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24/08/2021
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About the Author: Umm Aasiya is an Obstetrician and Gynaecologist. She gave up clinical practice due to health and family issues in 2020.  She uses her years of experience to share authentic medical knowledge. Her aim is to empower sisters through credible information, enabling them to make informed choices about their health.Her main focus is to connect with her Creator, learn and reflect upon the Quran as much as she can. The rest of her time is spent looking after her husband, 3 lovely children and their cat, Lulu. To read more of her articles, visit https://muslimahhealthmatters.com/

Credit for cover image: https://www.verywellfamily.com


Bismillah

You have been told that you have a low-lying placenta on your 20-week scan. 

What is placenta praevia?

What are the implications for your pregnancy?

In the majority of the cases, the placenta moves up. By the time you have the 32 weeks scan, your placenta is in normal location in the upper part of the womb.

In the small number of cases where the placenta is still low, you are at risk of bleeding during pregnancy. This can put you and your baby at risk.

What is Placenta Praevia?

Placenta is the afterbirth that is attached to the baby by the umbilical cord. The placenta is the source of nutrition to the baby.

Normally the placenta attaches to the uterus anywhere in the upper part.

1 in 200 women have the placenta attached to the lower part.

What is the Problem with a Low Lying Placenta?

You can see clearly what’s the problem. The placenta is blocking the birth passage!

When labour pains start, the lower part of the birth passage starts opening up. As it opens up the placenta starts separating.

The placenta has a very rich blood supply.

As it separates, bleeding starts.

The bleeding may be minimal or very heavy.

It is impossible to predict with placenta praevia who will bleed and who will not bleed.

So, you may have heard of friends who were told they have a low placenta. They had many scans and doctor appointments, only to be told later that the placenta had moved up and went on to have a normal delivery.

Then there are others who bleed throughout pregnancy and are in and out of hospital.

Who is more likely to have Placenta Praevia?

You have a higher risk of placenta praevia if you have had:

  • Previous caesarean section.
  • Twin pregnancy or higher, like triplets.
  • Pregnancy after IVF.
  • Fibroids of the uterus
  • Previous surgery of the womb-to remove fibroids or after miscarriage.
  • Age of mum- more common after the age of 35 years.

What happens after you are told you have Low Lying Placenta?

The Good Outcome

In most cases, you would have a perfectly normal pregnancy till you have a 20-week scan.

Your sonographer would inform you that you have a low-lying placenta.

If you haven’t had any bleeds, it is not a matter that should concern you greatly.

You would have a 32-week scan. In 9 out 10 cases, the placenta would have moved up.

The Not So Good Outcome

In some cases, you would have bleeds which are typically painless. These bleeds may happen spontaneously, and sometimes after intimate relations.

If you have any bleeds, your doctor or midwife will recommend abstinence throughout till you have the baby.

If you have any bleeds you need to go into the hospital to be checked out. You would need to stay in till there is no more bleeding. Most doctors would keep you in till 24-48 hours after your last bleed.

For many the whole pregnancy will be in and out of hospitals with bedrest and scans.

If you keep having bleeds, you may be given steroid injections to help mature the baby’s lungs. If you do need to have the baby early by caesarean section, one of the main problems with small babies is that they struggle with breathing as their lungs are not mature. 

What to expect if the placenta is still low on 32-week scan?

If you have been symptom free till now, it’s a good sign.

The chances are that even though the placenta is low it is not completely covering the neck of the womb.

Placenta praevia can be:

Complete – The placenta completely covers the neck of the womb. This is very unlikely to move up. Even if you are one of the fortunate ones who have not bled, you would still need a caesarean section to deliver the baby.

Incomplete – The placenta is low but not completely covering the neck of the womb. Sometimes you may have bleeds. Generally, your doctor would advise 2 weekly scans. In some cases, the placenta moves up and you can have a normal delivery.

Placenta accreta with placenta praevia

4-5 in 100 women with placenta praevia have placenta accreta.

Placenta accreta is a condition where the placenta attaches very deeply to the wall of the uterus. It does not separate easily after birth, either normal birth or caesarean section, and can cause torrential haemorrhage. 

Read here to learn more about placenta accreta.

If you have had a previous caesarean section, you are more prone to have both placenta praevia and placenta accreta, a low-lying placenta that is deeply attached to the uterus.

You will be referred to a higher centre specializing in dealing with these cases. Many women will need a hysterectomy (removal of the womb) at the time of caesarean section to prevent bleeding which can be life threatening.

What are the risks to your baby?

If you keep bleeding during pregnancy, your Obstetrician may have to make a decision to deliver the baby early.

The problem is that sometimes you may have little bleeds that are the precursors of a massive bleed. A huge bleed can put your life and the life of your baby at risk.

It is almost impossible to predict who will have a big bleed.

Your doctor has to weigh the risk of bleed against delivering a baby who is too small.

The aim is always to get up to 32-34 weeks. After this gestation, babies tend to do well and even if admitted to the baby unit, have a short stay before discharge.

Pregnancy outcomes

Generally speaking, women who have placenta praevia in the third trimester will have more antenatal visits and multiple scans.

If your baby has to be delivered preterm because of repeated bleeds, it may mean a longer hospital stay. Baby may have to be in special baby unit for a while.

Some women may have massive bleeds, either at home or while in hospital. It is a very frightening experience. If you are at home, you need to call in emergency services. 

Many women will have blood transfusion. You may need to take iron tablets in pregnancy and after delivery to optimize your haemoglobin levels.

Remember, there is nothing you can do to prevent a low-lying placenta.

If you have been diagnosed with placenta praevia, place your trust in Allah, follow the advice of your Obstetrician, and take one day at a time.

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