Placenta previa

Placenta previa is implantation of the placenta over the internal cervical opening. In some women during the pregnancy the placenta ( which is the nourishing organ for the foetus carrying the nutrients from the mother) grows down and down into the lower parts of the Uterus. If it attaches to the lowest part of the womb covering the opening of the os partly or completely it is called placenta previa. It is from this os the baby has to come out.

 

Types are:

1. Complete implantation over the os (complete placenta previa)

2. A placental edge partially covering the os (partial placenta previa)

3. The placenta approaching the border of the os (marginal placenta previa).

Causes:

• Advancing age (>35)
• Multiparity
• Infertility treatment
• Multiple gestation (larger surface area of the placenta)
• Prior uterine surgery.
• Recurrent abortions.
• Low socioeconomic status.
  

 

Symptoms:

• Painless third-trimester bleeding
• Malpresentations
• Prenatal morbidity.
• Dystocia. (Difficult Labor and Obstruction).
• Less Oxygen to the baby and further complications.
• Rarely baby distress.
  

Investigations the patient needs:

• Trans Vaginal Ultrasound.
• Trans abdominal Ultrasound.
• Coagulation Profile.

Treatment modalities:

First two trimesters, adequate bed rest with foot end elevation. This helps the placenta to migrate up and hence reduce the complication.

Tocolytics and Corticosteroids in case of prematurity to prevent fetal distress.

If bleeding persists, and is heavy immediate surgery is indicated.

Delivery is planned for the 36-37th week if the fetal lung maturity is satisfactory.

Delivery needs to be planned with matched blood Transfusion and informed consent for caesarean Hysterectomy.