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Placenta previa is a serious pregnancy complication in which the placenta covers the cervix completely or partially.

You may be diagnosed with placenta previa after you start experiencing vaginal bleeding during your pregnancy, or you could find out that your placenta is at least partially obstructing the opening of your cervix during a routine ultrasound. How do you proceed after you find out that you have placenta previa?  

Getting the placenta previa diagnosis is always a shock. It's one of those pregnancy complications in which a cesarean section is an absolute necessity. During pregnancy, a placenta previa is always a worry. What should you avoid when you have been diagnosed with complete or partial placenta previa, and what can you do to keep safe and sane?

Second trimester panic

Have you just been for an ultrasound, and your doctor told you your placenta was dangerously close to your cervix? Don't immediately panic if your OBGYN starts to give you a lecture about needing a cesarean. Many women who have ultrasounds during the second trimester of pregnancy will hear the message that their placenta is too close to the cervix, but there is still hope for you unless your placenta definitely covers the cervix completely.

There are three types of placenta previa [1]:

Complete Previa: the cervical opening is completely covered
Partial Previa: a portion of the cervix is covered by the placenta
Marginal Previa: extends just to the edge of the cervix

Some marginal previas can be delivered vaginally, although complete or partial previas would require a cesarean delivery.

The uterus expands downward as the baby grows, and pregnant women who were diagnosed with a low-lying placenta in the second trimester may well find that the problem has "cleared up" the next time they have a prenatal appointment. To throw in a bit of anecdotal evidence, I have several friends who had low-lying placentae during the second trimester, and who were told to brace themselves for a c-section and bed rest at home. By the third trimester, they all had normally placed placentae. The placenta actually implants wherever the fertilized egg first nestles, so the placenta does not move. Your uterus does, however. More frequent ultrasounds to check for placental migration are in order after you've been told you have a complete previa, or a low-lying placenta.

Placenta previa affects about 1 in 200 pregnant women in the third trimester of pregnancy. And you're more likely to have placenta previa if you had [2]:

  • More than one child
  • A cesarean birth
  • Surgery on the uterus
  • Twins or triplets
  • Are older than 35 

Activities to avoid

Some women who are diagnosed with placenta previa will need hospitalization and constant monitoring. Those women who have had no worrying symptoms like bleeding, and who can stay at home, will still need to avoid sexual intercourse or pelvic exams. Talk to your doctor about the type of activities that are allowed. In most cases, your doctor will discourage exercise, lifting, and even light housework. Working may be out of the question as well, unless you happen to have an at-home job. Most activities can trigger bleeding and possibly hemorrhage. This is rather dangerous for moms and babies alike. Call your doctor if you experience bleeding or pass blood clots, especially if they are really big. Here's some stuff that's probably not going to be OK with placenta previa, subject to discussion with your doctor:

  • Lifting any older children you have
  • Carrying groceries
  • Sex, and that includes orgasms as well
  • Soaking in a bathtub
  • Any exercises, except perhaps stretching
  • Traveling 
  • Pelvic exams 

Planning your delivery

Natural labor is very dangerous for women and babies where placenta previa has been diagnosed, but premature birth also brings its fair share of risk. How do doctors take these two factors into account to offer you and your baby a delivery that is as safe as possible? You will probably have an amniocentesis at some point during the third trimester, between 35 and 37 weeks. This is done to determine how mature your baby's lungs are. If the lungs have not matured yet, steroid shots will speed the process up to prevent breathing difficulties.

Your cesarean section will be scheduled at least 10 days before you are likely to go into labor naturally after that.

You can discuss the details with your doctor, and make any special wishes you have known. It will be a little earlier than normal, to prevent you from experiencing labor contractions. The risks of a cesarean are a little higher with placenta previa, because of the chance that the medical team will have to cut into the placenta itself in order to deliver your baby. As your doctor any questions you may have about this.

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