Brief overview
- Treatment: bed rest, possibly anti labor drugs, in case of danger to mother and child: premature induction of labor.
- Course and prognosis: Bleeding and danger vary according to placental position. Birth is by cesarean section in the vast majority of cases.
- Symptoms: Bleeding from the vagina, sometimes cramps.
- Diagnostics: palpation of the abdomen and vagina, ultrasound examination.
- Prevention: elimination of risk factors, bed rest and sparing to avoid bleeding
What is placenta praevia?
A placenta praevia more or less completely covers the internal cervix, i.e. the exit of the uterus through which the child passes at birth. Normally, the placenta is located well away from the uterine outlet. Depending on the extent of the defect, a distinction is made between:
- Deep-seated placenta: It does not reach the internal cervix, but sits closer to it than usual.
- Placenta praevia marginalis: The placenta touches the internal cervix but does not displace it.
- Placenta praevia totalis: The placenta completely covers the internal cervix.
Placenta praevia: What must be observed?
Bleeding is always an alarm signal. In this case, consult a doctor immediately!
If a premature birth is imminent, the doctor will usually prescribe drugs that inhibit labor. This includes atosiban, for example. Sometimes glucocorticoids (betamethasone) are used to accelerate the lung maturity of the unborn child.
If the pregnancy has already progressed beyond the 36th week, birth is usually induced.
How does the birth proceed?
Some women experience recurrent bleeding of varying intensity during pregnancy. Some pregnant women stay in the hospital temporarily or until the end of the pregnancy.
How does placenta praevia become noticeable?
A typical symptom of placenta praevia is a sudden onset of vaginal bleeding. It is most likely to occur in the second half of pregnancy, most often at the end of the second trimester or at the beginning of the third trimester. Sometimes the bleeding is accompanied by cramps.
While some bleeding from placenta praevia stops spontaneously – that is, without treatment – other bleeding requires the pregnant woman to receive a blood transfusion.
What causes placenta praevia?
There are some factors that are associated with an increased risk of placenta praevia. These include:
- Smoking
- Advanced age of the expectant mother
- Unusual shape of the uterus (uterine anomaly).
- Many pregnancies in the past
- Multiple pregnancy
- Cocaine abuse
- Scars in the uterus, for example, from surgery, cesarean sections, or abortions (scrapings)
- In vitro fertilization (artificial insemination)
Women who notice vaginal bleeding during pregnancy are strongly advised to consult a gynecologist. He will first ask them in detail about their medical history (anamnesis). Possible questions include:
- What week of pregnancy are you in?
- Do you have any pain?
- Have you been pregnant once or more before?
- Do you smoke?
In addition, he performs an ultrasound examination of the abdomen, a so-called transabdominal sonography. At the end of the second trimester, this provides information about the location of the placenta. Ideally, the patient’s bladder should be about half full to obtain a better overview of the position of the individual organs in relation to each other.
How can placenta praevia be prevented?
Among the most important precautions to avoid bleeding in placenta praevia is bed rest. Many women with a present placenta are strongly advised to spend the rest of the pregnancy lying down and avoiding exertion. Depending on the severity of placenta praevia, pregnant women are often banned from working, meaning they do not have to work during pregnancy.
