Treatment of placenta previa
Medically Reviewed by Dr Sravya, MBBS, MS
Introduction
Placenta Previa is the situation in which the placenta fully or slightly gets over the internal os of the cervix. It is a serious risk factor in postpartum hemorrhage and can cause morbidity and mortality of both the mother and neonate. This situation does not allow a safe vaginal delivery, and if the mother has placenta previa, there is no treatment for placenta previa available. It requires the delivery of the neonate to be
via cesarean delivery or management of bleeding and faster fetal development with medication.
Placenta Previa occurs in about 1 in every 200 pregnant women. The risk of symptoms of placenta Previa increases with age, smoking, and having a previous cesarean delivery. It is more common in those women who have had pregnancies several times. The severity of placenta Previa ranges from mild to severe. In severe cases of placenta Previa, the placenta may cover the entire cervix, making it more difficult and almost impossible for the baby to pass through the birth canal. There is a high risk of severe bleeding, placenta accreta, and preterm birth in women who have developed placenta previa.
If the mother has symptoms of low-lying placenta at 32 weeks, scan cesarean delivery is advised.
Types Of Placenta Previa
There are three types of Placenta Previa:
- Marginal placenta Previa: The placenta gets placed at the edge of the cervix. It touches the cervix but does not cover it. This type is more likely to resolve on its own before your baby’s due date. Also called low-lying placenta symptoms..
- Partial placenta Previa: In this condition, the placenta partially covers the cervix.
- Complete or total placenta Previa: In this, the placenta completely covers the cervix. It blocks the vagina. This type of placenta Previa is less likely to correct on its own.
Causes
The exact cause of developing placenta Previa is unknown. However, some factors
can contribute to the development of placenta previa, including:
- The placenta Previa is more common in women who have had a previous cesarean delivery. This is because the scar tissue from the cesarean delivery makes it difficult for the placenta to get attached to the upper part of the uterus.
- Women with a uterine abnormality, such as a septum or a fibroid, are more likely to have an increased risk of placenta Previa. This is because abnormalities create a pocket in the uterus where the placenta can attach.
- Multiple pregnancies are also a reason associated with an increased risk of placenta Previa and that’s because the placentas of multiple babies often compete for space in the uterus, which can lead to low-lying placenta symptoms.
- Late maternity is also a major risk factor for placenta Previa. This is because the lining of the uterus becomes thinner with the advancing age of women, which makes it more likely for the placenta to attach low and low-lying placenta symptoms can be seen there.
- Smoking and cocaine use can damage the lining of your uterus, and it can lead to placenta Previa.
Treatment Of Placenta Previa
There is no treatment available to move the placenta and change its position. Treatment of placenta previa depends on the severity of the bleeding or how far along the pregnancy is. With the diagnosis of placenta previa, the patient is consulted for elective delivery at the 36th to 37th week by performing a cesarean section. Some women with placenta previa have complications and require urgent cesarean sections at a very early gestational age.
Mothers with excessive and continuous vaginal bleeding must be delivered by doing a C-section regardless of gestational age. If bleeding is moderate, then expectant management can be followed if the gestational age is less than 36 weeks. In some cases, patients should be admitted and, if required, should be given magnesium sulfate for neuroprotection and steroids for the lung maturity of the baby.
During the first and second trimester, vaginal bleeding may be secondary to subchorionic hematoma, cervicitis, cervical cancer, threatened abortion, ectopic pregnancy, or molar pregnancy. For the third trimester, vaginal bleeding can be due to labor, placental abruption, vasa previa, or placenta previa.
Although vasa previa can be identified in grey-scale as linear structures within front of the inner os, the diagnosis is substantially easy by putting a flash of color Doppler over the cervix.
Let’s have a look at low-lying placenta treatment and vasa previa treatment.
Low-lying placenta treatment
The low-lying placenta is diagnosed when the inferior placental edge is at a distance of about 2 cm from the internal cervical os but does not overlap it. Low-lying placenta may be correlated with antepartum hemorrhage and it is an indication for cesarean delivery if persistent into the third trimester. If the placenta is low-lying and there is no bleeding, the doctor may suggest following regular monitoring to observe if the placenta moves up on its own. If the placenta does not move up on its own and there is no bleeding, the doctor may suggest any of the following treatments:
- Hospitalization: It is necessary for close monitoring and treatment of bleeding or other complications that may have developed. Women who require low- lying placenta treatment will need to be monitored closely throughout their pregnancy to check the baby's growth. This may include frequent ultrasounds to check the position of the placenta.
- Medications: Medications can be used to stop bleeding or prevent early labor. Medications such as Vitamin K, corticosteroids, blood transfusions, and Tocolytics can be prescribed by the doctor. It is very important to note that these types of medications should be used only under the supervision of a doctor.
- C-section delivery: This is the recommended method for delivery in most women with placenta previa because a vaginal delivery can result in excess bleeding for the mother and cause distress for the baby.
- Cervical cerclage: Cervical cerclage can help to prevent premature dilation. It is a procedure in which the cervix is sewn shut to prevent premature dilation.
- Balloon tamponade: In this procedure, a balloon is inserted into the vagina and inflated which puts pressure on the cervix and stops vaginal bleeding.
Vasa previa treatment
The main symptom of vasa previa condition is there is rupture of the vessels that carry fetal blood. This occurs at or near the delivery period if the condition is undetected and can result in prenatal mortality in 56% of cases if remains undiagnosed. The major complication of vasa previa treatment is to prevent this rupture of the vessels carrying fetal blood. Another symptom of vasa previa is fetal bradycardia.
Following are some measures taken for treating vasa previa:
- The vasa previa treatment is planned by cesarean section because a vaginal delivery can cause severe blood loss in the baby. It is specifically scheduled for 34-37 weeks of pregnancy or earlier if there is severe bleeding or other complications are developed.
- Before performing the cesarean section, the mother may be prescribed medications that will help to mature the baby's lungs and which will prevent bleeding.
- For the diagnosis, alternative methods such as digital palpation of a vasa previa, amnioscopy, fetal blood detection test, and palpation have been used mostly, and they have historical significance. MRI also has been suggested. All these methods need greater expertise than the color Doppler technique. Thus, they cannot cannot compare in speed and availability.
Frequently Asked Questions
There are no specific treatments available for placenta previa, but some preventive measures that doctors will recommend, such as bed rest, hospitalization, medications, and c-section delivery.
When you receive the proper treatment, most women and their babies get delivered safely. However, there is an increased risk of complications such as premature birth, low birth weight, and infection.When you receive the proper treatment, most women and their babies get delivered safely. However, there is an increased risk of complications such as premature birth, low birth weight, and infection.
There is no known option to prevent vasa previa. However, if you have any of the risk factors, it is very important to see your doctor and talk about your pregnancy care.
A low-lying placenta is a condition when the placenta is implanted lower in the uterus than usual.
There are some risks associated with c-sections, such as Bleeding, Infection, blood clots, and anesthesia complications.