Placenta Issues In Pregnancy

We have all heard about Pre-Eclampsia and Gestational Diabetes… But what about other Pregnancy Complications? How about Placenta Issues?

We are going to talk about 5 Placenta Issues that occur in many pregnancies in America. What causes them, the odds of developing them, how they are diagnosed and how they are treated. Awareness for these issues must be spread- they are more common than people think!

šPlacenta Previa: When the placenta is partially or completely covering the cervix- possibly preventing a vaginal delivery.

This is BY FAR the most common placenta issue we hear about. So we gave extra info on this one!

As your pregnancy progresses, your uterus expands- this affects the placenta's position. The area where the placenta is attached usually stretches upwards, away from your cervix. If the placenta stays low in your uterus, near to or covering your cervix, it may block the baby's way out. This is called low-lying placenta or placenta previa. It affects about 1 in every 200 births, but in most cases the cervix is not completely covered.

The position of your placenta will be recorded at your 18- to 21-week ultrasound. If your placenta is significantly low, you'll be offered an extra ultrasound scan later in your pregnancy (usually at about 32 weeks) to check its position again. For about 90% of women, the placenta will have moved upward by this point. However, if the placenta is still low in the uterus, there's a higher chance of abnormal bleeding during pregnancy and/or birth. This bleeding can be very heavy and put you and your baby at risk. 

Placenta Previa that does not resolve warrants a hospital birth- home birth can become risky at this point. If the placenta is near or covering the cervix, the baby can't be delivered through the vagina, so a cesarean section would be necessary. There often aren’t symptoms, but Placenta Previa can be associated with painless, bright red bleeding from the vagina during the last 3 months of pregnancy. If you notice this or anything unusual- be sure to contact your provider!

šPlacental Abruption: A serious condition in which the placenta starts to separate from the uterine wall.

Placental abruption is a serious condition in which the placenta starts to come away from the inside of the uterine wall prematurely.  Abruption can cause stomach pain, abnormal bleeding and frequent contractions and can also affect the baby, increasing the risk of premature birth, growth problems and stillbirth

It is not known exactly what causes placental abruption, but according to studies: factors that increase the risk include injury to the abdominal area, smoking, cocaine use, and high blood pressure. Abruption is a very serious complication that should not be taken lightly.

If you're near your due date, the baby will most likely need to be delivered as soon as possible and often, a cesarean section may be warranted. However, if the baby's very premature and the abruption is minor, you may be kept in hospital for close observation on complete bed rest until baby gets closer to term.

Placenta Accreta and it’s variations: Placenta accreta occurs when the placenta—the organ that provides nutrients and other support to a developing fetus—attaches too deeply to the uterine wall.

This often leads to two major complications: the placenta cannot normally deliver after the baby’s birth, and attempts to remove the placenta can lead to heavy bleeding. This is a serious condition that can cause complications for the baby and mother, especially during the delivery.

Causes of Accreta are unknown. According to research, accretas are often related to placenta previa (occurs in 5-10% of previas) or prior cesarean section. A cesarean delivery increases the possibility of a future placenta accreta, and the more cesareans, the greater the increase. Multiple cesareans were present in over 60% of placenta accreta cases. Other uterine surgeries and IVF have also been linked to Placenta Accreta.

Providers do everything possible to diagnose an Accreta- however, this is not always possible prior to delivery. If diagnosed early, it is likely the provider will suggest a cesarean delivery prior to term to avoid potential complications. Usually between 34-37 weeks gestation, depending on the severity of the condition.

Babies born before 37 weeks are often admitted to the NICU- however their prognosis is usually very good. If there is heavy bleeding- to save mother and baby, the delivery may be scheduled even sooner. Hemorrhaging may occur from attempts to remove the placenta- if this is not managed properly, it can become life threatening to the mother.

Women who do deliver vaginally may require specialized procedures to remove the placenta and control hemorrhaging. Finally- there is a risk of hysterectomy if blood loss cannot be controlled.

Bottom Line on Accreta- If caught early and managed by an experienced provider, outcomes can be positive for both mother and baby. Be sure to report any symptoms to your provider if you experience them!

Normal vs Various Accretas

Normal vs Various Accretas

šPlacenta Accreta: when the placenta attaches too deep in the uterine wall but it does not penetrate the uterine muscle. (most common type of accreta- 80% of cases)

šPlacenta Increta: when the placenta attaches even deeper into the uterine wall and does penetrate into the uterine muscle (less common- 15%)

šPlacenta Percreta: when the placenta penetrates through the entire uterine wall and attaches to another organ such as the bladder. (rare- 5%)

More Resources Here:

https://americanpregnancy.org/pregnancy-complications/placenta-previa/

https://my.clevelandclinic.org/health/diseases/9435-placental-abruption

https://www.brighamandwomens.org/obgyn/maternal-fetal-medicine/pregnancy-complications/placenta-accreta

https://www.marchofdimes.org/complications/placental-accreta-increta-and-percreta.aspx

 https://americanpregnancy.org/pregnancy-complications/placenta-accreta/