Note from a wise Doctor

I had the pleasure of having an incredible Maternal-Fetal Medicine doctor right in my city. Before getting into all the questions and concerns, first, I want to share a few words from my doctor, Dr. P (as you’re reading this, yes, it’s a Bosnian accent) 😀

“When you are told that you potentially have placenta previa on a routine sonogram <20 weeks gestation, first thing is NOT to panic. It is a common diagnosis so early in pregnancy because the lower uterine segment where pregnancy is housed is not yet developed, so many times the placenta ONLY appears as previa or low lying placenta. More than 90% of the time, later in pregnancy around 28-30 weeks of gestation, a sonogram will confirm true placental location that will be sufficiently away from the neck of the womb and represents normal findings…

If placenta is truly previa and completely covers neck of the womb (confirmed by the sonogram latter in pregnancy), be aware that vaginal blood spotting or even light bleeding episodes are common. No panic again, as it is self limiting and will resolve over few days to weeks. 

Start to prepare yourself and your family that delivery (once placental previa is confirmed by later sonogram) will be earlier than planned – 2 to 4 weeks earlier than due date because your doctor will desire to deliver your baby before term-labor starts as regular uterine contractions may cause serious vaginal bleeding (by shearing forces of uterine wall contraction movements against placental tissue that does not contract so bleeding occurs at the line of placenta to uterine wall separation) that would necessitates emergency delivery for maternal and fetal sake. 

Many doctors will follow current guidelines created by ACOG (American College of Obstetrics and Gynecology) that advise for earlier delivery, as early as 36 weeks (whole month earlier than due date) to avoid significant bleeding from previa if labor develops. 

Please, do not preoccupy yourself too much about this earlier delivery, as your baby will be sufficiently mature and risk of respiratory complications at and beyond of 36 weeks gestation are small. However, this risk is lesser than risk of significant and serious vaginal bleeding from previa if delivery is postponed and you are in labor. 

Now, once you have diagnosis of placenta previa, many things will be ‘forbidden’ to you and your spouse… You will have to practice ‘pelvic rest’, that is, no sexual intercourse, no vaginal douching or washing, to avoid constipation, to avoid heavy physical exercise or activity – in other words, anything that may potentially increase uterine activity (that is always present at some mild level) and cause vaginal bleeding from placenta previa. Idea behind this is not to make your life miserable, but to reduce or even prevent fearful life episodes (and frequent visits to emergency room or your physician office) associated with vaginal bleeding. 

And finally, everyone will ask themselves, where will be safe to have delivery? 

In many patients with placental previa but no morbidly adherent placenta (also called accreta) suspected, delivery can be managed at your hospital. Though, it also depends on level of your physician self-confidence, and ability of hospital to provide support and ancillary services, almost all hospitals can accommodate delivery of patient with placental previa at and beyond 36 weeks of gestation. 

In rare circumstances, like when placenta previa with accreta is suspected, it would be beneficial to plan delivery at tertiary care center – that is, hospital that have all ancillary services and multitude of doctors of different specialties that could be required during the surgery (e.g. if additional surgical help is needed to repair adjacent organs or special radiological procedures required prior surgery itself).”

Mladen Predanic, MD, MSc, FACOG/ Texas

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