Placenta Previa

Placenta Previa

Placenta previa is a condition when the placenta or placenta is at the bottom of the uterus so that it covers part or all of the birth canal. Apart from covering the birth canal, placenta previa can also cause heavy bleeding, both before and during labour.

The placenta is an organ that forms in the uterus during pregnancy. This organ functions to distribute oxygen and nutrients from the mother to the fetus, as well as remove waste from the fetus.

Normally, the placenta is at the bottom of the uterus at the beginning of pregnancy. However, as the gestational age increases, the placenta will move upward, which will eventually position itself at the top of the uterus.

In the case of placenta previa, the position of the placenta does not move from under the uterus until near the time of delivery.

Causes of Placenta Previa

The cause of placenta previa is not known with certainty, but there are several factors that are thought to make pregnant women more at risk of suffering from this condition, namely:

  • Age 35 or over
  • Not the first pregnancy
  • Pregnant with twins
  • Abnormal fetal position, for example breech or transverse
  • History of miscarriage
  • Abnormal shape of the uterus
  • History of placenta previa in previous pregnancy
  • History of surgery on the uterus, such as curette, removal of myoma, or caesarean section
  • Use of cocaine or smoking while pregnant

Symptoms of Placenta Previa

The main symptom of placenta previa is bleeding from the vagina that occurs in the late second or third trimester of pregnancy. The characteristics of the bleeding are generally in the form of:

  • Without pain
  • Bright red in color
  • It can be a lot or a little
  • Can happen again in a few days

This condition is often regarded as  menstruation during pregnancy . Sometimes, this bleeding also appears after intercourse and is accompanied by contractions or stomach cramps.

When to see a doctor

Immediately consult a doctor if spots or  bleeding occur during pregnancy that do not subside, especially if they occur during the second or third trimester, or are accompanied by:

  • Bleeding profuse
  • pale skin
  • Hard to breathe
  • Dizzy
  • Low blood pressure
  • Anemia

Diagnosis of Placenta Previa

Doctors can suspect that pregnant women have placenta previa if bleeding occurs in the second or third trimester of pregnancy. However, to be sure, the doctor will carry out the following examinations:

  • Transvaginal ultrasound
    This procedure is performed by inserting a special tool into the vagina to see the condition of the vagina and uterus. This examination is the most accurate method for determining the location of the placenta.
  • Transabdominal ultrasound
    This procedure also functions the same as a  transvaginal ultrasound , which is to see conditions inside the uterus. The difference is, on a transabdominal ultrasound, the examining device is only attached to the abdominal wall so as to minimize the risk of bleeding due to the examination procedure.
  • MRI ( magnetic resonance imaging )
    This procedure is used to help doctors see the position of the placenta more clearly.

If a pregnant woman is suspected of having placenta previa, the doctor will not perform routine transvaginal ultrasound, in order to reduce the risk of heavy bleeding. The doctor may replace it with a transabdominal ultrasound, to monitor the position of the placenta periodically until the day of delivery arrives.

Treatment of Placenta Previa

Treatment of placenta previa aims to prevent bleeding. The treatment that will be given by the doctor depends on the health condition of the mother and fetus, gestational age, the position of the placenta, and the severity of the bleeding.

In pregnant women who do not experience bleeding or only experience light bleeding, the doctor will suggest self-care, in the form of:

  • Get plenty of rest and lying down
  • Reducing strenuous physical activity
  • Avoid having sex

Even though they don't need hospital treatment, patients must still be vigilant and seek medical help immediately if the bleeding is profuse and doesn't stop.

If a pregnant woman experiences heavy and repeated bleeding, the doctor will recommend that the baby be born as soon as possible by caesarean section . However, if the gestational age is less than 36 weeks, the pregnant woman will be given an injection of  corticosteroid drugs  first to accelerate the maturation of the fetal lungs.

If the bleeding is very severe and cannot be stopped, the pregnant woman will be referred for further treatment at the hospital. The doctor will also give a blood transfusion to replace lost blood.

Placenta Previa Complications

Placenta previa is a dangerous pregnancy complication, both for the mother and the fetus. In the mother, placenta previa can cause complications in the form of:

  • Shock
    Severe bleeding that can occur before, during, or several hours after delivery carries a risk of shock .
  • Blood clots
    Lying in the hospital for too long can increase the risk of pregnant women experiencing blood clots.
  • Increased risk of placenta accreta
    Placenta accreta is a condition when the placenta attaches too deeply to the uterine wall. This condition is classified as dangerous and can make it difficult for the placenta to be expelled, thereby exacerbating bleeding during labour.
  • Increased risk of placenta previa in subsequent pregnancies
    A history of placenta previa in the current pregnancy may affect the likelihood of this condition recurring in future pregnancies.

Whereas in the fetus, complications that can occur due to placenta previa are:

  • Premature birth
    If the bleeding continues, the baby should be delivered immediately by cesarean section, even if it is not full term. It is known that as many as 5% of cases of preterm birth are caused by placenta previa.
  • Fetus lack of oxygen
    Lack of oxygen (asphyxia) can occur due to bleeding in mothers who have placenta previa.

Prevention of Placenta Previa

Placenta previa is a condition that cannot be prevented. However, there are preventive measures that pregnant women can take to avoid placenta previa or bleeding, namely:

  • Do not smoke
  • Do not use drugs
  • Reducing strenuous physical activity
  • Reducing the frequency of sexual intercourse
  • Avoid traveling long distances when the gestational age is 28 weeks and over
  • Take a rest immediately when the spots come out
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