Placenta Previa

What is Placenta Previa?

Placenta previa is a pregnancy condition in which the placenta attaches low in the uterus and partially or completely covers the cervix. Normally, as the uterus expands, the placenta is positioned away from the cervical opening.

If the placenta continues to lie close to or cover the cervix after 20 weeks of pregnancy, it may be diagnosed as placenta previa. This can obstruct the baby’s passage during vaginal delivery and cause vaginal bleeding, particularly later in pregnancy.

Depending on how much of the cervix the placenta covers, your doctor may recommend a C-section to reduce the risk of complications during delivery.

What are the Types of Placenta Previa?

The following are the types of placenta previa:

What are the Symptoms of Placenta Previa?

The symptoms of placenta previa depend on how much of the cervix is covered by the placenta. Some women may experience no symptoms while others may notice mild to severe bleeding that require urgent medical attention.

Some common early warning signs and advanced symptoms of placenta previa include:

What Causes Placenta Previa?

The exact and definitive cause of placenta previa remains unknown. However, doctors have established a theory as to why it happens. It can include factors such as:

• Previous Caesarean Section: Earlier caesarean sections may have an impact on the placenta site.

• Previous Uterine Surgery: Uterine surgery, such as a fibroid removal or curettage, may change the lining of the uterus.

• Multiple Pregnancies: There may be an increased risk in women who have had multiple past pregnancies.

• Multiple Babies: In twin/multiple pregnancy, a larger placenta increases the risk of low implantation.

• Advanced Maternal Age: Women over the age of 35 are more likely to get placenta previa.

• Smoking During Pregnancy: Smoking may cause problems in the formation of the placenta and implantation.

• Previous Placenta Previa: The risk of a placenta that grows too close to the cervix is higher if you have had it in a previous pregnancy.

• Assisted Reproductive Techniques: Abnormal placental attachment may occur slightly more often in pregnancies that are conceived as a result of fertility treatments.

Disease Similar to Placenta Previa

Several pregnancy complications such as placental abruption or vasa previa can cause bleeding during pregnancy. Although they may appear similar, their causes and management differ significantly.

The comparative overview of the conditions that are similar to placenta previa is given below:

Placenta Previa vs Placental Abruption vs Vasa Previa

What are the Complications of Placenta Previa?

Placenta previa may cause complications, such as:

• Severe Bleeding: Excessive bleeding that occurs before or during the delivery process may become a medical emergency.

• Preterm Birth: If bleeding poses a threat to the mother and/or the baby, early delivery may be required.

• Low Birth Weight: Low birth weight is often a complication of premature birth.

• Placenta Accreta Spectrum: Placenta previa can sometimes be associated with the placenta accreta spectrum, a condition where the placenta attaches too deeply to the uterine wall. This condition can increase the risk of severe bleeding during delivery.

• Postpartum Hemorrhage (PPH): Heavy bleeding can occur after delivery because the lower part of the uterus may not contract as well as the upper part to stop bleeding.

• Cesarean Hysterectomy: In severe cases where the placenta grows deeply into the uterine wall, a hysterectomy may be needed to control heavy bleeding.

• Fetal Distress and Hypoxia: Severe blood loss in the mother can lower her blood pressure and reduce the oxygen reaching the baby. This can cause a dangerous drop in the baby’s heart rate.

• Blood Transfusion Requirement: There can be blood loss, which could require transfusion support.

• Emergency Caesarean Delivery: If the bleeding is unexpected, the delivery may have to be done on an emergency basis, which may necessitate surgery.

• Maternal Anaemia: Most people lose blood over and over, which can lower red blood cell counts.

Other pregnancy problems that are associated with the condition and may need to be kept an eye on are gestational diabetes, preeclampsia, postpartum haemorrhage, foetal growth restriction and premature labour.

When Should I See a Healthcare Provider?

You should seek immediate medical attention in case of the following:

• Heavy bleeding from the vagina at any time of pregnancy (or delivery) that is bright red

• Multiple episodes of vaginal bleeding during pregnancy

• Sudden heavy bleeding

• Severe abdominal pain

• Regular contractions occurring before full term

• Reduced foetal movement

• Dizziness or fainting

• If there is a significant amount of blood loss, signs include weakness or shortness of breath

Any bleeding, not just heavy, should not be overlooked during pregnancy. Early assessment allows the cause to be identified and the likelihood of complications to be minimised.

How is Placenta Previa Diagnosed?

It is usually diagnosed during routine prenatal imaging, which involves:

Diagnostic Overview Summary

Note: If a case of placenta previa is diagnosed early in pregnancy, it might resolve once the uterus expands and the placenta shifts higher. Follow-up scans are used to see how these changes take place.

How is Placenta Previa Treated or Managed?

Management of placenta previa is based on the amount of bleeding, the gestational stage, and the position of the placenta. Some of the tips to manage placenta previa include:

Common Medicines Used to Treat Placenta Previa

Medicine alone cannot be used to treat placenta previa. Medications are used, if needed, to decrease difficulties and support the pregnancy outcomes.

Common medicines used for placenta previa treatment are:

• Betamethasone or Dexamethasone: These corticosteroid injections may be given if early delivery is possible. They help speed up the baby’s lung maturity before preterm birth.

• Iron, Folic Acid, or Ferrous Ascorbate: These supplements may be prescribed to prevent or treat anaemia caused by repeated bleeding during pregnancy.

• Tranexamic Acid: This medicine may be used in selected bleeding situations under hospital supervision. It should not be self-used during pregnancy.

• Isoxsuprine or Nifedipine: These tocolytics may be used in selected cases to relax the uterus if contractions occur before delivery. They are not used to treat placenta previa itself.

• Anti-D Immunoglobulin: This may be given to Rh-negative pregnant women if bleeding occurs, to reduce the risk of Rh incompatibility-related complications.

• Blood Products: In cases of heavy bleeding, blood transfusion or plasma products may be required in the hospital.

Note: Placenta previa needs close obstetric monitoring. Medicines should be used only under the supervision of a gynaecologist or obstetrician. Heavy bleeding, dizziness, fainting, abdominal pain, contractions, or reduced baby movements require urgent medical care.

Living with Placenta Previa: Challenges and Caregiving

Living with placenta previa can be stressful because it may increase the risk of bleeding during pregnancy, especially in the second or third trimester. Some women may need frequent checkups, activity restrictions, planned hospital care, or a caesarean delivery depending on the placenta position, bleeding episodes, and pregnancy stage.

Some critical challenges and critical care points for placenta previa patients are:

What is the Prognosis?

While medications and lifestyle changes can be used to manage placenta previa, there are none that can actually reverse the condition.

During the second and third trimesters, the uterus grows, causing the placenta to shift upwards and away from the cervix. This process is sometimes called 'placental migration', even though the placenta does not actually move; instead, the uterus expands, changing the placenta’s position. The prognosis of placenta previa is based on the following:

• Type of placenta previa

• Age at diagnosis of the pregnancy

• Severity of bleeding

• Complications of the placenta

• Overall maternal health

A low-lying placenta in the second trimester might resolve before the baby is born. Complete placenta previa does not resolve and is associated with a lower likelihood of vaginal delivery. In such situations, however, the prognosis is usually favourable when handled by an expert obstetrician.

How Can I Prevent Placenta Previa?

Placenta previa cannot always be prevented. But there are some practices in a healthy pregnancy that can help reduce some risk factors, which include:

• Avoid Smoking: Smoking is a risk factor for abnormal placental implantation.

• Attend Early Prenatal Checkups: Scans regularly check for problems before they occur.

• Follow Medical Advice After Uterine Surgery: Healing from surgery may help your future reproductive health.

• Plan Future Pregnancies Carefully: Talk to your health care professional about when you would like to get pregnant again after a caesarean section.

• Maintain a Healthy Pregnancy Weight: Healthy maternal weight contributes to overall pregnancy outcomes.

• Manage Chronic Conditions: Conditions like diabetes and hypertension should be under control prior to conception.

• Seek Prompt Care for Pregnancy Bleeding: Complications can be avoided if the bleeding is treated early.

While prevention is not always feasible, early diagnosis remains one of the best ways to minimise risk.

Placenta Previa Treatment Cost in India

The cost of managing placenta previa in India depends on the severity of bleeding, number of scans and tests, hospital stay, type of delivery and need for additional care. Costs can be higher when an emergency C-section, blood transfusion, ICU admission or neonatal care is required.

An overview of the placenta previa treatment cost in India is given below:

Note: These costs are approximate and may vary by location, hospital, doctor’s fees, severity, treatment required, length of stay, and need for emergency, ICU or NICU care.

Does Health Insurance Cover Placenta Previa?

Yes, health insurance can cover placenta previa when the policy includes maternity benefits. Under IRDAI regulations, insurers offering maternity cover must cover complications related to pregnancy and childbirth, which can include placenta previa.

However, the coverage is subject to the policy’s terms and the applicable maternity waiting period, which can be up to 3 years depending on the insurer and plan.

Once eligible, the policy may cover expenses such as hospitalisation, diagnostic tests, treatment for bleeding, medically necessary caesarean delivery and blood transfusions, subject to the applicable limits and exclusions.

Disclaimer: Insurance terms differ between insurers, so policy documents should always be reviewed before making assumptions about coverage.

How Much Health Insurance Coverage is Needed for Placenta Previa?

This coverage for placenta previa will depend on the degree and the need for emergency care of the condition during the third trimester.

A pregnancy complicated by placenta previa can often be considered high-risk. The safe management of the condition within private or premium urban settings requires advanced tertiary support. A maternity coverage of ₹10 - ₹15 lakh should be adequate. However, it depends on the coverage inclusions and exclusions of the insurer and policy.

It is essential to get a health insurance plan that includes separate maternity riders and a sufficient sum insured to cover treatment costs for potential complications.