A low-lying placenta occurs when the placenta grows low down within the uterus (womb). It's not often an issue in early being pregnant, however after about 20 weeks a low-lying placenta (placenta praevia) could cause bleeding or imply that you could give start by caesaren part.
What’s placenta praevia?
The placenta develops wherever the fertilised egg embeds in your uterus (womb). Placenta praevia (generally spelled as placenta previa) occurs when the placenta develops low down in your uterus and stays low-lying past mid-pregnancy.
If the placenta is close to your cervix while you’re prepared to provide start, it might block your child's exit route by your vagina. Placenta praevia may trigger bleeding in mid to late being pregnant (RCOG 2018b).
The placenta could also be:
- Partly overlaying your cervix. That is known as minor placenta praevia, or grade 1 or 2 placenta praevia.
- Utterly overlaying it. That is known as main placenta praevia, or grade three or four placenta praevia.
In each circumstances, your child will in all probability should be born by caesarean part (RCOG 2018b).
Placenta praevia is extra frequent in ladies who smoke, have had a caesarean earlier than, or had fertility therapy (RCOG 2018a, b).
By the top of being pregnant, about one in 300 ladies has some extent of placenta praevia (Cresswell et al 2013). Most of those are minor placenta praevia.
How is a low-lying placenta identified?
A low-lying placenta could also be picked up throughout your mid-pregnancy anomaly ultrasound scan (RCOG 2018a, b). If the scan exhibits that you've a low-lying placenta, you'll be supplied one other scan at 32 weeks to see if it has moved (RCOG 2018a, b).
In case your placenta nonetheless seems to be low at your follow-up scan, or if it’s not doable to get an excellent image, your sonographer could ask to do a scan by way of your vagina (transvaginal scan) (RCOG 2018a, b). This may give her a clearer image, so she will be able to examine the accuracy of the unique scan.
In lots of circumstances, the later scan will present that the placenta has moved up and out of the best way (RCOG 2018a, b). If not, there's nonetheless time for this to occur. But when your placenta is on the again wall of your uterus, or when you’ve had a caesarean earlier than, it's much less seemingly that your placenta will transfer (RCOG 2018a, b).
Sometimes, placenta praevia is picked up in different methods:
- In case your child is in a breech place, is mendacity throughout your bump (transverse place) or is excessive up. This might be an indication that she's unable to get right into a head-down or engaged place, as a result of the placenta is in the best way.
- If in case you have painless vaginal bleeding within the second or third trimester, after intercourse, or in any other case. Name your physician or midwife instantly if this occurs.
What issues can occur with placenta praevia?
The primary consequence of placenta praevia is that you simply’ll have to have your child by caesarean if the placenta hasn’t moved by the point your labour begins (RCOG 2018b).
There are another issues you need to be conscious of, too. These seldom occur, but when they do, they are often severe.
If in case you have placenta praevia, there's a danger of sudden, painless bleeding throughout being pregnant or labour (RCOG 2018b). You'll want emergency medical care, and there’s a danger of going into labour early (RCOG 2018b).
You’re at better danger of bleeding, when you:
- have had placenta praevia earlier than
- have had a child earlier than, as a result of the danger of bleeding will increase the extra infants you've had
- have had a caesarean part earlier than
- are a smoker or cocaine-user
- are over 35
- have a historical past of miscarriage or a earlier termination of being pregnant
With out therapy, extreme bleeding (haemorrhage) will be life-threatening for each you and your child (RCOG 2018a). However be assured that that is uncommon, and the bleeding will be handled shortly.
Having placenta praevia will increase your likelihood of creating placenta accreta. This unusual complication occurs when the placenta embeds itself too deeply within the wall of your uterus (RANZCOG 2015, RCOG 2018a, b). The placenta stays connected to your uterus, moderately than coming away after your child is born.
It’s extra more likely to occur when you've had a earlier caesarean and the danger will increase the extra caesareans you have got (RCOG 2018b). Your danger additionally will increase when you:
- have had different surgical procedure to your uterus
- have uterine fibroids or a uterine abnormality
- are greater than 35 years outdated
- have had IVF
(RCOG 2018a, b)
Your medical workforce will concentrate on your historical past when you have got your scans (RCOG 2018a, b). Chances are you'll be supplied a kind of Doppler scan or a magnetic resonance imaging (MRI) scan to examine for placenta accreta (RCOG 2018a, b).
Placenta accreta carries a danger of very heavy bleeding throughout a caesarean (RANZCOG 2015, RCOG 2018a, b). However your medical workforce may have a blood transfusion on standby for you in case it’s wanted.
That is a fair rarer complication, however your danger of creating it's increased you probably have placenta praevia.
Vasa praevia occurs when the blood vessels from the umbilical twine run by the membranes overlaying the cervix, as an alternative of straight into the placenta (RANZCOG 2016). As a result of these membranes aren't protected by the umbilical twine or the placenta, they'll simply tear and trigger bleeding (RCOG 2018c).
Vasa praevia occurs in between one in 1,200 and one in 5,000 pregnancies (RCOG 2018b, c).
The danger of bleeding that comes with vasa praevia places your child's life in danger, moderately than yours (RANZCOG 2016, RCOG 2018b, c).
Vasa praevia could also be identified throughout your mid-pregnancy anomaly ultrasound scan, or at a follow-up scan you probably have a low-lying placenta (RCOG 2018c).
It might solely be found, although, throughout early labour or when your waters break earlier than or throughout labour (RCOG 2018c). If this occurs, your caregiver will suggest you have got your child by fast emergency caesarean (RANZCOG 2016, RCOG 2018b, c).
How is placenta praevia managed?
Managing placenta praevia is typically only a matter of your medical workforce watching and ready, whereas monitoring the place of your placenta.
Your care will differ relying on whether or not or not you've had any bleeding. Chances are you'll be suggested to keep away from having intercourse for the remainder of your being pregnant, significantly when you’ve had bleeding (Lockwood and Russo-Stieglitz 2019).
Your physician could suggest extra ultrasound scans to observe the place of your placenta and if she's involved you could have different issues.
Should you've had no bleeding, you'll in all probability be capable of keep at residence till the start (RCOG 2018b), though your physician will in all probability suggest that you simply don’t journey far out of your hospital throughout your third trimester.
If in case you have any bleeding, contractions or period-type pains earlier than you're resulting from be admitted, go straight to hospital so that you will be monitored (RCOG 2018a, b). Chances are you'll be requested to remain till your child is able to be born, even when your signs cease.
In case your signs don’t cease, or when you go into untimely labour, your child will should be born by emergency caesarean part (Lockwood and Russo-Stieglitz 2019).
If in case you have vasa praevia, your physician could suggest admitting you to hospital from round 30 weeks of being pregnant for monitoring, relying in your scenario (RANZCOG 2016, RCOG 2018c).
In case your child could also be born prematurely, your physician could suggest that you've an injection of steroids, which can assist velocity up the event of your child's lungs (RANZCOG 2016, RCOG 2018a, b, c).
When will my child be born if I’ve placenta praevia?
If in case you have placenta praevia, however stay freed from different issues, you're more likely to be supplied a deliberate caesarean between 36 weeks and 37 weeks (RCOG 2018a, b).
Each a senior obstetrician and senior anaesthetist ought to take care of you in the course of the caesarean (RCOG 2018a, b, c).
As a result of you might be extra weak to heavy bleeding throughout a caesarean, the workforce caring for you should have a blood transfusion on standby, simply in case (RANZCOG 2015, 2017, RCOG 2018a, b). Within the unlikely occasion that your medical workforce can’t cease the bleeding, they could want to guard your well being by performing an operation to take away your uterus (hysterectomy) (RANZCOG 2015, RCOG 2018a, b).
If in case you have main placenta praevia, or have had bleeding, your physician could suggest a caesarean barely earlier, between 34 weeks and 37 pregnant (RCOG 2018a).
If in case you have placenta accreta, you’ll in all probability be supplied a deliberate caesarean for while you're between 35 weeks and 37 weeks, or earlier in case your physician thinks you might go into labour earlier than this (RCOG 2018a, b).
Should you’ve been identified with vasa praevia, your physician will give you a deliberate caesarean as early as 34 weeks of being pregnant, and even earlier when you’ve had bleeding (RCOG 2018b, c).
What can I do to assist myself if I’ve placenta praevia?
You possibly can't do something to vary the place of your placenta. However you are able to do loads to remain wholesome and effectively.
Eat loads of nutritious meals, significantly these which can be wealthy in iron, comparable to crimson meat, legumes and leafy greens. This may scale back your probabilities of changing into anaemic (RCOG 2018a, b). In case your iron ranges are low, your physician or midwife could suggest that you simply take iron dietary supplements.
Should you’re in hospital, preserve your circulation going to assist forestall blood clots. Attempt to transfer round, drink loads of water, and use compression stockings in case your midwife provides them to you (RHWS 2010).
If in case you have a low-lying placenta and are ready to see in case your placenta strikes up, it’s sure to be a worrying time for you. Relaxation assured that there’s a lot that may be finished to maintain you and your child secure and effectively.
Discover out extra about caesarean sections.