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Placenta previa

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Duringpregnancy,theplacentaprovidesthegrowingbabywithoxygenandnutrientsfromthe
mothersbloodstream.Placentapreviameanstheplacentahasimplantedatthebottomofthe
uterus,coveringthecervix.
Whenababyisreadytobeborn,thecervix(neckofthewomb)dilates(opens)toallowthebaby
tomoveoutoftheuterusandintothevagina.Whenawomanhasplacentaprevia(theplacenta
hasimplantedatthebottomoftheuterus,overthecervixorcloseby),thebabycantbeborn
vaginally.Partialplacentapreviameansthecervixispartlyblocked,whilecompleteplacenta
previameanstheentirecervixisobstructed.
Someofthecausesincludescarringoftheuterinelining(endometrium)andabnormalitiesofthe
placenta.Aroundoneinevery200pregnanciesisaffected.

Symptoms
Themostimportantsymptominplacentapreviaispainlessvaginalbleedingafter20weeks.
However,therearecausesofvaginalbleedingotherthanplacentaprevia.Allbleedingduring
pregnancyshouldbereportedtoyourdoctorforpromptinvestigationandtreatment.

Why the bleeding happens

Duringthelaterstagesofpregnancy,thebottompartoftheuterusthinsandspreadsto
accommodatethegrowingbaby.Iftheplacentaisanchoredtothebottomoftheuterus(asoccurs
withplacentaprevia),thisthinningandspreadingseparatestheplacentaandcausesbleeding.
Sexualintercoursecanalsocausebleedingfromtheplacentapreviainlaterpregnancy.During
labour,thecervixthinsanddilates,whichwouldnormallyallowthebabytoexitintothevagina.In
placentaprevia,thedilationofthecervixfurthertearstheplacentaandcausesbleeding.

Possible complications
Someofthecomplicationsofplacentapreviainclude:

Majorhaemorrhage(bleeding)forthemother
Shockfromlossofblood
Fetaldistressfromlackofoxygen
Prematurelabourordelivery
Healthriskstothebaby,ifbornprematurely
Emergencycaesareandelivery
Hysterectomy,iftheplacentafailstocomeawayfromtheuterinelining
Bloodlossforthebaby
Death.

Causes and risk factors

Someofthepossiblecausesandriskfactorsofplacentapreviainclude:

Placentaprevia

Lowimplantationofthefertilisedegg
Abnormalitiesoftheuterinelining,suchasfibroids
Scarringoftheuterinelining(endometrium)
Abnormalitiesoftheplacenta
Multiplebabies,suchastwins

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Multiplepregnancies-awomanwhohasalreadyhadsixormoredeliverieshasariskof
onein20.

Diagnosis methods
Apregnantwomanwhoexperiencesanyvaginalbleedingshouldbeadmittedtohospitaland
tested.Someofthetestsusedtodiagnoseplacentapreviainclude:

Ultrasoundscan
Feelingthemothersbellytoestablishthebabysposition(thebabyissidewaysor
presentingbottom-firstinaroundoneinthreecasesofplacentaprevia).

Digital vaginal examinations should be strictly avoided

Itissometimesdifficulttotellthedifferencebetweenplacentapreviaandplacentalabruption.
Placentalabruptionisaconditionwheretheplacentaseparatesfromtheuterinewall.Both
conditionsareflaggedbyheavybleedingofbrightredblood.
Avaginalexaminationisoftenusedtohelpdiagnoseplacentalabruption,butcouldtriggerheavier
bleedinginthecaseofplacentaprevia.Anultrasoundscanshouldalwaysbetakenfirst,anddigital
(finger)vaginalexaminationsstrictlyavoidedinthecaseofplacentaprevia.
Thedoctormaydoaspeculumvaginalexaminationverygentlytomakesurethebleedingisnot
comingfromthecervixorvagina.Oncethediagnosisismade,thepregnancyneedstobevery
carefullymonitored.Placentapreviaisapotentiallylife-threateningconditionfortheboththe
motherandherbaby.

Treatment options vary

Treatmentdependsonanumberoffactors,including:

Whethertheplacentapreviaiscompleteorpartial
Theexactlocationoftheplacenta
Theamountofbloodlost
Thegestationalageofthebaby
Thepositionofthebaby
Thehealthofthebaby
Thehealthofthemother.

Treatment during pregnancy

Medicaltreatmentaimstoeasethesymptomsandprolongthepregnancy.Optionsmayinclude:

Bedrest.
Hospitalisation.
Closemonitoring,suchasusingafetalmonitorandregularlycheckingthemothersvital
signs(forexample,bloodpressure).
Bloodtransfusionforthemother.
Avoidinganyactivitythattriggersuterinecontractionsorirritatesthecervix,suchas
sexualintercourseororgasms.

Delivery
Oncethebabyisoldenoughtobedelivered,acaesareansectionisusuallyperformed.Thebaby
mayneedtobemonitoredinintensivecaretomakesurealliswell.Themotherwillundergoa
rangeoftests,includingteststocheckherbloodcellcountsandtheclottingabilityofherblood.

Where to get help

Placentaprevia

Yourdoctor
Obstetrician

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Emergencydepartmentofyournearesthospital
AlwayscallanambulanceinanemergencyTel.000
FamilyPlanningVictoriaTel.(03)92570100

Things to remember

Duringpregnancy,theplacentaprovidesthegrowingbabywithoxygenandnutrientsfrom
themothersbloodstream.
Placentapreviameanstheplacentahasimplantedatthebottomoftheuterus,overthe
cervixorcloseby,whichmeansthebabycantbebornvaginally.
Treatmentaimstoeasethesymptomsandprolongthepregnancyuntilatleast36weeks.

This page has been produced in consultation with, and approved by:

RoyalAustralianandNewZealandCollegeofObstetriciansandGynaecologists
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Placentaprevia

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