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The placenta is a rich vascular tissue seen in the inner wall of the uterus. It provides nutrition to the growing baby through the umbilical cord. It also helps in removal of wastes from the developing baby. The placenta is usually present on the upper part of the uterus and grows during pregnancy in size and vascularity.
However, if this placenta is towards the lower portion near the cervix, it is known as previa, meaning prolapse. This could happen during the third trimester of pregnancy. There are chances that it will block the cervix, which is the opening of the uterus into the birth canal. This may hinder normal delivery and can be one of the reasons necessitating cesarean section. As the baby tries to push through the placenta, the highly vascular placenta can tear and cause significant bleeding. It can be a big risk to both the mother and the baby.
Placenta previa is quite common and can happen for every 1 in 200 pregnancies. Though what causes it is not very clear, some of the predisposing factors include the following:
- Advanced maternal age (35 or more)
- Smoking mothers
- Have had children
- History of C-section
- Carrying twins or triplets
- History of uterine surgeries
There could be complete previa or total previa.
- If the placenta is in the lower portion of the uterus, but not close to the cervix, with about 2 cm distance between the cervix and the placenta tip, it is termed as low-lying placenta.
- If the placenta sits on the border of the cervix, but does not cover the opening, it is partial or marginal previa.
- When it is in the lower portion and completely covers the cervix, it is complete previa.
Placental position is monitored throughout pregnancy, and by the second trimester, the doctor can suspect potential previa. Though the placenta may be in the lower half of the uterus during the first trimester, it usually moves up towards the end of the second trimester. If it does not, then the doctor might request for periodic testing to ensure it is in place.
- Fresh bleeding during the third trimester is indicative of previa. Managing previa depends on how far you are into the pregnancy and how severe the bleeding is.
- If it is minimal, then only observation will suffice. Bed rest with no intercourse, no pelvic exams, and limited travelling is recommended.
- If the previa is confirmed and there is no bleeding, a C-section will be scheduled at 37 weeks.
- If delivery cannot wait, then the baby will be immediately delivered at the end of 34 weeks, post which the baby and mother will be kept under observation.
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