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Causes and treatments of placenta previa

plasenta-previa

plasenta-previa

The placenta is an organ that develops in the uterus during pregnancy, which has the main function as a vital link between mother and fetus, ensuring healthy growth and development during pregnancy from providing nutrients to maintaining blood circulation to the fetus.1.

 

Normally, the placenta is positioned under the uterus at the beginning of pregnancy. However, as the pregnancy progresses, the placenta may move up the uterus. Abnormal conditions of the placenta can occur during pregnancy such as placenta previa.

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Table of Contents

What's Placenta Previa?

Placenta previa is a medical condition that occurs in pregnancy when the placenta sits too low in the uterus, covering part or all of the cervix.1This condition can cause serious complications for both the mother and the unborn baby. As scary as it sounds, with the right treatment, many mothers who experience placenta previa are able to get through their pregnancies safely.

The types of placenta previa3:

  • Total placenta previa: The placenta completely covers the cervix.
  • Partial placenta previa: The placenta partially covers the cervix.
  • Marginal placenta previa: The placenta is near the edge of the cervix, but does not completely cover it.

The Causes of Placenta Previa:

Placenta previa occurs when the placenta attaches to the lower part of the uterus, partially or completely covering the birth canal (cervix). The exact cause is not clearly known, but there are several risk factors that can increase the chances of placenta previa occurring:

  1. Age of the mother: Women who are over 35 years old have a higher risk.
  2. Pregnancy History: Women who have experienced placenta previa in a previous pregnancy.
  3. History of Uterine Surgery: Previous surgery on the uterus, such as cesarean section or curettage, may increase the risk.
  4. Multiple Pregnancy: Women with multiple or more pregnancies have a higher risk of
  5. Multiparity: A woman who has given birth several times before.
  6. Smoking: Smoking during pregnancy may increase the risk of placenta previa.
  7. Cocaine use: Use of certain drugs, such as cocaine, may increase the risk.
  8. Abnormal Implantation: A placenta that develops abnormally in the uterus.
  1.  

Placenta Previa Symptoms

The main symptom of placenta previa is painless vaginal bleeding during the second or third trimester of pregnancy. However, there are some other symptoms that may appear2:

  1. Vaginal Hemorrhage:
    • Sudden painless bleeding, usually bright red in color.
    • This bleeding may stop on its own but often returns after a few days or weeks.
  2. Uterine Contraction:
    • Some women may experience abdominal contractions or cramps.
  3. Pain:
    • Although rare, some women may feel mild pain or cramping.

Placenta Previa Diagnosis:

Diagnosis of placenta previa is usually done through various examination methods, with ultrasonography (USG) as the main tool. Here are some of the ways in which placenta previa is diagnosed:

  1. Ultrasonography (USG)

Transabdominal Ultrasound:

  •  Transabdominal ultrasound has a high sensitivity in detecting placenta previa, especially in the third trimester.

Transvaginal Ultrasound:

  • Transvaginal ultrasound is performed by inserting an ultrasound probe into the vagina. This method is more accurate in determining the position of the placenta relative to the cervix7.
  1. Pencitraan Resonansi Magnetik (MRI)
  • MRI is used as an additional tool to assess the position of the placenta, especially if there is ambiguity in the ultrasound results or if complications such as placenta accreta (placenta that is too deeply attached to the uterine wall) are suspected.

Placenta Previa Complications

Placenta previa can lead to various serious complications for both the mother and the fetus. Here are some of the risks of complications associated with placenta previa4:

  • Antepartum Hemorrhage : Painless vaginal bleeding is the main symptom of placenta previa and can occur in the second or third trimester of pregnancy. This bleeding can be heavy and life-threatening.
  • Intrapartum and Postpartum Hemorrhage: The risk of severe bleeding during labor and after delivery is increased in placenta previa. Postpartum bleeding (after delivery) can be very dangerous and requires immediate intervention.
  • Preterm Labor: Placenta previa increases the risk of preterm birth (before 37 weeks of pregnancy) due to bleeding or necessary medical intervention. Premature babies may face various health complications.
  • Placenta Accreta: Placenta accreta occurs when the placenta attaches too deeply and too tightly to the uterine wall. This can lead to heavy bleeding during labor as the placenta cannot detach easily.
  • Placenta Increta and Percreta: In more severe cases, the placenta may penetrate deeper into the uterine muscle (increta) or penetrate the entire uterine wall and reach other organs such as the bladder (percreta).

How Placenta Previa is Treated

Managing placenta previa requires a careful and planned approach to ensure the safety of both mother and baby. Here are the steps that are commonly taken to manage placenta previa and ensure a safe and smooth delivery:

  1. Routine Monitoring with regular ultrasound examinations
  2. Increase your rest time,
  3. decrease physical activity.
  4. No sexual intercourse, to reduce the risk of contractions or bleeding.
  5. Take medication if needed or signs of complications.
  1. Hospitalization if bleeding occurs or placenta previa is severe. And in case of severe bleeding, a blood transfusion may be required to replace the lost blood and maintain the stability of the mother's condition.
  2. Preparation for Caesarean Section because in many cases of placenta previa, normal delivery is not possible safely, so a planned caesarean section is performed. The timing of the cesarean section will be determined based on the gestational age and condition of the mother and fetus.
  3. Consultation with an obstetrician Specialist who is experienced in dealing with high-risk pregnancies can help in planning for optimal treatment. labor plan with the doctor to know the steps to be taken in case of complications and what to expect during labor.

The treatment of placenta previa should be tailored to each individual's specific condition. Therefore, it is important to work closely with the medical team to get the right treatment and ensure the safety of both mother and baby.

Referensi:

  1. Reddy, U. M., et al. “Maternal age and risk of stillbirth throughout pregnancy in the United States.” American Journal of Obstetrics & Gynecology (2017).
  2. Jauniaux, E., et al. “Placenta previa and placenta accreta: Diagnosis and management.” American Journal of Obstetrics & Gynecology (2019).
  3. Silver, R. M., et al. “Placenta previa, placenta accreta, and vasa previa.” Obstetrics & Gynecology (2015).
  4. Ananth, C. V., et al. “The association of placenta previa with history of cesarean delivery and abortion: A metaanalysis.” American Journal of Obstetrics & Gynecology (2003).
  5. Cnattingius, S., et al. “Tobacco use and the risk of placenta previa.” Obstetrics & Gynecology (1993).
  6. Rayburn, W. F., et al. “Impact of maternal cocaine use on pregnancy outcome.” Obstetrics & Gynecology (1989).
  7. Tikkanen, M., et al. “Placental abruption: Clinical presentation, management, and maternal and fetal outcomes.” Acta Obstetricia et Gynecologica Scandinavica (2006).
  8. Smith, G. C. S., et al. “Accuracy of ultrasonography in the diagnosis of placenta previa.” Obstetrics & Gynecology (2006).