The new podcast episode is a C-section birth experience episode – yay! And we did talk about placenta previa so I thought – why not write a post as well with a bit more information?
As always: the new episode is available on all major podcast platforms under Elephant in the Womb!
Also another note: there seem to be a million ways to pronounce previa in this sense – I just went with what I had always heard/said. I even googled it before and there were three different pronunciations so – I apologize in advance if it doesn’t fit your mould haha!!
*Disclaimer: This blog is intended for informational purposes only. The information on this blog should not be used as a substitute to medical advice or medical treatment. As always, your Primary Care Provider, a doctor, or another health professional is your best resource for specific questions and medical advice. If you believe you or a loved one are experiencing a medical emergency, please contact 911.*
Although this is a term many are probably familiar with, there may be some who are not. I also wanted to include some information about how doctor’s diagnose it, since during the episode I was unsure of the exact time frame when decisions are made regarding whether or not it might “move” or change, and how labour will proceed.
Note: I’ve also included some of this information verbally at the end of the podcast episode for those who prefer audio learning.
What is placenta previa?
To understand what placenta previa is, lets clarify the two main components: the placenta and the cervix.
You probably know that the placenta is the home your baby exists in within your uterus during pregnancy. After you give birth, you also give birth to the placenta! It is much more complex than this, and truly an amazing organ. It provides your baby with the nutrients and oxygen it needs to thrive through the umbilical cord; it also helps to remove any waste.
I cannot say enough about the placenta because 1) it is amazing; and 2) it is complex. I do hope in the future to discuss this more in-depth with someone with more expertise than I!
When you are pregnant, the placenta is attached to the uterine wall. The location of attachment can vary – ideally, it is attached near the top of the uterus or on one of the sides. Sometimes, the placenta is attached closer to the cervix – so lower down in the uterus.
As a quick recap, the cervix is the narrow end of the uterus. It connects the uterus to the vagina. It is sort of like a “gatekeeper” to the uterus, especially during pregnancy when it it closed (though not everyone’s does this – cervical insufficiency may occur, where the cervix begins to open and soften too early). Again – this is a topic I could delve way more into but for the purposes of this post, we will keep it simple. So: the cervix is the narrow end of the uterus and it is normally closed during pregnancy, until closer to the end when we want it to open and thin out, to allow for birth. This is dilation and effacement (or the opening and thinning of the cervix, respectively). These things need to occur to allow baby to be born vaginally.
When the placenta is attached to the uterine wall closer to the cervix, so near the bottom of the uterus, placenta previa can occur. This is when the placenta partly or fully blocks the cervix. You can see why this might be a problem – it can cause severe bleeding, as well as other complications such as preterm delivery.
What causes this to occur and how common is it?
The cause is not fully understood, but there are identified risk factors for placenta previa. These include:
- Age of the mother – >35 years increases risks
- Past history of uterine surgery, C-section or multiple abortions
- Multiparous mothers – or those who have had more than one child
- A history of placenta previa with previous pregnancies
Most sources cite placenta previa as occurring in 1 in every 200 pregnancies.
What are the symptoms and how is it diagnosed?
It does not always present with symptoms, but if it does painless bleeding in later pregnancy is common. Sometimes, contractions occur along side this bleeding. It is diagnosed by ultrasound.
Any bleeding in pregnancy is something you should contact your provider for – they should give you “instructions” at one of your earlier visits as to how to proceed when they are not available or dependent on the amount of bleeding you are having. If you have concerns about bleeding – don’t look on the internet, contact a healthcare provider, Telehealth, or head to ER as instructed by your provider! THIS IS NOT MEDICAL ADVICE – just information.
Some women may have no symptoms at all. The diagnosis is usually made as a result of what is seen on a routine ultrasound in pregnancy. If at the second trimester ultrasound (your anatomy scan usually), it is noted that the placenta is <2 cm from the internal os or opening of the cervix then a follow-up scan is usually arranged for around 32 weeks. It is not uncommon for women to have a low-lying placenta around this time, but most cases resolve by the follow-up scan.
At 32 weeks, if the placenta is noted to be >2 cm away, then that is usually the end of that. No follow-ups are scheduled and everything is considered normal. If it is still <2 cm away however, another follow-up scan should be scheduled for 36 weeks.
At the 36 week ultrasound, a decision is made based on what is seen. If the placenta is fully covering the cervix, then a C-section will be scheduled. If it is not covering it but is still <2 cm away, then a discussion may be had about how is best to proceed.
What is the treatment?
At 36-weeks if placenta previa is present and identified, then the treatment is generally a C-section delivery. The timing and specifics of this will depend somewhat on yours and babies status, but will usually be between 36 and 37+6 weeks gestation.
A patient with active, heavy bleeding may require a C-section much earlier (or they may require other treatments and hospitalization).
To reduce the risk of bleeding (or other bleeding episodes if patient is symptomatic), certain precautions may be taken or advised. Cervical examinations are generally avoided due to the risk of hemorrhage if the cervix is partially dilated.
The question of vaginal intercourse and whether the above situation is a risk is yet to be answered. More studies are needed, but there are recommendations to avoid vaginal intercourse to orgasm after 20 weeks due to a potentially similar risk as a cervical exam (it may also cause contractions).
Women may also be asked to avoid strenuous exercise, heavy lifting of >20 lbs (which may be challenging if you have other children…), and standing for a time period of greater than 4 hours. Some data has shown that these may pose a greater risk for premature labour because they are related to increased pressure in the abdomen.
If bleeding does occur, hospitalization may be necessary and further treatment and rest recommendations would follow. Women diagnosed with placenta previa should seek immediate assistance for bleeding because it can be an emergency. As I mentioned above, if you’re pregnant and are bleeding, seek assistance and guidance from your trusted healthcare professional or seek immediate medical attention (follow the guidance of your provider – again, these are conversations that should be had at one of your earlier medical appointments!).
If you want to read more, here is a helpful handout on placenta previa which also discusses two other conditions – placenta accreta and vasa previa. Please speak to your healthcare provider if you have placenta previa and have questions or concerns.