PREGNANCY DAYS For most pregnant women, carrying a baby to term is largely a mysterious process. This section helps new parents answer some of the most important questions about pregnancy and childbirth.

Bleeding in Pregnancy 

ANTEPARTUM BLEEDING (Before delivery)

This is bleeding in the later part of the pregnancy and can have serious consequences to both you and the baby.

What is placenta praevia?

It is a condition in which the placenta is located in the lower part of the uterus covering or touching the internal organs. The cause is not known but is generally seen in multi paras.

What are the causes?

The most common causes are placenta praevia and abruption placentae, others being -

• Placenta praevia
• Abruption placentae
• Vasa praevia
• Rupture of marginal sinus
• Excessive show
• Local lesions

1. cervical erosion
2. cervical polyp
3. cervical cancer
4. infection in the vagina

• No cause known

How will I know if I am at a higher risk for this?

• Although no cause is known, the risk of placenta praevia increases with maternal age. The risk increases 9 folds for women older than 40 years.

• The risk also increases with parity. The chances increase with every pregnancy.
  
• If there is a previous history of a scar on the uterus due to previous cesarean section or any other operation, the chances increases further.

• Cigarette smoking also increases the chances of placenta praevia.

• Multiple gestations like twins or triplets also increase the risk. 

What are the implications?

The most common presentation is painless, recurrent bleeding and it is unrelated to the activity. Often bleeding takes place at night. The first bleed is never catastrophic. It may stop and restart later or it may continue to a small degree and cause anemia.

The uterus is normally relaxed and soft and no area of tenderness is found. The anemia is proportionate to the amount of bleeding.

Ultrasound will be diagnostic and will locate the position of the placenta.

What can be the associated features?

1. It may cause failure of engagement of the head of the fetus.
2. The baby may present in an abnormal presentation like transverse or breech.
3. Congenital fetal anomaly.
4. There is more incidence of post partum hemorrhage.

Will I be put on bed rest?

Women with diagnosis of placenta praevia have an approximately 10 times higher risk of ante partum hemorrhage.

Your management would depend on whether you are bleeding or not.

In cases where the mother is actively bleeding, immediate admission to the hospital is advised and further management is based on shock and blood loss ensued.

In cases where there is no active bleeding, one has to try to take pregnancy to term. Small intermittent self remitting bleeds are less problematic but you may have to be put on bed rest and drugs to relax the uterus. In cases of intermittent bleeding after 34 weeks, it is better to be admitted and monitored for the activity of the uterus, status of the fetus, amount of blood loss and correction of anemia if any.

Bed rest is advocated for prevention of complications and to prolong the pregnancy as much as possible.

Will I have a normal delivery?

Whether you can go for a normal delivery or not depends on the type of placenta praevia, your age, the condition of your baby. If everything is normal you will be given a trial of normal delivery only if the distance between the edge of the placenta and the internal organs is more than 2 cm. Most of the times cesarean section is preferred.

What is the type of anesthesia that I can take?

If you go for a cesarean section, regional anesthesia is preferred and is safer too. There is a risk of going through the placenta and causing bleeding. One has to be prepared for such cases and for any such emergency.

What are the risks that I may face in cesarean sections?

The most common risk is post partum hemorrhage as discussed before. In most of the cases, because of bleeding in the pregnancy time, mother may not be able to tolerate any more bleeding. So anemia becomes a serious risk factor.

Chances of cervical tears are also high and many a times the placenta may have to be removed manually. 

One will have to maintain a high standard of anti sepsis measures because the chances of infection after delivery are very high.

 

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