Everything You Need to Know About Life-Threatening Placenta Previa
Approximately 1 in 200 Singaporean women experience the potentially life-threatening condition during pregnancy called placenta previa. Arm yourself with knowledge to keep you and your unborn child safe.
Placenta previa, also known as low-lying placenta, is a condition in which the placenta lies low in the uterus. This results in a partial or complete block of the cervical opening (the part of the lower uterus that leads to the vagina).
The placenta is the organ that acts as a life support system to the developing fetus by passing oxygen and nutrition from mother to baby. It also eliminates waste from the baby's blood.
The placenta, where the baby's umbilical cord develops from, attaches itself to the uterine wall.
If the placenta is low and blocks the cervical opening at the point of delivery, you would need to deliver via c-section.
There are three types of placenta previa.
- Complete previa where the cervical opening is completely covered.
- Partial previa where the placenta covers a portion of the cervix.
- Marginal previa where the placenta extends to the edge of the cervix.
While a low-lying placenta can be diagnosed as early as 12 weeks into the pregnancy, you really don't have to work yourself up into a frenzy at this point. The condition is usually diagnosed as placenta previa only after 20 weeks.
The good news is that in almost 90% of cases, the placenta moves back up before the baby is due. As the uterus grows and stretches, the placenta moves higher in the uterus and away from the cervix.
In the event that it does not, the potential risk of severe maternal bleeding can occur. In some rare, unfortunate cases, a hysterectomy (surgery to remove the uterus) may be required to control the bleeding.
Watch this video for a more visual understanding of placenta previa.
Signs and Symptoms
- Bleeding. This is a warning sign not to be ignored. Once women enter their second trimester, it is extremely crucial to look out for vaginal bleeding as a sign of placenta previa. The bleeding is typically bright red and painless. It can range from light to heavy and is likely to occur when you cough, strain yourself, or have sexual intercourse. While the bleeding does usually stop on its own, it is likely to return after several days or even weeks.
- Cramping. Though pain is uncommon, some women have experienced light to moderate cramping.
Causes and Risk Factors
The exact cause of placenta previa remains a mystery, but the following seem to be the largest contributing factors to the condition.
- Uterine Factors. Scarring of the lining tissues of the uterus. This is usually caused by previous surgery on the uterus for reasons such as removing fibroids (benign tumours of muscular and fibrous tissues that develop in the wall of the womb).
- Placental Factors. The position of the placenta is in direct relation to where the embryo plants itself in the uterus. Therefore, an embryo that plants itself low causes the placenta to also position itself low. Other placental factors include abnormally large placenta, such as in the case of multiple pregnancies.
In her book The Mother of All Pregnancy Books, Ann Douglas states that placenta previa occurs in “2.8 of every 1000 single pregnancies” and “3.9 out of every 1000 twin pregnancies”.
Women are most susceptible to placenta previa when they:
- Have a history of abortion or multiple dilation and curettage (a procedure to remove tissue from inside the uterus)
- Have had c-section (the risk increases with each subsequent c-section)
- Have endometrial scarring (bands of fibrous scar tissue that form within the uterus) from a previous episode of placenta previa
- Have had several children
- Are over the age of 35
- Do not have sufficient recovery and healing time between pregnancies
- Take cocaine
Complications associated with Placenta Previa
The complications that can possibly arise out of complete placenta previa are not to be taken lightly.
Singapore specialist Dr. Iswaran Subrahmanyam, Sai Association Clinic Pte Ltd, cautions that placenta previa is "a very serious complication that can possibly cause maternal death".
Similarly, America’s leading midwife Ina May Gaskin warns that complete placenta previa is “one of the most dangerous complications that can occur in any pregnancy”.
Complications women may experience are:
- Preterm labour. If heavy or uncontrollable bleeding occurs before the due date, the baby will have to be delivered immediately by c-section. Preterm birth may put the baby at risk of conditions like low birth weight and respiratory issues.
- Hysterectomy. Placenta previa can cause life-threatening haemorrhaging during and after delivery. This would call for a blood transfusion. In up to 10% of complete placenta previa cases, a hysterectomy may be required to control bleeding.
When to Call the Doctor
Bleeding would be the key indication to call your doctor. Even if the bleeding seems little or harmless, it is always best to err on the side of caution and get immediate medical attention.
From his 18 years of experience in Obstetrics & Gynaecology, Dr. Iswaran says that he “cannot emphasise enough the importance of being alert, to ensure that your gynae is contactable at all times” and “never to delay seeking immediate medical help” in the case of bleeding.
Time is everything. Dr. Iswaran spoke of the devastating experience of losing one of his patients, an ambulance driver’s wife, who succumbed to excessive bleeding caused by the condition and lost her life en route to the hospital.
Another of his patients, a nurse, managed to pull through after a hysterectomy was performed. She was given 19 pints of blood.
Whether or not there is vaginal bleeding, your gynaecologist will do an ultrasound during your 16 or 20 week check up. This is done to determine the position of your placenta. In order to ensure that you are diagnosed accurately, it is likely that you will have an abdominal and transvaginal scan.
During the scan, extra precaution will be taken to ensure that the wand-like device inserted into your vagina will not disrupt your placenta. Your doctor will avoid performing routine vaginal examinations on you if placenta previa is suspected. This is to reduce any possible risk of heavy bleeding.
If you are diagnosed with or suspected to have placenta previa, your gynaecologist will monitor you very closely for the rest of your pregnancy.
Additional ultrasounds will be performed to check on the position of your placenta, but pelvic and vaginal examinations will be avoided as much as possible. Your baby's heartbeat will also have to be closely monitored.
As an expecting mother, being diagnosed with placenta previa can come across as a rude shock and cause great anxiety. It is however, crucial to remain calm and optimistic.
Madam Shaheenah Suraiyah, a Singaporean mother of five children shared how she was surprised to be diagnosed with placenta previa while expecting her fifth child.
Given her previous smooth deliveries, she never thought anything could possibly go wrong. “I was worried and was losing sleep over it. Then I told myself that I had to stay positive and not make the situation worse, or the rest of my pregnancy would be a nightmare”.
She remained in close contact with her doctor and was monitored frequently for the rest of her pregnancy. Shaheenah was part of the fortunate 90% of women whose placenta shifted back up. She eventually had a natural delivery and a healthy baby.
Treatments and Drugs
Unlike an infection or illness, placenta previa is not something that you can typically cure by administering medication. You might be given medication to prevent preterm labour and, ideally, to help your pregnancy to progress to the 36th week.
If it is likely that you have to deliver earlier than your due date, you may be asked to take steroid injections to strengthen your baby's lungs. You will also be asked to closely follow these preventive measures:
- Avoid any kind of strenuous exercise or activities
- Avoid sexual intercourse
- Avoid pelvic examinations
- No lifting of heavy objects
- Bed rest
- Hospital bed rest (for heavy bleeding)
- Blood transfusion (if too much blood has been lost)
- No douching (washing or cleaning out the vagina with water or other mixtures)
If the bleeding persists or your baby starts showing any signs of distress, the only solution would be an emergency c-section. This is crucial for the safety of you and your child.
Don't let the thought of a c-section scare you, though. In fact, according to Gynaecologist.sg, three out of 10 Singaporean babies are delivered by c-section.
If the bleeding continues after your baby is born, and if your life is at risk, you may require a hysterectomy.
Lifestyle and Home Remedies
The most important thing to do if diagnosed with placenta previa is to take it easy. Slowing down is generally uncharacteristic of driven and ambitious Singaporean women, working or not.
If being idle is not your cup of tea, you may want to think again. When your precious bundle of joy arrives, idle time will be a thing of the past.
If you are working and worried that resting may affect your career, fret not. In Singapore, most companies do offer leeway and flexible arrangements for expecting mothers. You can also apply for paid hospitalisation leave for at least 30 days.
And in case you're wondering, this will not adversely affect your performance ranking. You are after all contributing to nation building!
For the stay-at-home mums, especially those with toddlers or older children, you might want to look into arrangements for an extra hand. You could consider temporarily staying with your parents or hiring a helper.
It is crucial that you do not exert or strain yourself in any way. And that includes not carrying your older children.
So really, slow down, grab a cup of tea, and rest in bed with a good book for company. Reading will help to ease you off some of the anxiety and stress that you might be going through.
While there is no fail proof method of preventing placenta previa, knowing and understanding the risks may help to lower the odds of it occurring.
For example, smoking and the consumption of cocaine greatly increase the chances for placenta previa. If you have any such addiction during, or when planning a pregnancy, seek help immediately.
In case you are trying to quit smoking, you can dial the Singapore quit line at 1800 438 2000. For additional information on quitting smoking do visit the Health Promotion Board website.
You may also wish to consider factors such as your age and how many children you've already had. Especially if you have undergone any kind of surgery on your uterus, it would be a good idea to speak to a gynaecologist before trying to conceive. Forward planning is ideal in any situation.
While it is definitely not a condition that you would take lightly, do not let it take too much of a toll on you. Most importantly, take the necessary precautions, take the best possible care of yourself, go for frequent check ups and try your best to stay positive!
Do you have any queries on placenta previa? We'd love to answer them, so drop us a comment mums!