Placenta previa is uncommon in a first pregnancy
but the tendency increases with additional gestations.
The three placenta previa types are total placenta
previa, partial placenta previa and marginal placenta
previa, with marginal being the most common of
the three. A routine ultrasound performed in weeks
18-20 allows the diagnosis of previa. In other
instances diagnosis is made when the pregnant
mother experiences 2nd trimester bleeding. A reevaluation
through ultrasound will be typically performed
between weeks 30-36. In a large number of cases
the placenta will move out of the way before week
30 when the pregnancy progresses and the uterus
would have expanded and stretched.
What
Causes Placenta Previa
Once again the cause is not known but the risk
increases in the following situations:
• Placenta previa in an earlier pregnancy
• If you had previous c-section(s)
• In multiple pregnancy
• In older women
• In women who smoke
• If uterine surgeries were performed e.g. D&C
or fibroids removal
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Any bleeding in the second half of pregnancy warrants
medical attention. Painless vaginal bleeding which
is sudden near the end of the 2nd trimester or
the beginning of the 3rd is indicative of placenta
previa. Ultrasounds are effective in detecting
this problem. Vaginal probe is never performed
as it may cause a disruption and result in severe
bleeding.
• Bleeding in late pregnancy suggests pre-labor
contractions are dislodging the roots of the placenta.
This threatens baby's nourishment and oxygen supply
if labor were allowed to proceed. The added stress
is that the placenta will hinder baby's way out
through the birth canal. Cesarean becomes necessary
to save the baby.
• Cesarean becomes inevitable in cases with
total previa. With marginal or partial previa
vaginal birth is still possible. A vaginal or
cesarean delivery will depend on how much the
cervix is covered.
• A woman with any kind of previa should
not put anything into her vagina including douches
or medications. Sexual intercourse should be avoided.
Bed rest is advised to decrease pressure at the
placental site. All kinds of strenuous activities
should be avoided and that includes heavy jobs
and carrying heavy articles.
• If after week 36 the placenta is found
to be lying low but not covering the cervix and
there is no bleeding, the mother has the option
of staying at home but extra visits to the doctor
is necessary. Most doctors would prefer the 'wait
and see approach' so that baby matures up while
still in the utero. Others would prefer to induce
labor early. Either way you have to take things
easy.
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