What is the present placenta?
This is a condition where the placenta (placenta) completely or partially covers the internal opening (inner mouth) of the uterus. The placenta is the so-called present.
Typical symptoms of the present placenta are sudden bleeding from the vagina, without pain or contraction of the uterus. The tendency for bleeding increases the closer you get to the estimated delivery date. This is because the lower part of the uterus then expands.
The bleeding can be triggered by intercourse, or by contractions of the uterus. The first time it bleeds can also be during childbirth.
For ultrasound examination before week 20 of pregnancy, the placenta is present in 5–6% of pregnant women, while less than 1% has the placenta present at the end of pregnancy. This is because the placenta is pulled upwards and away from the uterine opening as the uterus grows and the lower part stretches.
The present placenta may be because the fertilized egg attaches too far into the uterus. Another reason may be that the placenta is unusually large, as in the case of multiple pregnancy.
The risk of developing this placenta increases if you have given birth to many children earlier in your life. The risk also increases with high age, previous cesarean section and if you have had this condition before.
The present placenta is suspected of bleeding at the end of pregnancy, especially if the pregnant woman has no pain. The diagnosis is confirmed by ultrasound.
If there are symptoms of this condition (bleeding without pain), seek medical advice immediately. You will then be hospitalized for further examination of the uterus. The reason you need to be hospitalized is that bleeding may increase during the examination. Ultrasound is the most important investigation.
If your doctor or midwife sees the present placenta during a routine examination in the 17th-19th week, new examinations at 30-32 weeks are necessary to see if the placenta is still present.
If this placenta is detected at around the 17th – 23rd week, you will be asked to live as usual. New ultrasound will be performed around the 30th and 32nd week. If the placenta is still present at this time, you will be told to be a little more cautious, for example, you must refrain from intercourse during the rest of the pregnancy and you should not use tampons. Since the problem for the baby is first and foremost the risk of premature birth, the most important strategy is to prolong the pregnancy until the fetus is lung mature.
The ultrasound is repeated around the 36th week, as the placenta can contract all the way to birth. If you do not bleed, and you can quickly get to the hospital with a maternity ward if you start bleeding, you can continue to stay home.
If the placenta is present, it may be necessary to provide both antidepressants – if the birth threatens to begin early – and cortisone to speed up the baby’s lung maturity. An amniotic fluid test can determine if the baby’s lungs are mature enough for a planned delivery (caesarean section).
If the placenta completely covers the opening to the uterus, the baby must be delivered by caesarean section. If the placenta only partially covers the opening, many will be able to give birth normally.
In case of major bleeding, acute caesarean section must be done because of the risk to both the mother and the child’s life.
In most cases, the prognosis is good, whether you give birth normally or by cesarean section. Seating and transverse position occur somewhat more frequently in placental previa. Serious and life-threatening complications for the mother are rare. The prognosis for the child is good, provided good follow-up and rapid measures in case of acute bleeding.
A woman who has had placental previa has a 4-8% probability of suffering the same complication in subsequent pregnancies.