The uterus resembles an inverted pouch with a sealed opening. A normal placenta attaches to the posterior, anterior, or lateral wall of this pouch—the uterine body—delivering nutrients and oxygen to the baby via the umbilical cord.If after 28 weeks of pregnancy, the placenta attaches below the fetal presenting part—reaching the lower uterine segment or even the placental edge—and partially or completely covers the opening of the "bag," known as the internal cervical os, it is termed placenta previa.
Placenta previa is further classified into marginal, partial, and complete types. During late pregnancy, the lower uterine segment gradually stretches in preparation for delivery. A placenta covering the cervical os or its margin cannot stretch, causing separation between the placental attachment site and the uterine wall, leading to bleeding. This bleeding often occurs without any apparent cause or abdominal pain and may recur in late pregnancy.Pregnant women often discover bloodstained sheets upon waking and seek medical attention.
Multiple factors contribute to placenta previa, primarily:
Repeated abortions, cesarean sections, or curettage causing endometritis or endometrial damage. Due to insufficient blood supply, the placenta extends into the lower uterine segment to absorb more nutrients.
Abnormal placental development or excessive size, such as a secondary placenta positioned in the lower uterine segment, or a placenta in a twin pregnancy stretching downward to the lower uterine segment to provide increased nutrients.
Failure of the fertilized egg to implant promptly upon reaching the uterine cavity, causing it to continue migrating downward and implanting in the lower uterine segment, is another cause of placenta previa.
Additionally, advanced maternal age, multiparity, maternal smoking, or substance abuse increase the risk of placenta previa.
How to self-check for placenta previa?
Since bleeding from placenta previa is often unexplained and painless, self-examination and self-care are crucial.
1. If you experience unexplained, painless vaginal bleeding during early or mid-pregnancy, inform your doctor promptly during prenatal visits to assess for abnormal placental positioning early.
2. If placental positioning is abnormal, abstain from sexual intercourse throughout pregnancy. Avoid strenuous physical labor and exercise. Promptly treat colds and coughs. Maintain regular bowel movements to prevent sudden increases in abdominal pressure that could trigger bleeding.
3. Maintain good vulvar hygiene to prevent infections. Infections can cause uterine contractions and induce bleeding.
4. During the late stages of pregnancy, prioritize bed rest in the left lateral position to ensure adequate sleep. Increase nutritional intake to support optimal fetal growth and development within the uterus, enhancing the infant's postnatal viability. Consistently monitor fetal movements to promptly identify any abnormalities such as intrauterine hypoxia.
5. If anemia develops due to recurrent bleeding, medication should be taken under medical supervision to correct it. Hospitalization for red blood cell transfusions may also be necessary.
6. Pregnant women with placenta previa should be admitted early for observation and treatment under medical guidance. Management varies by individual case; do not delay diagnosis or treatment by taking chances.
7. Seek emergency medical care immediately at the hospital if vaginal bleeding or lower abdominal pain occurs. Call 911 for transport if bleeding is heavy.
8. Choose a large hospital for prenatal care and delivery to avoid life-threatening situations. Small hospitals may lack adequate emergency resources to handle severe bleeding during pregnancy or childbirth, potentially delaying critical intervention.
However, there is no need to panic. While placenta previa poses risks to both mother and baby, regular prenatal checkups and adherence to your obstetrician's guidance typically ensure a safe pregnancy and delivery.
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