Placenta Complications in Pregnancy: What to Know (video/podcast)

During pregnancy, an organ called the placenta develops inside the uterus to help provide blood, oxygen and nutrients to the developing baby through the umbilical cord. Think of the placenta as a life support system, supplying everything the baby needs while in the uterus.

The health of the placenta is directly linked to the health of the baby, so complications, such as placenta previa and placental abruption can create a high-risk pregnancy. 

In this video, San Diego Health host Susan Taylor talks about diagnosing and treating placental abnormalities with Daniela Gomez, MD, an OB-GYN at Scripps Clinic who specializes in maternal and fetal medicine.

Placenta previa is a complication that happens when the placenta completely or partially covers the cervix, which is the opening of the uterus through which the baby is delivered. This can cause severe bleeding if not addressed. 

The exact cause of placenta previa is not known, but some factors can increase the risk. These include being 35 or older at the time of delivery, carrying multiple babies, such as twins or triplets, having conceived through in vitro fertilization (IVF) or previously having had a cesarian section or other uterine surgery.

Although some women with placenta previa may experience painless vaginal bleeding, most have no symptoms.

“Placenta previa is usually diagnosed using ultrasound. Typically, we pick these up at the time of the anatomic survey, which happens anywhere from 18 to 20 weeks,” says Dr. Gomez. “But if you haven't had an ultrasound and you are having heavy vaginal bleeding, it's always important to call your doctor and seek immediate medical attention.”

While there is no specific treatment for placenta previa, the physician will follow the condition throughout the pregnancy with ultrasound. Monitoring varies depending on the patient, but most women will have at least two additional ultrasounds to check on the location of the placenta.

In many cases, Dr. Gomez notes, placenta previas diagnosed at the 20-week ultrasound exam tend to resolve on their own. If this does not happen, the mother will most likely need to have a cesarean section delivery at 36 to 37 weeks. This is necessary to prevent her from pushing against the blood vessels of the placenta that cover that cervix during contractions, which would increase her risk of bleeding.

Placental abruption is a complication that occurs when the placenta separates too soon from the uterus. An abruption can raise the risk of heavy bleeding and contractions as well as affect the baby’s well-being. Symptoms of placental abruption may include bleeding, severe abdominal pain or frequent contractions, along with back pain. 

It isn’t possible to reattach a separated placenta, so care plans depend on the severity of the abruption and how far along the pregnancy is. Placental abruption treatment options may range from closely monitoring the situation at home or in the hospital to delivering the baby early, often through a cesarean section.

Fortunately, maternal fetal medicine specialists can help manage placenta previa, placental abruption and other high-risk pregnancy conditions. If you are pregnant and have painless bleeding, severe abdominal pain, early contractions or anything that seems unusual or concerning, contact your doctor immediately.

“For any woman diagnosed with a placental abnormality or a placental complication, it is very important to make sure she maintains all of her medical visits and ultrasounds,” says Dr. Gomez.

“Maternal fetal medicine specialists make sure that we are doing specialized ultrasounds to take a very good look at that placenta. We also monitor symptoms along with the patient’s obstetrician and coordinate delivery timing and any other medical visits to help keep everyone safe through pregnancy and delivery.”