Placenta Previa

Image of Pregnant Mother with Placenta Previa

A Closer Look at Placenta Previa

Definition

This condition usually occurs when the placenta implants in the lower part of the uterine segment is encroaches on the internal cervical os. There are three types of this condition:

1. Low Implantation
 - the placenta implants in the lower uterine segment

2. Partial Placenta Previa
 - the placenta partially oclcudes the cervical os

3. Total Placenta Previa
 - the placenta totally occludes the cervical os

One of the most common causes of bleeding during the second half of pregnancy is Placenta Previa.

The Wrath Behind Placenta Previa

The exact cause is unknown. It may be linked to uterine tumors or uterine scars from surgical procedure.

There are factors that may affec the site of the placenta's attachment to the uterine wall. It includes:
 - defective vascularization of the decidua;
 - multiple pregnancy (the placenta requires a large surface for attachement);
 - previous uterine surgery;
 - multiparity;
 - advance maternal age (35 years old and above).

The lower uterine segment of the uterus fails to provide as much nourishment as the fundus. The placenta tends to spread out, seeking the blood supply it needs, becoming larger and thinner than normal. The placental villi are torn from the uterine wall as the lower uterine segment contracts and dilates in the third trimester. As the internal cervical os effaces and dilates, the uterine vessels are torn and the Uterine sinuses are expose at the placenta site and bleeding can occur.

What to look for?

The following are the signs and symptoms of a pregnant mother who are diagnosed to have placenta previa:

1. Painless, bright red vaginal bleeding (common during the 20th week of pregnancy, especially during the third trimester);
2. Scanty bleeding (earliest sign of placenta previa);
3. Palpatation may reveal a soft, nontender uterus;

What are the tests to know that I have Placenta Previa?

Diagnostic tests are done to identify if the pregnant woman have manifested the signs and symptoms of Placenta Previa. The purpose of these tests is to confirm the condition and to provide a specific medical intervention.

1. Pelvic examination under a double setup (preparations for an emergency cesarean deliver) - because of the likelihood of hemorrhage to confirm the diagnosis.
2. Laboratory studies may reveal decreased maternal hemoglobin levels because of blood loss.
3. Transvaginal ultrasound scanning is used to determine placental position.
4. Radiologic test such as femoral arteriography, retrograde catheterization, or radioisotope scanning or localization, may be done to locate the placenta.

What are the Medical Management?

• Dependent on when the first episode occured and the amount of bleeding;
• Limitation of maternal activities;
• Monitoring of relevant vital signs;
• Emotional support;
• Rectal or vaginal examination, which could stimulate uterine activity should not be performed unless equipment is available for vaginal and ceasarean delivery;
• Vaginal delivery is considered only when the bleeding is minimal and the placenta previa is marginal or when the labor is rapid;
• Immediate cesarean delivery is performed as soon as the fetus is sufficiently mature or in the case of intervening severe hemorrhage.

What are the Possible Ways to Manage Placenta Previa at Home?

1. Immediately report any signs of bleeding and abnormal symptoms that you have felt to your doctor;
2. Have someone to monitor your vital signs if active bleeding occurs. This include the blood pressure, pulse rate, respiratory rate and fetal heart rate. Record it and refer to the doctor when you have arrived the hospital;
3. Monitor the amount of bleeding (pad counts) and refer it to the doctor. This is to identify the amount of blood loss.

The Threat of Placenta Previa

Placenta previa is a critical condition that can cause postpartum hemorrhage and infection. It can also cause fetal death if there is no immediate medical intervention applied to the pregnant mother.