Placenta Praevia

The placenta is an organ within the uterus (womb) through which the unborn baby gets nutrients (food) and oxygen,
as well as removing waste products. It is attached to the wall of the uterus by many blood vessels.
Contents
What is placenta praevia?
What causes placenta praevia?
How will I know if I have placenta praevia?
What do I do if I have a bleed?
What happens at the hospital?
Do I have to have a caesarean?
How dangerous is a placenta praevia?
Reference
Further reading
What is placenta praevia?
The placenta is an organ within the uterus (womb) through which the unborn baby gets nutrients (food) and oxygen,
as well as removing waste products. It is attached to the wall of the uterus by many blood vessels.
Normally, the position of the placenta will move as the womb grows and stretches, so that eventually, by the last
three months of pregnancy, it should be near the top of the womb.
In some cases however, (one in 200 pregnancies) the placenta stays in the lower portion (part) of the womb, and
either partially or completely covers the cervix (neck of the womb). This is known as placenta praevia.
Placenta praevia occurs in four grades, ranging from minor to major:
o Grade 1 (minor) the placenta is mainly in the upper part of the womb, but some extends to the lower part.
o Grade 2 (marginal) the placenta reaches the cervix, but doesn't cover it.
o Grade 3 (major) the placenta partially covers the cervix.
o Grade 4 (major) the placenta completely covers the cervix (most serious type of placenta praevia).
What causes placenta praevia?
Often there is no obvious cause for placenta praevia, but the placenta may develop lower than it should because:
o there is a large placental area (eg. with twins)
o there may be scarring of the lining of the uterus from previous caesarean or curette
o there may be late implantation of a fertilized ovum (egg)
o smoking may increase your risk (cause unknown)
Nothing you do can change placenta praevia. Only growth of the womb over time can improve the position of the
placenta.
How will I know if I have placenta praevia?
Placenta praevia is usually picked up with an ultrasound between 18-20 weeks. If a "low lying placenta" is found, a
further scan is done at 32 weeks to see if the placenta is still low. Only two to five percent of placentas that are "low
lying" on the early scan become placenta praevia grade three or four later in the pregnancy.
The signs and symptoms
o Sudden, painless, bright red vaginal loss, usually in the later half of the pregnancy
o Painless vaginal bleeding after sex
o Uterine cramping with bleeding
o Bleeding during labour
Placenta praevia is the most common cause of painless bleeding in the last three months of pregnancy. Bleeding
occurs because of growth of the lower part of the uterus, which stretches and thins to make room for the growing
baby. This may cause the placenta to tear at the edges, resulting in bleeding (your blood, not your baby's).