LOW PLACENTA
In most pregnancies, as the uterus grows and stretches, with the growing baby, the distance between the lowest edge of the placenta and cervix will increase, so that the placenta is clear of the cervix. Usually you will have a repeat scan at 32 weeks by the sonographer if the placenta is low at 20 weeks to confirm the placental position. This may be done by transvaginal scan (where the probe is gently placed inside the vagina) to check the position of the placenta. 9 out of 10 women with a low lying placenta will no longer have a low-lying placenta when they have their follow up scan.
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If the placenta remains low lying at 32 weeks, it is called placenta praevia, where the placenta is less than 20mm from the cervix or completely covers the cervix. Placenta praevia is more common if you have had a caesarean birth, had fertility treatment to become pregnant or you smoke. The length of your cervix may be measured to predict the possibility of early labour and whether you are at increased risk of bleeding. You will be referred to an obstetrician to discuss your options for the birth of your baby and also you will be offered a further ultrasound scan at 36 weeks, to check the placental position.
Once placenta praevia is confirmed, if the placenta remains less than 20mm from the entrance to the cervix at 36 weeks, a caesarean birth will be the safest way to deliver your baby. If the placenta is further than 20mm from your cervix you can chose to have a vaginal birth.
Unless you have heavy, recurrent bleeding or go into labour your Ceasarean will take place between 36 and 38 weeks. If you have any complications your Caesarean may need to be earlier than this. Some obstetricians may give corticosteroids to help with babies lung maturity, due to early delivery.
The amount of blood lost after placenta praevia Ceasarean birth is higher than other Caesarean births. A senior obstetrician and anaesthetist will be present at the time of birth. You are more likely to need a blood transfusion, particularly if you have heavy bleeding. There are many different things that doctors can do to stop the bleeding, including giving drugs to contract the uterus, but if it continues and cannot be controlled a hysterectomy (removal of uterus) may be needed.
