Are you at risk of placenta previa?

There are many complications and conditions that come during pregnancy, like placenta previa. Placenta previa occurs when a baby’s placenta partly or completely covers the mother’s cervix (the outlet for the uterus), doctors say.

Dr Iba Mayele, an obstetrician gynaecologist at Clinic Galien, Kimironko, says placenta previa is when the placenta attaches inside the uterus but near or over the cervical opening, thus interfering with normal delivery of a baby. The placenta is crucial to keeping your baby alive and well in pregnancy.

“The placenta is the structure that develops in the uterus during pregnancy and it is responsible for providing oxygen, nutrition, and removing wastes from the baby. The placenta connects to the baby through the umbilical cord,” says Dr Ruzindana Kenneth, a consultant at Kigali University Teaching Hospital Kigali (CHUK).

Mayele says that there are three types of placenta previa which include; complete placenta previa: Here, the internal cervical opening is completely covered by the placenta.

Partial placenta previa: The internal cervical opening is partially covered by the placenta and, the marginal placenta previa; this is where the placenta is at the edge of the internal cervical opening.

Mayele notes that if a woman has placenta previa, the healthcare provider will monitor her and the baby to reduce the risk of such complications.

Placenta previa can cause severe bleeding, possibly life-threatening vaginal bleeding (haemorrhage) can occur during labour, delivery or in the first few hours after delivery, he adds.

Mayele further says that placenta previa can also lead to preterm birth. Severe bleeding may prompt an emergency C-section before your baby is full term.

SIGNS AND SYMPTOMS

He says that the common symptoms include vaginal bleeding in the second half of the pregnancy (the bleeding is bright), painless vaginal bleeding after sex, uterine cramping with bleeding, and bleeding during labour.

Experts say that the bleeding occurs because as the pregnancy progresses, the placenta gets detached from the uterine walls. In the third trimester, the uterine walls become thinner and spread to accommodate the growing foetus. If placenta previa is present, the placenta is attached very low on the uterine wall. This thinning makes the placenta stretch and tear away from the uterine wall, leading to bleeding.

Ruzindana says that most of the symptoms of placenta previa occur in the third trimester (after 28 weeks of gestation), sometimes in the second trimester. Usually, mothers complain of red virginal bleeding without pain, frequently in the second half of the pregnancy.

He adds that some women may have mild contractions, and several women who are diagnosed with placenta previa early in their pregnancy, it usually resolves on its own as the uterus grows. It may increase the distance between the cervix and the placenta. The more the placenta covers the cervix, the less likely to resolve.

COMPLICATIONS

Mayele explains that complications may include dangerously low blood pressure, bleeding after delivery, complications for the baby may include foetal growth restrictions.

RISK FACTORS

Ruzindana notes that women who are at risk of this condition are those who have had more than one child, those who have had C-section delivery or women who have had surgery on the uterus, or multiple gestation (twins or triplets).

Mayele states that the baby may have scars on the uterus sac occurring from previous surgery, including, Caesarean delivery, and uterus fibroid.

DIAGNOSIS

According to Ruzindana, an ultra sound examination is used to establish the diagnosis; doctors do a trans-abdominal using a probe on the abdominal wall or transvaginal probe which is inserted inside the vagina but away from the cervical opening.

Ultra sound evaluation may be performed depending on the location of the placenta. It is important that sound

TREATMENT

Ruzindana explains that treatment depends on the extent and severity of the bleeding, the gestation stage of the pregnancy and the condition of the foetus, the position of the placenta and whether the bleeding has stopped.

In many cases, a C-section is required for complete placenta previa and may be necessary for other types of placenta previa.

“The C-section delivery is planned for women with placenta previa, as soon as the baby is safely delivered. This is typically after 36 weeks of gestation, although an emergency C-section at any gestation age may be necessary if there is heavy bleeding that cannot be stopped after treatment in the hospital,” he states.

Women who have bleeding that cannot be stopped should be admitted to the hospital for further care. If there has been little or no bleeding, or the bleeding has been stopped, doctors recommend bed rest, Ruzindana urges.

He also says that home care is not always appropriate and women who remain at home must be able to access medical care immediately should the bleeding resume. In most cases, women with placenta previa in the third trimester of pregnancy are advised to avoid any sexual intercourse and to reduce their activity level.

Women with excessive bleeding may require blood transfusions and intravenous fluids, Ruzindana says.

“In some cases, we may use tocolytics (these are medications that slowdown or inhibit labour).We give or recommend corticosteroids medicine to enhance lung development in the foetus prior to C-section delivery, or if bleeding occurs before 34 weeks when the lungs of the baby have not yet developed enough,” Ruzindana notes.

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