Even though the word “placenta previa” sounds unfamiliar, it is not as unfamiliar as you think. If you have come across situations where pregnant women talk about “wedemaha pahath wela”, then you are no stranger to placenta previa.
What is placenta previa?
Placenta is “wedemaha” in Sinhalese. It connects the developing baby inside the uterus, to the mother via the umbilical cord (pekani wela). Through the placenta the baby gets all its nutrients and oxygen. The usual location of this vital structure is the upper back wall of the uterine cavity. Placenta previa is defined as development of the placenta partially or completely overlying the lower segment of the uterus. It occurs in about 1 in 200 pregnancies.
Placenta previa is graded according to severity. There are four grades.
Grade 1 – Low lying placenta not reaching OS
Grade 2 anterior – Anterior Low lying placenta reaching OS
Grade 2 posterior – Posterior low lying placenta reaching OS
Grade 3 – Low lying placenta covering OS but shifts to a side with dilating OS
Grade 4 – Low lying placenta completely covering OS and fixed
Grade 1 and grade 2 posterior are considered as minor degree. Grade 2 anterior and above are considered as major degree placenta previa. Major degree placenta previa necessitates caesarean section because vaginal delivery may cause severe life threatening bleeding.
Why does placenta previa occur?
Risk of placenta previa is higher among women who have had a previous similar episode. Injury to the uterus interferes the formation of the lower segment of the uterus as pregnancy advances; thus lower segment caesarean section, myomectomy, dilatation and curettage increase the risk. High number of previous pregnancies, especially if poorly spaced, increases the risk of placenta previa. Women younger than 20 years of age and older than 35 year of age are at a higher risk. Twin pregnancies and gestational diabetes mellitus are commonly accompanied by a larger than normal placenta which may reach the lower segment simply because of its size. Smoking and consumption of alcohol during pregnancy increases the risk of placenta previa exponentially.
It is important to understand that even though the placenta is lower down early in the pregnancy, it rides up as the lower segment develops. Only placenta previa persisting into late pregnancy is potentially problematic.
What are the symptoms of placenta previa?
Most common presentation is with vaginal bleeding. Bleeding may be mild or severe. Some women experience cramping abdominal pains. In some cases bleeding starts soon after labour.
Ante natal ultrasound scans can easily detect placenta previa. Your obstetrician will warn you about the condition and if it is of major degree, he will plan for a caesarean section.
How does it affect the unborn baby?
Mild bleeding rarely threatens the baby. Severe bleeding on the other hand can endanger the lives of both mother and the baby.
What should you do?
All bleeding per vagina should be investigated. Harmless conditions also cause vaginal bleeding. Differentiating harmless from harmful requires specialist review. Therefore rush to your obstetrician.
By: Dr T.M.S.Sameera B. Madugalle MBBS (COL)
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