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Placenta previa in Kenya

placenta praevia

Placenta previa is a complication during pregnancy, making the placenta to partially or completely cover the opening of the placenta. The condition has different symptoms, but the most prevalent one is bleeding during the 20 weeks of pregnancy. Sometimes is painless vaginal bleeding.

placenta praevia
Total placenta previa causing bleeding, illustration. Source: Getty Images

There are 4 types of placenta previa. Sometimes sex triggers bleeding. Read more about the causes, types, complications, and the dos and don’ts.

What is placenta praevia?

The placenta develops along with the baby in the uterus (womb) during pregnancy. It connects the baby with the mother’s blood system and provides the baby with its source of oxygen and nourishment. The placenta is delivered after the baby, and is also called the afterbirth. In some women the placenta attaches low in the uterus and may cover a part or all of the cervix (entrance to the womb). This attachment often shows up in early ultrasound scans, when it is called a low-lying placenta. In most cases, the placenta moves upwards as the uterus enlarges. For some women, however, the placenta continues to lie in the lower part of the uterus in the last months of pregnancy. This condition is known as placenta praevia.

Who is this information for?

This information is intended to help you if you have, or have been told you may have, a low-lying placenta (placenta praevia) after 20 weeks of pregnancy. It may also be helpful if you are a partner, relative or friend of someone in this situation, or if you are interested in knowing about placenta praevia.

What are the risks to me and my baby?

Because the placenta is in the lower part of the womb, there is a risk that you may bleed in the second half of pregnancy. Bleeding from placenta praevia can be heavy, and so put the life of the mother and baby at risk. However, deaths from placenta praevia are rare. You are more likely to need a caesarean section because the placenta is in the way of your baby being born.

Causes of placenta previa

The cause of the pregnancy complication remains unknown to date.

How is placenta praevia diagnosed?

A low-lying placenta may be suspected during the routine 20-week ultrasound scan.

The best way to confirm whether or not you have placenta praevia is with a transvaginal ultrasound scan (where the probe is placed inside the vagina). This is safe for you and your baby.

Placenta praevia may be suspected if you have bleeding in the second half of pregnancy. The bleeding is usually painless and may occur after sexual intercourse.

What extra antenatal care can I expect if I have a low-lying placenta?

If your placenta remains low-lying in the second half of pregnancy, you will have at least one more scan to check whether the position of the placenta has moved with the development and stretching of the uterus.

If your placenta does not cover the cervix and you have no bleeding during your pregnancy, your repeat ultrasound scan should be at 36 weeks.

Additional care will be given based on your individual circumstances. If you have major placenta praevia (the placenta covers the cervix) you may be offered admission to hospital after 34 weeks of pregnancy. Even if you have had no symptoms before, there is a small risk that you could bleed suddenly and severely, which may mean that you need an urgent caesarean section.

You should always contact the hospital if you have a low-lying placenta and you have any bleeding, contractions or pain.

If your placenta praevia is confirmed, you and your partner should have the opportunity to discuss the options for delivery with your doctor. Depending on your circumstances, you may be advised to have a planned caesarean section.

In a few instances, a blood transfusion is essential to save your life and the life of your baby. If you feel that you could never accept a blood transfusion, then you should explain this to your obstetrician and midwife as early as possible. You can then discuss any objections or particular questions that you may have. You may need to have your baby in a hospital which has additional expertise available, should the need arise.

What will happen at the birth?

Your healthcare team will recommend the best way for you to give birth based on your own individual circumstances. If you have a major placenta praevia, your baby will need to be delivered by caesarean section.

Unless there is severe bleeding or another indication, delivery by caesarean section should be performed after 38 weeks. You will usually have a course of antenatal corticosteroids to help your baby in pregnancy to reduce complications from being born premature.

If you have a placenta praevia, you are more likely to need a blood transfusion. Blood supplies should be available, as necessary, for your individual circumstances. In extreme cases, if the bleeding continues and cannot be controlled, a hysterectomy (removal of the womb) may be the only means of controlling the bleeding.

If there is bleeding before your due date, you may have to be delivered earlier than planned.

Is there anything else I should know?

● You may be advised to avoid having sexual intercourse during pregnancy, particularly if you have been bleeding.

● You may be offered an examination with a speculum (a plastic or metal instrument used to separate the walls of the vagina) to see how much and where your bleeding is coming from. This is an entirely safe examination.

● If you have a low-lying placenta, you should eat a healthy diet rich in iron to reduce the risk of anemia.

Placenta previa is common in females. However, it is recommended to get immediate gynaecological assistance. Contact our women clinic specialist or book appointment today.

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