Placenta previa

Placenta praevia: description

A placenta praevia (placenta praevia) is a non-normal placenta (uterine lining) in the uterus. The placenta is a disk-shaped organ with a diameter of about five to 20 centimeters. She is two to four inches thick and weighs on average about 500 grams. The placenta serves to supply nutrients and oxygen to the unborn child. It also produces important hormones such as progesterone, estrogen and hCG (human chorionic gonadotropin), which are important for maintaining pregnancy.

A placenta previa more or less completely covers the inner cervix, ie the exit of the uterus, which the child has to pass through at birth. Normally, the cakes are well away from the uterus exit. Depending on the extent of the misconception one distinguishes:

• Deep-seated placenta: It does not reach the internal cervix but is closer to it than usual.
• Placenta praevia marginalis: The placenta touches the inner cervix, but does not move it. Together with the deep-seated placenta, the placenta praevia marginalis accounts for about half of all cases of placenta previa.
• Placenta praevia partialis: The placenta partially displaces the internal os. It accounts for about a third of the lag anomalies.
• Placenta praevia totalis: The placenta completely covers the internal cervix. It is present in about 20 percent of the cases.

Overall, a placenta praevia occurs in about one in every 200 pregnancies.

Placenta previa: symptoms

The placenta praevia usually manifests itself by a sudden onset of vaginal bleeding. It most likely occurs in the second half of pregnancy, most often at the end of the second trimester or at the beginning of the third trimester. It may be accompanied by seizures in some cases.

The bleeding can be massive and cause danger to life for both mother and child. Therefore, always look for a doctor during vaginal bleeding during pregnancy!

Placenta previa: causes and risk factors

Normally, during the course of pregnancy, the placenta moves towards the maternal head, ie towards the upper end of the uterus. This happens because of the growth of the uterus. This ensures that the birth canal is clear. If this movement of the placenta stops, a placenta previa arises. At the end of pregnancy, the uterus expands so that the placenta praevia can rupture and cause painless bleeding.

There are several factors associated with increased risk of placenta previa. These include:

• Smoke
• old expectant mother’s age
• unusual form of the uterus (uterine anomaly)
• many pregnancies in the past
• Multiple pregnancy
• cocaine abuse
• Scars in the uterus, for example, through surgery, caesarean section or abortions (scraping)
• In vitro fertilization (artificial insemination)

Placenta previa: examinations and diagnosis

If you notice vaginal bleeding during pregnancy, visit your gynecologist. He first asks you in detail about your medical history (anamnesis). Possible questions are:

• In which week of pregnancy are you?
• Do you have pain?
• Have you been pregnant once or several times before?
• Do you smoke?

Subsequently, your doctor will examine you. He scans your stomach to determine any hardening and the position of the child. He then examines the vagina to locate the source of bleeding.

In addition, he carries out an ultrasound examination through the abdomen (transabdominal ultrasound). It can give information about the seat of the placenta at the end of the second trimester. The patient’s bladder should be about halfway filled in order to determine the positional relationships between the individual organs. Then the patient and the doctor can decide together which mode of birth – of course, or cesarean section – should be performed.

Placenta praevia: treatment

If you are diagnosed with a placenta praevia marginalis or partialis during a check-up, the doctor will advise you to take bed rest. All activities should be kept to a minimum. In addition, the small pool should be spared. This means that you should abstain from sex, do not put anything in the vagina and should not rinse it. If premature birth is imminent, the doctor may prescribe medication that inhibits labor. These include, for example, atosiban. In addition, glucocorticoids (betamethasone) can be given to speed up the lung maturity of the unborn child.

If bleeding occurs through a placental previa, the therapy must be carefully weighed. The danger of severe bleeding for both the mother and the unborn child must be considered. Overall, the risk of hemorrhaging the placenta praevia must be weighed against the risk of premature birth. If the pregnancy has progressed beyond the 36th week, the birth is usually initiated. Almost always a cesarean section is made. In case of heavy bleeding with a large blood loss, the pregnant woman may need to transfer blood products (blood transfusion).

Placenta previa: disease course and prognosis

The course of a placenta previa can be very different individually. A deep placenta and a placenta praevia marginalis can remain uncomplicated and unnoticed. Other forms, such as the placenta praevia totalis, on the other hand, can be associated with heavy bleeding and a high mortal danger. While some bleeding in placenta praevia may stop spontaneously – without any treatment – others may be life threatening for both the mother and the unborn child. Breasted bleeding may bleed again after a few days or weeks. With the right treatment and the conscious handling of the disease, many patients can Placenta previa but give birth to healthy children.