Placenta Previa is a condition where the placenta embeds itself in such a way that it partially or completely covers the cervix. In such a case, the placenta lies low in the uterus and is at risk of separation from the uterine wall during labor contractions. When a pregnant woman experiences painless vaginal bleeding during the third trimester, the doctor may conduct an ultrasound to check for placenta previa. Other symptoms that might indicate placenta previa are a large uterine size, breech or transverse position of the baby or premature contractions.
Usually placenta previa is detected during routine ultrasound scans of the growing fetus. Women who are over 35 years or have had multiple pregnancies are at higher risk of placenta previa. If a woman is diagnosed with placenta previa, she will need to take bed rest. Often hospitalization is necessary. Travel must be avoided and pelvic examination by the doctor is not advisable. Instead the doctor will resort to ultrasounds and MRI.
Placenta previa can cause growth retardation in the fetus due to irregularly placed placenta. This can lead to increased chances of congenital anomalies. The expectant mother is at risk for hemorrhage. Blood transfusion is resorted to in cases of severe bleeding.
High Risk Pregnancy
A woman's medical status, lifestyle or external factors may be the cause for high risk pregnancy. Some complications are unavoidable, while the risk in some others can be minimized by the help of the gynecologist / physician. Many times complications can also occur without any warning signal. Sometimes causes and risk factors can be identified early and suitably treated.
Anemia in pregnancy: Anemia occurs when the red blood cells are too few in the body. This leads to a lowered ability of the red blood cells to carry oxygen. Since the fetus is dependant on the mother's blood anemia can cause poor fetal growth, pre term birth and low birth weight. Anemia of pregnancy, iron deficiency anemia, vitamin B 12 deficiency, anemia due to blood loss, folate deficiency anemia are some of the types of anemia during pregnancy.
Pre term labor: In high risk pregnancies more than 11% of the babies born are pre term. Pre term labor begins before completion of thirty seven weeks of pregnancy. Pre term labor may mean either uterine contractions, rupture of amniotic sac and/or cervical dilatation. Many factors can contribute to pre term labor. Some of the key factors are:
By 8 months, the baby in the womb positions itself as it does not have much place to move about. Most babies position themselves head-down otherwise known as cephalic position during this time. In very few cases the baby positions itself feet-down or in breech presentation.
By the beginning of the third trimester, the medical practitioner will physically feel the mother's abdomen and will be able to tell the positioning of the baby. This is usually done using Leopold's maneuver. Location of the heart beat, position of the baby's bottom and head helps the doctor determine the position of the baby. About 25% babies are positioned breech during this time but they turn to normal position on their own within the next couple of months.
When the mother is approaching full term and the baby is still positioned breech, the medical practitioner may conduct a pelvic examination or an ultrasound to confirm the positioning of the baby. At 37 weeks about 3-4% babies are in breech position. Even after 37 weeks if the baby is presenting breech position then it might not turn on its own to the cephalic position. In general breech babies are delivered through a cesarean section. Generally normal delivery is not advised for a breech position baby when:
Frank breech: Bottom first with feet up near the head (feet straight up).
Complete breech: Bottom first with legs crossed in Indian style.
Footling breech (incomplete breech: One or both feet are positioned to come out first.
Stargazers: When the baby is in any one of the above mentioned positions but is extending its neck completely as though it is watching a star it is called as stargazer. Babies positioned like this are usually delivered using c-section.
Helping baby from breech to cephalic
ECV: External Cephalic Version is a procedure wherein pressure is applied to the mother's abdomen for manual manipulation of the baby's position. The pressure helps the baby take a head-down position. ECV has its own limitations and many a times the baby moves back to the breech position. Women with pregnancy complications like low amniotic acid, bleeding and twins cannot undergo this procedure.
Tilt position: The Breech Tilt inversion technique is used to help a breech baby flip to a head-down position. The mother is asked to lie on a couch placing her feet up on an ironing board. The head is positioned down while the feet are placed up. 20 minutes a day is the recommended duration. This exercise needs to be done only after approval from the authorized medical personnel or midwife.
Chances of having a breech baby
A mother who has had one or more of the following conditions may have a breech baby: multiple pregnancies, excessive amniotic fluid, baby having anomalies, placenta lying low, uterus anomalies and Placenta previa.
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Bibliography / Reference
Collection of Pages - Last revised Date: March 20, 2023