Written by Dr.M.D.Mazumdar, MD
Placenta previa is a type of antepartum hemorrhage.
Antepartum hemorrhage is defined as bleeding from the genital tract that occurs after the 28th week of pregnancy till the birth of the baby.
Other Causes of Antepartum Hemorrhage are Abruptio Placentae / Placental Abruption
and extra-placental causes like cervical erosion, cervical polyp, cervical carcinoma and varicose veins of the vagina or vulva.
Placenta previa is a condition where the placenta is implanted completely or partially in the lower part of the uterus.
The incidence of placenta previa is about 1 in every 200 pregnancies. In the USA, the incidence is 0.3-2.0%. It can go 1 - 5 times higher in pregnancies after a previous caesarian section.
There are 4 types of placenta previa, classified according to the position of the placenta on the uterine wall.
Certain factors can increase the incidence of placenta previa.
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Bleeding usually occurs after 28 weeks of pregnancy, although it can occur earlier. It starts spontaneously and can stop spontaneously when the patient stays at bed rest.
Ultrasonography is the most valuable aid in the diagnosis of placenta previa. With routine ultrasound being done at around 16 weeks of pregnancy at most hospitals, placenta previa can be detected quite early. About 90% of the placenta previas identified before 16 weeks tend to migrate upwards with the enlargment of the uterus. And by the 28th week of pregnancy, they are present in the upper segment of the uterus.
The rest of the 10% of patients with placenta previa should be kept under careful observation till fullterm and provided appropriate treatment.
Treatment depends on the amount of bleeding and the maturity of the fetus.
Maternal complications include hysterectomy, antepartum bleeding, intrapartum and postpartum bleeding, as well as blood transfusion, septicemia, and thrombophlebitis. Maternal mortality (death of the patient) is rare in a well equipped hospital.
Perinatal mortality (death of the foetus) occurs in around 4% - 8% of patients, mostly due to prematurity.
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