The types of placenta previa include:

• Complete placenta previa occurs when the placenta completely covers the opening
from the womb to the cervix.

• Partial placenta previa occurs when the placenta partially covers the cervical opening

• Marginal placenta previa occurs when the placenta is located adjacent to, but not
covering, the cervical opening.

The term low-lying placenta or low placenta has been used to refer both to placenta previa and
marginal placenta previa. Sometimes, the terms anterior placenta previa and posterior placenta
previa are used to further define the exact position of the placenta within the uterus as defined
by ultrasound examinations.
Etiology
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).

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.

Risk factors

o Prior placenta previa (4-8%)

o First subsequent pregnancy following a cesarean delivery
o Multiparity (5% in grand multiparous patients)
o Advanced maternal age
o Multiple gestations
o Prior induced abortion
o Smoking