Bleeding in Pregnancy 

What is placenta praevia accreta?

It is a condition in which the placenta is adhered to the uterine surface.

How will I know that I am at a greater risk for this condition?

The risk increases with conditions like previous cesarean section, previous history of placenta praevia, any surgery if done on the uterus before, fibroids etc.

How will this be diagnosed?

If your doctor is suspecting this condition, it is better to go ahead with ultrasound and doppler studies. This is the best modality of investigation.

What is the treatment of choice?

The treatment involves elective cesarean section. Most of the times one may need to go for a hysterectomy also. In very few cases, this condition is treated conservatively.

What are abruptio placentae?

This is the condition in which the placenta located in the upper segment of the uterus gets detached completely or partially and causes bleeding. It is most commonly seen in the 34-35 weeks of gestation.

It is also termed ‘accidental hemorrhage'.

How will it manifest?

The condition may manifest in external bleeding. We say ‘may’ because in 80 % of cases, the bleeding may be localized and concealed. You may go to the hospital feeling weak and the doctor will find signs and symptoms of blood loss without an external manifestation.

The extent to which the bleeding is concealed is also determined by the tone and contractility of the uterus.

In fact, the greater the amount of external bleeding, the less wide as a rule is the area of placental separation. 

What are the risk factors for this condition?

• Multiparity - the risk increases markedly after the 4th pregnancy
• Low socioeconomic condition
• Preeclampsia,chronic hypertension
• Polyhydramnios
• Premature rupture of membranes
• Folic acid or other nutrient deficiencies
• Trauma
• Fibroids
• Smoking and cocaine abuse
• Malformations in the uterus

A correlation is also found in unexplained elevated maternal serum alpha feto proteins in the second trimester and pregnancy complications like abruption placentae.

What will be the symptoms?

The classic symptoms are bleeding with abdominal pain. Bleeding may not be too much, but if associated with abdomen or back ache, one has to contact the doctor. One may also present with symptoms of shock, depending on the amount of blood loss.

The doctor will find the uterus tense and tender and the fetal parts may not be felt very well.

Co existing signs of preeclampsia like raised blood pressure, edema and proteinuria makes the diagnosis more likely. The blood pressure may be low in cases where the bleeding has been more.

One has to be careful in distinguishing between placenta praevia and abruption placentae.

What is vasa praevia?

Vasa praevia is the condition in which the vessels supplying blood to the baby is in the lower segment of the uterus below the presenting part of the baby. The most common symptoms are vaginal bleeding after spontaneous or artificial rupture of membranes. There may also be a sudden drop in the heart rate of the fetus.

This condition is not generally diagnosed earlier but if known, elective cesarean section before the rupture of the membranes is planned.

There is also an entity in 2 % females where the cause of the ante partum hemorrhage is not diagnosed.