Placenta Praevia

Placenta praevia is a pregnancy complication characterized by the placenta partially or completely covering the internal cervical os (the opening of the uterus into the vagina). This condition can cause bleeding during pregnancy and delivery, and may lead to other complications for both the mother and the baby.

Symptoms

• Painless vaginal bleeding in the second or third trimester, which can be heavy or light
• Bleeding may stop on its own, but it can also start again
• Abdominal pain or cramping may occur if the placenta separates from the uterus (placental abruption)
• Premature labor or rupture of membranes may occur due to bleeding or other complications
• In some cases, there may be no symptoms until delivery

Types of Placenta Praevia

• Placenta praevia type 1 (low-lying placenta): The placenta is in the lower part of the uterus, but it does not cover the internal cervical os.
• Placenta praevia type 2 (marginal placenta praevia): The placenta reaches the margin of the internal cervical os, but does not cover it.
• Placenta praevia type 3 (partial placenta praevia): The placenta partially covers the internal cervical os.
• Placenta praevia type 4 (complete placenta praevia): The placenta completely covers the internal cervical os.

Causes and Risk Factors

The exact cause of placenta praevia is not known, but several factors increase the risk:

• Previous uterine surgery (e.g., cesarean section, abortion, or D&C)
• Multiple gestations (twins, triplets, etc.)
• Placenta accreta (a condition where the placenta grows too deeply into the uterus)
• Smoking during pregnancy
• Advanced maternal age
• Prior history of placenta praevia

Treatments and Management

The goal of treatment is to minimize bleeding, ensure the mother's safety, and deliver a healthy baby:

• Bed rest: Women with placenta praevia may be advised to stay in bed to reduce bleeding and prevent complications.
• Corticosteroids: Medications may be given to promote fetal lung maturity if preterm delivery is necessary.
• Blood transfusions: Women with significant bleeding may require blood transfusions to replace lost blood.
• Cesarean section: Delivery by cesarean section is often necessary, especially in cases of complete placenta praevia or severe bleeding.
• Monitoring: Women with placenta praevia will be closely monitored for signs of bleeding, fetal distress, and other complications.

Complications

Placenta praevia can lead to several complications, including:

• Severe bleeding (hemorrhage): Excessive bleeding can be life-threatening for both the mother and the baby.
• Preterm labor: Bleeding or other complications may trigger preterm labor.
• Placental abruption: The placenta may separate from the uterus, causing bleeding and depriving the baby of oxygen and nutrients.
• Fetal growth restriction: The baby may not receive enough oxygen and nutrients due to the placenta's abnormal position.

Prevention

While there is no guaranteed way to prevent placenta praevia, women can reduce their risk by:

• Avoiding smoking during pregnancy
• Maintaining a healthy weight and diet
• Getting regular prenatal care to monitor for potential complications
• Avoiding unnecessary uterine surgery or procedures