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Placenta previa occurs when the organ joining the fetus to the uterus (placenta) is attached so low in the uterus that it partially or totally blocks the opening of the uterus (cervix). The condition varies in severity, depending on how close the placenta is to the cervix. There are three types of placenta previa: total, in which the placenta covers the entire os (opening to the cervix); partial, in which the os is only partially covered; and marginal, in which the placenta almost touches the os' edge.
Individuals who are pregnant with multiple gestations are more likely to develop placenta previa, although it's not clear why. However, most individuals who develop the condition have no apparent risk factors.
Women are more likely to suffer from placenta previa if they have had previous pregnancy terminations and/or cesarean sections, a previous diagnosis of placenta previa, or erythroblastosis.
Incidence and Prevalence: The incidence of placenta previa is 0.3% to 5% of all pregnancies. The three types of placenta previa occur with different incidences: total placenta previa occurs 20% to 45% of the time, partial placenta previa occurs about 30% of the time, and marginal placenta previa occurs 25% to 50% of the time (Joy). |
Source: Medical Disability Advisor
| Pregnant women over 40 are at the greatest risk of developing placenta previa, at 2%; and females who have had a previous C-section have a 1.5 to 5 times greater risk of developing this disorder (Joy). Women who smoke or use cocaine also have a higher risk. |
Source: Medical Disability Advisor
History: Painless second- or third-trimester bleeding (hemorrhage) is the primary sign of placenta previa. Although there may be some spotting of blood early in the pregnancy, the first episode of hemorrhage usually begins sometime after the twenty-eighth week of pregnancy. Caused by placental tissue separating from the uterus, the bleeding is sudden, painless, and profuse. There may be some cramping. Physical exam: The uterus is usually soft, relaxed, and nontender. A digital exam is not done as it may cause more bleeding. Most cases of placenta previa turn up during routine ultrasound exams. Tests: Ultrasound is then used to view the placement of the placenta in the uterus. Ultrasound is correct 95% of the time if done through the abdomen and 100% of the time if done through the vagina; the monitoring of the uterus shows contraction with hemorrhaging in 20% of people (Joy). Complete blood count (CBC) and coagulation studies such as prothrombin time (PT), active partial thromboplastin time (aPTT), fibrin split products, and fibrinogen can rule out disseminated intravascular coagulation. Placenta increta, placenta percreta, and placenta accreta can be ruled out by MRI. |
Source: Medical Disability Advisor
The treatment depends on the amount of bleeding, how far along the pregnancy is, the ability of the fetus to survive, how much the placenta covers the cervix, and whether or not labor has begun. Hospitalization is mandatory until it is certain the condition of the mother and fetus is stable. Major blood loss is replaced by transfusions.
Tocolytic medication should be given to prevent premature labor and to prolong pregnancy until at least 36 weeks, unless abruptio placentae has been diagnosed. At the thirty-sixth week of pregnancy, patients are brought to early delivery to reduce further risks to the mother and fetus. Preterm labor and hemorrhage are absent in roughly 25% to 30% of females with placenta previa who make it to 36 weeks (Gabbe 519).
A study revealed that out of 9,656 cases of placenta previa, 81% had cesarean sections (Salihu). Cesarean section is the delivery method used in most cases because it presents the least risk to the mother and fetus. Vaginal delivery is only used if the placental placement is high enough in the uterus and the fetus is presenting headfirst (cephalic presentation), or if there is no chance of the fetus surviving.
Regular prenatal visits to a physician or maternity clinic are essential for a healthy, safe pregnancy, delivery and postpartum period. |
Source: Medical Disability Advisor
| For the mother who has access to transfusions, antibiotics, and cesarean section delivery, the outcome is excellent. Half of females with the disorder have premature labor, and there is a 2% to 3% death rate for the fetus (Joy). Fetuses can also have anemia, genetic disorders, and difficulty breathing. However, these problems may be greatly reduced by early intervention and aggressive care both before and after birth. |
Source: Medical Disability Advisor
| The mother risks excessive bleeding (hemorrhage), shock, and death. The fetus may suffer blood loss (hemorrhage) due to tearing of the placenta or birth injury. Babies have a 2% to 3% chance of death from the disorder (Joy). A diagnosis of anemia or other blood disorder may cause further complications. |
Source: Medical Disability Advisor
| If hospitalization or complete bed rest is necessary, the individual will be unable to work. If the individual is physically able to work, work responsibilities must be sedentary, with frequent work breaks. Following a cesarean delivery, heavy lifting and prolonged standing will temporarily be restricted. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Has individual had a previous placenta previa?
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Has she had previous pregnancies? Cesarean delivery?
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Over 35 years of age?
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After the twenty-eighth week of pregnancy, did she experience sudden, profuse, and painless bleeding? Any cramping?
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On exam is the uterus soft, relaxed, and nontender?
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Was placenta previa diagnosed on a routine ultrasound?
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Have conditions with similar symptoms been ruled out?
Regarding treatment:
- How far along in the pregnancy is individual?
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Has bleeding been controlled?
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Were transfusions necessary?
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Is individual hospitalized?
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Is individual on complete bed rest?
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Is she on medication to prevent premature labor?
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Did individual have a cesarean or vaginal delivery?
Regarding prognosis:
- Is individual's employer able to accommodate any necessary restrictions?
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Does individual have any conditions that may affect the ability to recover?
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Were there any complications such as hemorrhage or shock?
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Did the fetus die?
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If necessary, has individual obtained counseling to assist with the grief process?
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Source: Medical Disability Advisor
| CitedGabbe, Steven G., et al., eds. Obstetrics - Normal and Problem Pregnancies. 4th ed. New York: Churchill Livingstone, Inc., 2002.Joy, Saju, and Deborah Lyon. "Placenta Previa." eMedicine. Eds. Ronald Levine, et al. 14 Oct. 2004. Medscape. 20 Oct. 2004 <http://emedicine.com/med/topic3271.htm>. Salihu, H. M. "Placenta Previa: Neonatal Death after Live Births in the United States." American Journal of Obstetrics and Gynecology 188 5 (2003): 1305-1309. |
Source: Medical Disability Advisor
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