Since the placenta supports your growing baby by providing food and oxygen, any abnormalities of the placenta may compromise the development of your baby.
A number of problems associated with the placenta can arise during pregnancy, and it's therefore important to get in touch with your healthcare professional at once if you suffer from any pain and / or bleeding in late pregnancy.
The condition placental insufficiency occurs when the placenta is unable to support the fetus adequately for various reasons. Such reasons include abnormal development, restriction of blood supply through the placenta, placental tissue loss, placental separation and a small or inadequately developed placenta. Insufficiency of the placenta may also arise in women with diabetes, in multiple pregnancy and if the pregnancy has gone more than a week or two past the due date.
Indications of placental insufficiency may include slow growth of the uterus and less-than-average weight gain, but the principle indicator is slow fetal growth, detected on ultrasound scanning. Some babies can be quite small inside the womb without having placental insufficiency, while others that are only slightly small may show signs of placental insufficiency. Placental insufficiency is confirmed on ultrasound when the scan shows a baby that's growing slowly, has a reduced volume of amniotic fluid (because it urinates less) or reduced blood flow in the umbilical cord on a Doppler scan. If your baby's growth is insufficient, your baby will need to be monitored more frequently, and induction of labor or a caesarean section will be undertaken when necessary as your baby may be better off outside the womb.
Placenta praevia means that the placenta is positioned abnormally near to the birth canal. This essentially means that the placenta implants in the lower part of the uterus, completely or partly over the cervix. This can cause severe bleeding either in the last trimester or when the cervix begins to open up at the start of labor.
Placenta praevia is potentially a very dangerous condition and is a major cause of bleeding in late pregnancy. It occurs in some 0.5% of pregnant women. Placenta praevia is more common in women who have had operations (including a previous caesarean section) on their womb, or who have a multiple pregnancy.
The condition, which often has no symptoms, is frequently picked up before delivery during a routine ultrasound scan. It varies in severity, depending on the amount of the placenta that lies close to the cervix. The more placental tissue that blocks the cervix, the higher the chances of bleeding before or during delivery. Although minor degrees of placenta praevia will not adversely affect pregnancy, severe cases in late pregnancy may give rise to sudden, unexpected, painless vaginal bleeding, and lead to serious vaginal bleeding otherwise delivered by caesarean section.
If bleeding is only slight and the pregnancy has several weeks to go before the baby is due, then bed rest is usually all that's necessary. This may need to be in hospital. In cases of profuse bleeding, however, a blood transfusion may be carried out. Where bleeding is heavy and the pregnancy is near term, immediate delivery by caesarean section is usually undertaken.
Placental abruption / separation
Placental separation, also known as placental abruption or abruptio placentae, arises when the placenta partially or completely detaches from the wall of the uterus. This, in turn, causes blood to build up in the void space and often, but not always, leak into the vagina.
The condition occurs in about 0.5 to 1% of pregnancies, although the cause remains unclear. It does, however, appear to occur more frequently in women who've had more than two children, and in women who have high blood pressure or pre-eclampsia.
Placental separation is described as mild, moderate or severe, depending on how much blood is lost and the extent of separation that has occurred. In cases where bleeding is internal, pain and signs of shock may be the only symptoms. Most cases involve only a small amount of blood loss and a small amount of placental separation, which need not affect the baby. However, severe cases where more than about a third of the placental surface comes off usually compromise the baby's oxygenation and result in fetal death.
A mild case of placental separation is usually managed with bed rest, but if it occurs in late pregnancy, then labor may be induced. In moderate cases, a blood transfusion may be carried out, and if the pregnancy is fairly advanced then a caesarean section may be undertaken. Severe cases of placenta separation, where severe shock, blood problems or kidney failure has resulted, are managed with a rapid blood transfusion and delivery, which is likely to be by caesarean section.
Source by Louise O Conor