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Pregnancy and Childbirth: The answers

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Cesarean section for placenta previa

The majority of women with placenta previa will be delivered by cesarean section. Only the ones with minor placenta previa (and all else being well) can look at the possibility of vaginal delivery.

 

The attending obstetrician should be able to explain why he or she is recommending a particular method of delivery.

 

Timing of the delivery in cases of placenta previa

In the absence of bleeding, efforts will be made to allow the pregnancy to get as close to Term as possible.

 

Of course, if it is major placenta previa, the final weeks - which may be as many as six to ten, may have to be spent in hospital. One of the main aims is to prevent unnecessary prematurity, whenever possible. If the mother starts bleeding and if this is heavy or recurrent; there will be no option but to deliver the baby.

 

Some mothers with placenta previa have no symptoms until they suffer one heavy vaginal bleed and delivery has to be made immediately. Delivery before 37 weeks of gestation will have to be carried out in almost 40% of such mothers.

 

Prematurity and placenta previa

Prematurity is a serious problem where there is placenta previa. In fact, it is the leading cause of losing a baby. In this condition, the loss of babies born before twenty-eight weeks of gestation is fairly high. Even the babies that survive suffer significant morbidity related to prematurity.

 

Other problems associated with placenta previa

Growth restriction of the fetus in the womb is commoner among women with placenta previa, affecting almost 1 in 6 of them, a much higher incidence than in the general pregnant population.

 

For some reason, the risk of serious malformations of the fetus is also almost doubled.

 

For the mother herself, there is the dramatically increased risk of cesarean delivery, serious blood loss (even after delivery), and increased susceptibility to infection in the post-delivery period.

 

Significance of low-lying placenta at the 18 - 20 weeks ultrasound scan

About 18% of all pregnant women (1 in 5) have a low-lying placenta at the half-way stage of  pregnancy (20 weeks).

 

By 37 completed weeks (Term); only about 2% (1 in 50) have placenta previa. For the majority, changes in the course of the pregnancy result in the placenta being in a normal location.

 

However, if a woman found a low-lying placenta at 20 weeks bleeds vaginally at any point thereafter, she should see her doctor promptly. She might turn out to be one of the few with whom the placental location remains low.

 

Follow up differs in different units. Some offer a repeat scan at around 34 weeks to ascertain placental location and possibly reassure the mother. Others do not routinely offer a repeat scan and only do so if and when there is a clinical indication. There is no evidence that one strategy is superior to the other.

 

Causes and predisposing factors for placenta previa

No causes are known but there are certainly predisposing factors. These include:

Ø Multiple pregnancy (twins or more)

Ø Multiple previous deliveries (multiparity),

Ø Older mothers (above age thirty five)

Ø Previous cesarean section

Ø Smoking during pregnancy.

 

Recurrence of placenta previa

Recurrence of placenta previa is not common. It occurs in about 5% of affected women.

 

Next Page: Placental abruption