Placenta Previa: Its Types and Management

Placenta previa its types causes and management

The placenta is a structure that provides nutrition to the fetus and excretes waste products during pregnancy. it is usually located in the upper part of the uterus, but in the placenta previa, it is located in the lower part of the uterus and cover all part of the cervix or cover partially the cervix. The cervix is the opening of the birth canal.

Types of placenta previa

Types of placenta previa and management

Low Lying

The major part of the placenta is attached to the upper segment and only the lower margin is placed on the lower segment but not up to the OS.


‌This type of placenta is located near the cervix but does not cover the opening(cervix).

Partial or Incomplete

In this type of placenta previa placenta cover some part of the cervix. but no cover fully when dilated.

Complete/ central

In this type, the placenta is covered all over the cervix (the opening part of the birth canal)

First, two are mild degrees.
The last two are major degrees.

Causes of Placenta Previa

  • The placenta moves when the uterus stretch and grows in early pregnancy. The placenta is located in the lower part of the uterus, but as the uterus grows Placenta moves to the top of the uterus, and in the third trimester the Placenta is commonly located on the top of the uterus.
  • Placenta previa is commonly found in women who have had many pregnancies in the past (multigravida).
  • Pregnancy with twins or triples.
  • Abnormal shape of the uterus.
  • Previous cesarean section.
  • In IVF pregnancy.

Risk factors

  • Smoking.
  • Use cocaine.
  • Pregnancy in order age.
  • Large placenta.
  • Abnormal shape of the uterus.
  • Previous cesarean section.
  • D&C.
  • Surgery for uterine fibroids.

Sign and symptoms

  • Bleeding during the second half of pregnancy.
  • Bright red vaginal bleeding without pain in the second trimester of pregnancy is the main sign of placenta previa.
  • In some cases, women have contraction cramps or sharp pains.
  • Bleeding that starts, stops, and again starts after some days.

Complications of Placenta Previa

Maternal complications –

Antepartum hemorrhage with varying degrees of shock is an inevitable complication.
Severe bleeding can occur during labor or before labor.

Malpresentation –
There is an increased incidence of breech and transverse lie.
Premature delivery.

Postpartum hemorrhage due to 15% morbidly adherent placenta (Placenta accreta, increta, percreta) on the lower segment.

Placenta previa accreta is a serious complication that may cause maternal death. accreta managed by hysterectomy.

Puerperium – Sepsis increased due to

  • Operational interference.
  • The placental site is near the vagina.
  • Anemia.

Fetal Complication

  • Fetal distress from lack of oxygen(Asphyxia).
  • Low birth weight baby.
  • Intrauterine death.
  • Birth Injuries.
  • Congenital malformation.
  • Severe bleeding may promote an emergency premature delivery and emergency cesarean section before the patient’s baby is full term.

Management of Placenta Previa

Adequate antenatal care is essential for improving women’s health status and anemia.
Management of placenta previa depends on the severity of the bleeding position of the placenta and fetus.
Heavy bleeding or complete placenta previa
Cesarean section is required for this condition even in early pregnancy. And if bleeding cannot stop then patient blood transfusion, IV fluids and bed rest, and Antifibrinolytic drugs like tranexamic acid.

In marginal and partial placenta previa which do not bleed severely.

In these conditions, bedrest and Limitations of activity can help to suppress bleeding. Some tocolytic drugs can help in this condition.

What is type 3 placenta previa?

Placenta previa is classified into 4 categories (Low lying, Marginal, Partial or Incomplete, and Complete/ Central) from minor to major. There may be a possibility of a normal(Vaginal) Delivery in the 1 and 2 categories, but a cesarean section will be required in the next 3 and 4 categories. There should be easy access to the hospital in case of any bleeding from the vagina.

What is the main type of placenta previa?

Low lying- lower margin of the placenta is placed on the lower segment but not up to the OS.
Marginal- Located near the cervix but does not cover the cervical opening.
Partial or Incomplete- This type of placenta previa, placenta cover some part of the cervix. but not on fully dilated.
Complet/ Central- Covers the entire cervix (The opening part of the birth canal)

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