Placenta praevia occurs in approximately 0.5% of pregnancies. Medical interventions are based on the severity of symptoms.
What is placenta praevia?
Placenta praevia is a malposition of the placenta in a pregnant woman. Depending on the form of placenta praevia, the birth canal is covered by the placenta to varying degrees. In the case of so-called placenta praevia marginalis, the placenta makes contact with the inner cervix, but a vaginal delivery is usually possible. If, on the other hand, placenta praevia totalis is present, the inner cervix is completely covered by the placenta; as a rule, a birth must take place here with the help of a Caesarean section. The symptoms of placenta praevia include, above all, vaginal bleeding, which occurs towards the middle of pregnancy. This is usually only maternal blood. Placenta praevia is most common in multiparous and/or multiparous women.
Causes
Placenta praevia occurs due to implantation of a fertilized egg in the lower part of the uterus. Statistically, the risk of placenta praevia increases if a woman’s uterus has been damaged in the past. Such damage may be the result of inflammation of the endometrium or previous cesarean sections. Factors such as previous miscarriages, uterine scrapings or so-called manual placental abruptions also have a favorable effect on the development of placenta praevia. Manual placental abruption is the term used in medicine to describe the necessary surgical removal of the placenta, which does not detach itself from the uterus after the birth process. The exact causes of implantation of a fertilized egg in the lower uterine region are still largely unknown.
Symptoms, complaints, and signs
Placenta praevia is a malposition of the placenta in pregnant women. The excessively low position of the placenta, which may partially or completely cover the uterine orifice, is manifested in the middle to last third of pregnancy by bleeding from the vagina. These may be intermittent but may also be continuous, usually involving bright red blood originating from the mother. In rare cases, if the villi are also damaged, it may also be fetal blood that leaks. Normally, the bleeding is not painful, but the pregnant woman may lose a lot of blood if the placenta completely covers the internal cervix, so in some cases shock may occur. The blood loss not infrequently leads to circulatory problems and dizziness. In placenta praevia, the abdomen remains soft and is not sensitive to pressure. It often affects women who have already had several cesarean deliveries or who have undergone scrapings after miscarriages. Often, the presence of placenta praevia requires bed rest or, in the case of severe bleeding, hospitalization. Most often, a cesarean delivery is necessary because natural childbirth carries the risk of excessive blood loss.
Diagnosis and course
The suspicion of a present placenta praevia arises in various cases due to an occurring hemorrhage during the last three months of pregnancy. Typically, such bleeding is painless. Preventive ultrasound examinations during pregnancy can also indicate the presence of placenta praevia; the corresponding images allow precise localization of the placenta. If placenta praevia is suspected, physicians strongly advise against performing a medical examination of the vagina (vagina) by palpation; this may increase bleeding. During the course of a developing placenta praevia, stretching of the lower uterine area occurs. These distensions are favored by contractions of the uterus (the womb). Due to uterine stretching, the placenta can now partially detach from the uterine lining and tear. As a result, the bleeding typical of placenta praevia occurs. As a rule, medical measures are now required to ensure the integrity of mother and child.
Complications
With placenta praevia, those affected usually suffer from various symptoms that can occur during pregnancy.This can be noticed by heavy bleeding, which, however, does not have to be associated with pain. There are also no contractions and the patient’s abdomen feels very soft. In most cases, placenta praevia is not associated with any particular complications or other serious damage. The child also develops normally in most cases, so there are no complications in this case either. However, in many cases placenta praevia can lead to depression or other psychological discomfort and possibly anxiety in the patient. For this reason, a doctor must be consulted in any case of this disease. Treatment of placenta praevia is done with the help of medications. Even in this case, there are usually no complications and the symptoms disappear relatively quickly. Only in severe cases of placenta praevia a cesarean delivery is necessary. In most cases, however, there are no particular complaints even in this case.
When should you go to the doctor?
Placenta praevia must always be treated by a doctor. If the condition is not treated, it usually results in stillbirth and further serious complications. Self-healing does not occur with this disease. A doctor should be consulted for placenta praevia if there is irregular bleeding during pregnancy. The severity of this bleeding can vary greatly, and the blood is usually bright red. Likewise, those affected suffer from dizziness or circulatory problems, which can significantly reduce the quality of life. In most cases, the bleeding is not associated with pain. Therefore, if these complaints occur during pregnancy, a doctor must be consulted immediately. Placenta praevia is treated by a gynecologist. In an emergency, the hospital should be visited, for further treatment surgical intervention is necessary. The life expectancy of the mother is not negatively affected by placenta praevia in this case.
Treatment and therapy
Professional treatment of placenta praevia is based on various factors. For example, the severity of any bleeding that has occurred, the degree of maturation of the fetus, and the general condition of the expectant mother all play a role. In various cases, inpatient care of the affected woman is medically advisable in the presence of placenta praevia. If placenta praevia causes only light bleeding in the patient and the child cannot yet be delivered due to its stage of development, physicians often administer medications to inhibit labor. In addition, depending on the individual case, active substances can be used that promote lung maturation of the fetus. In addition, doctors often recommend consistent physical rest. Such rest serves to prevent recurrence of bleeding. If placenta praevia is accompanied by heavy bleeding and/or if the child’s development already permits delivery, this is often done as quickly as possible with the help of a cesarean section.
Outlook and prognosis
As individual as the course is with placenta praevia, so is the prognosis. Both a deep-seated placenta and a placenta praevia marginalis can also go completely unnoticed, while a placenta praevia totalis can sometimes even be accompanied by severe bleeding and a great risk to life. In placenta praevia, possible bleeding usually stops spontaneously, so treatment is not necessary. However, it can also happen that bleeding becomes a danger to the life of the expectant mother as well as the unborn child. In addition, bleeding that has already stopped may start again after a few days or even weeks. However, with the right treatment and a conscious approach to the situation, it is still possible for patients with placenta praevia to give birth to healthy children. For the prognosis, it does not matter whether a spontaneous birth or even a cesarean section is performed. Basically, it must be said that the more placental tissue covers the cervix, the greater the probability of bleeding before or during birth. However, the risks themselves are generally very low. For example, maternal mortality is less than one percent, and fetal peripartum mortality (mortality rate before or during birth) is about ten percent.If an expectant mother has already been diagnosed with placenta praevia once, the risk of this condition recurring is up to eight percent.
Prevention
Because the exact causes of placenta praevia occurring are largely unclear, prevention is almost impossible. However, regular check-ups during the course of pregnancy can help to detect any placenta praevia that may be present at an early stage. Among other things, this allows measures to be taken that can reduce the risk of bleeding occurring when placenta praevia is present (such as physical rest for the expectant mother).
Follow-up
In most cases, only very limited aftercare measures are available to the affected person in the case of placenta praevia, so a physician should be consulted at an early stage. Only with a timely diagnosis can further complications be prevented, so that even a normal pregnancy proceeds. A doctor should therefore be consulted at the very first signs and symptoms of placenta praevia. In most cases, those affected are dependent on taking various medications. It is always important to ensure that the medication is taken regularly and in the correct dosage in order to alleviate the symptoms permanently and correctly. If there are any uncertainties or questions, a doctor should always be consulted first. Regular checks are also necessary during treatment to monitor the current state of the disease. In an emergency, a Caesarean section must be performed. In many cases, the affected parents also depend on the psychological support of friends and relatives. This can prevent depression and other psychological upsets. The further course of placenta praevia depends very much on the manifestation of the disease, so that a general prediction is not possible in this case.
What you can do yourself
Placenta praevia can hardly be countered by self-help measures. Diagnostic tools to combat it are exclusively regular control examinations, which, however, fall into the medical field. Essential everyday tips can be summarized under the term “protection”. Affected women should not subject themselves to psychological pressure. In everyday life and at work, it is important to take it easy. Stress regularly leads to the well-known complaints of placenta praevia. Adherence to rest periods has proven to be particularly effective. A midday nap and a comfortable lying position on a sofa are sometimes the best remedies. Sporting challenges should generally be avoided. Women should especially take care of the area around the pelvis. This includes abstaining from sex as well as refraining from vaginal douching. Tampons or other objects should not get into the vagina under any circumstances. The partner and close friends and relatives should pay particular attention to harmony in everyday life when placenta praevia is diagnosed. By taking on tasks, they can help to ensure that the mother-to-be is protected. This serves not least also the well-being of the unborn child. Complications from psychological causes must not be underestimated.
