The World of Pregnancy

What Does It Mean when your Placenta is Low during Pregnancy?

The placenta is an organ which forms on the internal uterine wall shortly after conception. Through the placenta the fetus receives oxygen and nutrients from the mother, and she gets various substances and products from her baby.

Usually, the placenta attaches by the uterus about the cervix. In a smaller percentage of 1% from births, the placenta forms at the uterus`s base and will partially or totally cover the cervix. When the placenta blocks the cervix, we use the term of “placenta previa.”

Causes

There aren`t any known specific causes of placenta previa. However, there are some risk factors which increase the chances for placenta previa. These risk factors are:

  • Smoking – It`s associated in 1 out of 4 cases of placenta praevia. Smoking decreases the amount of oxygen that reaches the fetus, thus leading to the formation of a large placenta.
  • Medical history – It includes interventions which affect the uterine mucosa, similar to the dilatations made by a sharp curette, procedures made in case of spontaneous or therapeutic abortion.
  • C-sections – From all women who had Caesarean section, 4 out of 100 will develop placenta previa in a future pregnancy; from those who had 4 or more C-sections, the risk is of 10 out of 100 cases.
  • Multiple pregnancies – 1 out of 1,500 women will develop placenta previa at first birth; women who had 5 or pregnancies, the risk is of 1 out of 20.
  • Mother`s Age – From all pregnant women under 19 years old, only 1 out of 1,500 develop placenta previa; at those over 35 years old, the risk is only for 1 out of 100 cases.
  • Consuming cocaine during pregnancy.
  • History of placenta previa.

Placenta previa diagnosed before 20 weeks of pregnancy has big chances to develop on its own. Around 90% from all cases diagnosed before the 20th pregnancy week will solve on their own until the end pregnancy. While the uterus will grow in size, the position of the placenta changes in relation with the cervix, so at the end of pregnancy the placenta will block the cervix.

Symptoms

Symptoms or signs of placenta previa can be:

Sudden, painless vaginal bleeding; its quantity can vary from small to abundant. The blood is usually bright red. The bleeding can appear since the 20th week of pregnancy, but is more common in the third trimesters.

Symptoms of preterm birth. One out of 5 pregnant women with placenta previa has uterine contractions as well.

Bleedings from placenta previa can reduce or stop for a while, but in almost all cases they`ll reappear again after a few days or weeks.

Some pregnant women with placenta previa don`t experience any symptom. In these cases, the only diagnosis is made by ultrasound when one will be made for other causes, when the causes for vaginal bleeding will be investigated or if the bleeding starts at the beginning of labor.

Low Lying Placenta Exercise

Many doctors always encourage women who expect a baby to add daily exercises to their routine. If a pregnant woman has just been diagnosed with placenta previa, she might be discouraged from doing any exercises as she might risk experiencing bleedings or early labor.

Depending on the severity of your condition, there are a few exercises with low intensity which may be suitable during pregnancy. In lots of situations, an easy walking or elliptical machine should be comfortable and safe enough along with a few cardiovascular activities. Talk to your doctor about some low intensity physical exercises that you are able to do at the beginning of your pregnancy for about 30 minutes per day, but only if your pregnancy develops in a healthy way.

Another great option can be Pilates and yoga. The stretching exercises should be changed or removed, any twist motions need to be performed only at the level of the shoulders, and you might want to choose including some variations of exercises with the help of chairs so your pelvic area can be supported.

Having a routine of low-intensity physical exercises can benefit your body`s health as well as your mood, but only as long as you have your doctor`s approval.

Low Lying Placenta Precautions

Patients with placenta previa who don`t experience bleedings need to follow a few measures of precaution:

Avoiding intense physical activities, such as running or lifting weights (over 9kg).

Immediately contacting the doctor if bleedings occur.

The presence of a phone near you at all times.

Warning your doctor that he doesn`t need to make a pelvic (vaginal) examination.

Avoiding sexual contact after the 28th week of pregnancy. Before this period will be determined possible risks in case of sexual contact.

Avoiding vaginal tampons or vaginal showers.

The pregnant woman needs to be near a hospital to be able to receive care along with her baby born prematurely.

Patients with placenta previa who bleed can receive hospitalization. If case the fetus is completely developed, it will be performed a C-section.

Investigations

An ultrasound scan is the medical investigation used for diagnosing placenta previa or “low lying placenta.” In some cases, an ultrasound cannot offer a clear image of the location of the placental insertion.

Besides cases when a C-section will be performed in the near future, vaginal examination isn`t recommended because there might be additional damages of the placenta that can occur, leading to massive bleeding.

Fetal heart monitoring is used to establish the health of the baby.

Watchful Waiting

In case the bleeding diminish or stops, the birth can be delayed. Watchful waiting will be established (the doctor will wait and carefully supervise the evolution of the pregnancy). Watchful waiting will rely on the health of the baby:

In case that the fetus has an age between 24 to 34 gestational weeks, the doctor can administrate corticosteroids to hasten the fetal lung development and prepare the fetus for a premature birth. The doctor can also administrate iron supplements to prevent or treat anemia and it`s recommended a diet rich in fibers or the administration of laxatives to prevent constipation. The doctor may also choose to administrate immunoglobulin to pregnant women with negative Rh who have a fetus with positive Rh. In case that there won`t be any immunoglobulin, the immune system of the mother with negative Rh will synthesize antibodies when contacting the blood with positive Rh of the baby, antibodies that are dangerous for the baby with positive Rh.

If the bleeding doesn`t stop, the pregnant woman will remain in the hospital and be closely monitored until the moment when the fetus is mature enough to be born. Moderate loss of blood can be replaced with blood transfusions which can prolong the pregnancy until the fetus is mature enough to be born.

The contractions can be diminished or stopped with the administration of tocolytic medicines. The benefits from using such medication aren`t yet completely determined.

In case the bleeding is massive and cannot be controlled, there`ll be made a C-section and a possible blood transfusion. Around 1 out of 10 women with placenta previa require a hysterectomy (surgical removal of the uterus) to stop the bleeding.

Treatment – Generalities

In cases of patients with placenta previa, the treatment depends on:

  • The type of bleeding, which will influence the decision of hospitalization of the pregnant woman, the requirements for blood transfusion and the schedule of the period of birth.
  • The general health of the mother; for instance, the presence of anemia after massive blood loss.
  • The development and physical health of the baby. When possible, the birth is delayed until fetal lung maturation is complete.
  • The portion of the cervix which is covered by the placenta. Due to the fact that there might be massive bleeding during vaginal birth, C-sections are preferred when placenta previa is involved.

Low Lying Placenta Treatment (Surgery)

In case of placenta previa, the birth takes place through Caesarean section.

Around half of pregnancies with placenta previa end through premature birth (before the 37th week of pregnancy). The disorders of babies are mostly related to prematurity. The baby born prematurely requires special attention in a neonatal intensive care unit. The care in such a unit can last from a few days to a few weeks, depending on the child`s disorders and the necessities of the care.low lying placenta 20 weeks

The treatment of placenta previa is made by:

  • An obstetrician.
  • Perinatal specialist.

The treatment for a child born prematurely is made by a neonatologist.

Outpatient Treatment

Pregnant women need to be very careful when experiencing vaginal bleedings. Sudden, painless bleedings can sometimes be the only symptoms of placenta previa.

It`s recommended to contact the doctor immediately as you notice:

  • Moderate vaginal bleeding during the first trimester of pregnancy. Severe vaginal bleedings refer to bleedings which fill a tampon within an hour (don`t use internal tampons), and moderate bleedings refer to bleedings which fill more than 8 tampons within 24 hours.
  • Any vaginal bleeding during the second and third trimesters of pregnancy.

Pregnant Women with a History of Placenta Previa

Women who already experienced a pregnancy with placenta previa need to be aware of the risks that may appear with a new pregnancy. The doctor will be able to inform the patient about the possible risks.

In a few cases, placenta previa might lead to the death of the fetus. The mother needs to be morally supported after such a loss. Psychological therapy can be a good option.

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