Plasenta Previa

What is the placenta?
The placenta is a lining that forms on the inner wall of the uterus during pregnancy, commonly known as the baby’s partner.
is an organ. It is connected to the baby by the umbilical cord and is a substance between the mother’s blood and the baby’s blood.
exchange of nutrients. Through the placenta, nutrients and oxygen pass from the mother’s blood to the baby, while waste
substances pass from the baby’s blood into the mother’s blood and are excreted from the body. In this way, the nutrients
Another function of the placenta is to secrete certain hormones important for pregnancy.
The placenta is a very important organ during pregnancy, but after birth it
The placenta is completed and separated from the uterine wall by uterine contractions and excreted from the body.
What is Placenta Previa?
Normally, the placenta can be located in the front, back, top or sides of the uterus. Placenta previa,
The placenta is located in the lower part of the uterus, covering the cervix. Placenta
in previa, if the placenta completely closes the cervix, the baby’s birth canal is closed
normal delivery cannot take place, the only delivery option is a caesarean section. Placenta previa is present in approximately 200
occurs in 1 pregnancy.
Types of Placenta Previa
Total placenta previa: The placenta completely covers the cervix. Total placenta previada
delivery can only be done by caesarean section. Total placenta previa accounts for 20 percent of placenta previas.
creates.
Partial placenta previa: The placenta partially closes the cervix.
Marginal placenta previa: The placenta is at the edge of the cervix but does not close it.
Low-lying placenta: The placenta does not close the cervix, the placenta
It is not previa but is located 2-5 cm from the cervix.
What Causes Placenta Previa?
The cause of placenta previa is unknown, but some factors can increase the risk of placenta previa.
increase the risk of developing a disease. The main risk factors can be summarized as follows:
If placenta previa was observed in a previous pregnancy, the risk of it occurring in other pregnancies is also increased.
The risk of placenta previa increases in patients who have had many cesarean sections. As the number of cesarean sections increases
The chance of the placenta being misplaced also increases.
Multiparity (more than one birth): In women who have already given birth
placenta previa is more common.

Advanced maternal age
Previous uterine surgeries (fibroid surgeries etc.)
Having had many abortions
Multiple pregnancy: increased risk of placenta previa due to the large placenta
is being considered.
Placenta anomalies
Cigarette smoking
What kind of symptoms does placenta previa cause?
The most characteristic symptom of placenta previa is sudden, painless vaginal bleeding. This
bleeding usually occurs after 28 weeks of gestation. Percent of patients with placenta previa
In 25%, the bleeding is accompanied by preterm labor.
In placenta previa, the uterus is usually soft palpated and no tenderness is seen.
How do we recognize placenta previa in the clinic?
Ultrasound is the most appropriate method for the diagnosis of placenta previa. It can be examined more clearly with Doppler.
Placenta previa can be diagnosed after the 24th week. In pregnancies in the 2nd trimester (2nd three
month) routine ultrasound examinations often show that the placenta is close to the cervix
is detected. However, as the pregnancy progresses, the uterus enlarges and the placenta can be pulled upwards. This is called
90 percent of placentas that are located close to the cervix at term move away from the cervix and settle normally when the pregnancy reaches term (after 37 weeks).
week), it is seen that it moves away from the cervix and settles normally. Therefore, after the 24th week
A previous diagnosis of placenta previa can be misleading.
What are the Risks of Placenta Previa?
The biggest risk for mother and baby in placenta previa is bleeding. Unrecognized placenta previa
cases may bleed enough to require a blood transfusion. This bleeding can be fatal for mother and baby.
can be of such a magnitude as to put you at risk, even removal of the uterus in cases where the bleeding cannot be stopped.
may be required. Bleeding can occur in patients with placenta previa during pregnancy and at delivery.
It can also be seen after birth.
In patients with placenta previa, adhesion disorders of the placenta to the uterine wall (placenta
acreata, increata, percreata) are more common than other pregnant women. In this case, the placenta
may not leave the uterus after birth, and when it does, it may still be life-threatening.
can cause bleeding. These patients with placenta previa may also require hysterectomy.
Frequent bleeding episodes in placenta previa, even if they are not life-threatening
may cause developmental delay.
Because of the low location of the placenta, in patients with placenta previa, the baby’s mother
The likelihood of having a side or breech position in the abdomen is also higher than in normal pregnancies,
These baby positions are also more risky positions for labor.
With placenta previa there is a higher risk of preterm labor, which is associated
prematurity (premature birth).

How are Placenta Previa Patients Followed?
– Due to all these risks we have mentioned, pregnant women with placenta previa are followed up more frequently.
should be taken care of. There may be no problems during pregnancy. Today, placenta previa
75 percent of pregnant women can continue their pregnancy until term (37 weeks).
– Placenta previa that starts bleeding is hospitalized and closely monitored. Not yet at term
in pregnancies that do not reach (less than 37 weeks), because the baby is still small, for the physician
Choosing to give birth or wait is a difficult dilemma. Gestational week, severity of bleeding, mother
and the condition of the baby. Early delivery of a baby with placenta previa
Although it can cause problems with prematurity, waiting can also be risky.
– In patients with placenta previa with little bleeding, the baby is still at the week of viability.
If not, the patient is closely monitored and waited until the baby’s lungs mature. If necessary
If the pregnancy is between the 24th and 34th week, lung maturation injections (celestone) are also given because of the risk of premature birth. In this way, with close follow-up, without risking the life of mother and baby
The pregnancy is tried to be maintained until the mida (37th week).
– In patients with placenta previa with a lot of bleeding, it is not advisable to wait. Mother and
the mother’s bleeding is stopped by inducing labor to protect the baby.

Childbirth in Patients with Placenta Previa
Placenta previa marginalis (the placenta is at the edge of the cervix but does not cover it)
normal delivery can be attempted in patients if the baby is in head position. All other
in patients with placenta previa, a cesarean section because normal delivery causes too much bleeding
the birth is carried out.
If there is active bleeding, it is best for mother and baby to deliver without waiting.
The primary goal in placenta previa is to keep the mother’s condition stable. By opening an intravenous line
the mother is given fluid support. A few units of blood are kept ready in case of need.
If the bleeding decreases or stops and the mother’s condition is stable, in pregnancies earlier than 36 weeks
the birth can be delayed for a while longer. So that the baby can receive the necessary medicines for lung maturation.
time can be bought to implement it.
I have placenta previa, what should I pay attention to?
– The follow-up and delivery of pregnant women with placenta previa must be carried out by a specialist experienced in risky pregnancies.
an obstetrician and gynecologist should perform the delivery. Birth with placenta previa
The hospital to be built is a 24-hour hospital, with an operating room team always ready, intensive care unit
center with a unit and a blood bank.
– You should avoid excessive physical activity because of the risk of bleeding in placenta previa.
Your doctor may also recommend bed rest.
– For the same reason, patients with placenta previa should not have sexual intercourse during pregnancy.
is prohibited.
– In patients with placenta previa, vaginal examination and
vaginal ultrasound is not performed. For this reason, the gynecology and obstetrics
It is a good idea to remind the specialists that you have placenta previa.
– Carry a list of people with the same blood type with you so that you can call them if needed.
you can keep it with you.
– If you bleed, you should contact your doctor immediately.