Placenta Previa: A Guide

Placenta Previa: A Guide

Placenta previa is a common obstetric condition that causes bleeding during the last trimester of pregnancy. It occurs when the placenta attaches to the lower segment of the uterus, instead of the uterine wall as is normally expected.

Symptoms:

• The most typical symptom is vaginal bleeding, which can be bright red or dark red.

• Bleeding can occur suddenly or gradually, be heavy or light.

• Bleeding may be accompanied by uterine contractions, or it may not.

• Other symptoms may also appear, such as:

• Abnormal fetal presentation

• Fetal heart failure

• Difficult or undetectable fetal heart rate

• Blood-tinged amniotic fluid

Diagnosis:

• Diagnosis is primarily based on ultrasound. Ultrasound is the safest and most accurate method to determine the location of the placenta.

• A vaginal examination may be performed to assess the condition of the cervix, but it should only be performed when necessary and with caution, as it can cause further bleeding.

• Retrospective diagnosis after delivery is based on the examination and observation of the placenta.

Causes:

• The exact cause of placenta previa is unknown.

• However, several factors can increase the risk of developing the condition, including:

• Older maternal age

• History of multiple pregnancies

• History of multiple abortions or curettages

• Uterine abnormalities

• Large fetus

Classification:

• Placenta previa is classified based on the location of the placenta relative to the cervical opening:

• Low-lying placenta: The edge of the placenta is less than 3 cm from the cervical opening.

• Marginal placenta previa: The placenta attaches to the uterine wall, but its edge is close to the cervical opening.

• Partial placenta previa: The placenta partially covers the cervical opening.

• Partial central placenta previa: The placenta covers a large portion of the cervical opening.

• Total central placenta previa: The placenta completely covers the cervical opening.

Management:

• Management of placenta previa depends on the time of detection, the severity of bleeding, and the condition of the fetus.

• Before labor:

• Closely monitor the mother’s condition, amount of bleeding, and fetal heart rate.

• Replace blood as needed.

• Transfer to a hospital with obstetric specialties when bleeding is excessive or signs of fetal distress are present.

• During labor:

• Total central placenta previa: Cesarean delivery is the optimal method of treatment.

• Other clinical presentations: Vaginal delivery may be attempted if bleeding is not heavy, but close monitoring is required. If bleeding is heavy or signs of fetal distress are present, Cesarean delivery is the optimal method of treatment.

• After delivery:

• Control the uterus, administer uterine contractions to prevent postpartum hemorrhage.

• Closely monitor the mother and newborn’s condition.

Complications:

• Bleeding: The most common complication of placenta previa. Bleeding can be mild or severe, even leading to maternal death.

• Fetal distress: Due to placenta previa reducing the amount of blood supply to the fetus.

• Premature birth: The fetus may be born prematurely due to bleeding or the need for early Cesarean delivery.

• Uterine injury: May occur in cases of excessive bleeding or during Cesarean delivery.

Prevention:

• There is no effective way to prevent placenta previa.

• However, pregnant women should undergo regular prenatal checkups to detect the condition early and provide timely treatment.

Conclusion:

Placenta previa is a dangerous obstetric condition that can cause severe bleeding, fetal distress, and even maternal death. Early diagnosis and timely treatment are crucial to ensure the safety of the mother and the fetus.