Placenta Previa

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:

• Maternal factors like preeclampsia, chronic medical illness, infection like urinary tract infections, vaginal infections, drug abuse, abnormal structure of the uterus, cervical incompetence, previous pre term birth.
  
  
• Factors involving pregnancy like abnormal or decreased function of the placenta, placenta previa and abruption, premature rupture of membranes
  
  
• Factors involving the fetus like behavior of intrauterine environment, multiple gestation and erythrobalstois fetalis which means Rh blood group incompatibility.
  
  

Intrauterine Growth Restriction (IUGR): This is a condition in which the fetus is smaller than expected for the number of weeks of pregnancy or there is fetal growth restriction. Newborn babies with IUGR are small for their gestational age. The baby's fetal weight is less than the 10th percentile. The fetus with IUGR may be born at term or prematurely. They appear thin, pale and have loose dry skin. Some have a wide eye look.

IUGR can begin at any time of pregnancy. While early onset of IUGR is due to chromosomal abnormality, late onset is due to other related problems. Although it is not possible to prevent IUGR, it can normally well managed by the doctor.

Generally the earlier and more severe the growth restriction, the greater the risk. Careful monitoring of the fetus growth is needed in all cases of IUGR. This is done by ultrasound and Doppler studies and mother's weight gain monitoring. Other ways to watch the potential high risk is by fetal movement counting, non stress testing, and biophysical profile examination.

Post term pregnancy: In contrast to pre term pregnancy, post term pregnancy lasts for more than forty two weeks. About 7% of babies are born at forty two weeks or later. Such post term pregnancies can cause longer hours of labor and operative delivery. Mothers are at increased risk for vaginal birth trauma due to large baby. Cesarean deliver is likely for post term babies.

Multiple pregnancy: Multiple pregnancy means two or more fetuses. A very small percentage (about 3%) of women experiences multiple pregnancy.

Post partum hemorrhage: This is when excessive bleeding follows the birth of the baby in the mother. About 4% of women have post partum hemorrhage. Immediate medical intervention is required to stop bleeding. Some women with placental abruption and placenta previa are more susceptible for post partum hemorrhage than others.

RH disease: This disease occurs when there is incompatibility between the blood of the mother and the baby. This again is a high risk factor in pregnancy.

Premature rupture of membranes: Premature rupture of membranes means breaking open of the membranes before labor begins, especially before thirty seven weeks of pregnancy. Nearly 10% of pregnancies suffer premature rupture of membranes.

Rupture or membranes is caused by natural weakening of membranes or from force of contractions. Low socioeconomic conditions, sexually transmitted infections, previous pre term birth, vaginal bleeding and cigarette smoking during pregnancy are some of the main causes for premature rupture of membranes. One third of the premature births suffer from premature rupture of membranes.

Gestational diabetes: Diabetes in pregnancy can have serious consequences for the mother and the fetus. The severity of the problem depends upon the degree of the mother's diabetic disease. In the US about 9 % if women have diabetes and one third of them do not know it. 2 to 3% of women develop diabetes during pregnancy called gestational diabetes. Here the mother who does not have diabetes develops a resistance to insulin because of the hormones of pregnancy.

Breech baby

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:

• The baby is large
  
• Baby is very small
  
• Mother has narrow pelvis
  
• Mother has a low lying placenta
  
• Baby's feet are below its bottom.
  

Breech types

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.

Tags: #Placenta Previa #High Risk Pregnancy #Breech baby