The placenta is an organ that develops in the uterus during pregnancy. Its purpose is to nourish the baby. Oxygen and nutrients pass through the placenta to the baby. Waste products pass back out to the mother’s blood stream.
Placenta previa occurs when the placenta becomes implanted near or over the cervix. The cervix is the lower part of the uterus that opens into the vagina. With this condition, the placenta may cover part or all of the cervix. This condition is only diagnosed after 20 weeks of gestation.
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Possible causes of placenta previa include: A scarred endometrium—the lining of the uterusA large placentaAn abnormal uterusAbnormal formation of the placenta
Placenta previa can cause problems in pregnancy and birth. These include: Abnormal bleeding, sometimes heavyPremature separation of the placenta from the uterusPremature birth
Problems with penetration of the placenta into the uterine muscle or through the entire uterine wall
Factors that may increase your chance of developing placenta previa include: Previous cesarean sectionUterine problemsMultiple pregnancy—two or more fetusesMultiple previous full-term pregnanciesIncreased ageSmoking
Placenta previa symptoms vary depending on how much of the cervical opening is covered. The main symptom is painless bleeding from the vagina. This bleeding can range from light to very heavy. It usually occurs suddenly during late pregnancy. Spotting that occurs early in pregnancy may point to placenta previa.
Anything that disrupts the placenta, such as sexual intercourse, or digital exam of the vagina and cervix, may cause bleeding.
Complications of placenta previa include: Major bleedingIncreased risk of infectionIncreased likelihood of a blood transfusionPremature birth, which occurs when an infant is less than 37 weeks of gestationFetal blood loss during laborShockMaternal or fetal death
The doctor will ask about your symptoms and medical history. A physical exam will be done. A pelvic exam will not be done if placenta previa is a possibility. A pelvic exam may cause bleeding. Instead, an
will be done through the vagina or abdomen to view the placenta in the uterus. If placenta previa is detected early in pregnancy, with or without bleeding, another ultrasound will be done during the third trimester to be sure it has resolved.
If you had cesarean section in the past, and the ultrasound indicates a potential problem with the placenta, your doctor may recommend an MRI scan.
Treatment depends on several factors, including the amount of bleeding
and the gestational age of the fetus. Recommendations for treatment include: Pelvic rest—avoid sexual intercourse and tampon use if placenta previa continues into third trimesterHospitalization for major placenta previa at or beyond 34 weeks of gestationMedications to prolong your pregnancy and help with growth of fetal lungs with symptomatic placenta previa or bleeding at 24-34 weeks
How you will delivery your baby depends on your ultrasound results at 36 weeks of gestation. There is a possibility that the placenta previa will go away on its own. A cesarean section may be necessary if the placenta covers the opening of the cervix, there is heavy bleeding at delivery, or other serious complications arise that affect the health of the mother and baby.
There are no current guidelines to prevent placenta previa.
Placenta previa. American Pregnancy Association website. Available at:
http://americanpregnancy.org/pregnancycomplications/placentaprevia.html. Updated May 2007. Accessed August 6, 2013.
Placenta previa. EBSCO DynaMed website. Available at:
http://www.ebscohost.com/dynamed. Updated October 15, 2012. Accessed August 6, 2013.
Pregnancy complications. US Office on Women's Health website. Available at:
http://www.womenshealth.gov/pregnancy/you-are-pregnant/pregnancy-complications.html. Updated September 27, 2010. Accessed August 6, 2013.
5/12/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Podrasky AE, Javitt MC, et al. American College of Radiology (ACR) Appropriateness Criteria for second and third trimester bleeding. Available at: http://www.acr.org/~/media/ACR/Documents/AppCriteria/Diagnostic/SecondAndThirdTrimesterBleeding.pdf. Updated 2013. Accessed May 12, 2014.
Last reviewed August 2013 by Andrea Chisholm; Brian Randall, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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