Low Lying Placenta in Indian mothers-
Symptoms, Causes and Diagnosis

Last modified on October 2020
With inputs from Dr. Pragnya Rao - General Physician

The diagnosis of a low lying placenta when you’re so close to giving birth to the baby you’ve been waiting for is never a pleasant thing to hear from your gynaecologist. A low placenta in Indian mothers is rare but can be dangerous for your baby as its close proximity to the cervix may hamper the baby’s passage way out. The placenta plays a key role in protecting the baby in the womb. As your baby grows in your womb, there are several reasons why you may experience the rare shift in placental position. A low lying placenta that has the potential to cause complications, however, does not happen overnight. Ultrasound scans are one of the most effective ways to help track this movement early on. This article also highlights some of the early symptoms of this disorder that will help you identify the disorder early, lessening the severity of its complications on a later stage.

Chapter 1: What is a Low Lying Placenta?

What does low lying placenta mean?

A placenta previa or a low lying placenta means a complication in a pregnancy that occurs when the placenta covers part or whole of the cervix.
The placenta is an organ that develops within the uterus during pregnancy and provides oxygen and vital nutrients to the baby. It also eliminates the wastes from entering the baby’s blood. It attaches itself to the walls of the uterus, and the baby’s umbilical cord surfaces from it.

If you develop this condition in first trimester, the placenta will gradually move up as the pregnancy advances and the uterus stretches. But in some cases, the placenta attaches itself or moves down to the lower part of the uterus at the later stage of pregnancy.
In most cases, it is uncertain what causes low lying placenta. There are, however, a few risk factors that may contribute to its development. These are as follows:

It has been observed by anatomic pathologist Dr. Melissa Conrad Stoppler that Asian women are more prone to developing placenta previa despite the fact that its reasons are unclear. She also says that women carrying male fetuses are more likely to develop the condition than women carrying female fetuses. This, however, has been deemed a myth. There is no link between gender and placental position. A placenta can attach itself anywhere in the uterus and it is only a source of blood, oxygen, and nutrients to the fetus.

Types of placenta previa:

A normal placenta is usually located at the posterior or anterior part of the uterus. A low placenta is further differentiated by terms such as posterior or anterior low lying placenta to define the exact location and position of the placenta. A placenta previa is mainly of four types:

  • A low placenta – is common during the early stage of pregnancy. It usually resolves by itself at 12 weeks as the pregnancy advances.
  • A partial placenta previa – is when the placenta covers only half or partial opening of the uterus from the cervix.
  • A complete placenta previa – is when the placenta is fully or completely covering the opening of the uterus or womb
  • A marginal placenta previa – is when the placenta is extremely close to the opening of the cervix but not covering it partially or wholly.

normal

Normal

marginal

Marginal Placenta Previa

partial

Partial Placenta Previa

total-placenta

Total Placenta Previa

In both partial placenta previa and complete placenta previa, there is a high chance of painful or painless vaginal bleeding throughout pregnancy and life-threatening bleeding during labor, delivery, or few hours after childbirth (Postpartum hemorrhage). A low placenta may also cause preterm birth.

Summary:
A low placenta is a condition that partly or wholly covers the opening of the uterine cavity. A partial, low lying, and marginal placenta generally are more likely to move upwards when compared to a complete placenta previa. However, with the right amount of rest
and precautions, even a complete placenta previa tends to move upwards by the 32nd week of gestation

Consult a gynaecologist online on MFine to find out more about low lying placenta

Chapter 2: Low Lying Placenta Symptoms

A low lying placenta is usually diagnosed during a regular ultrasound scan. But one of the main symptoms is either
light or heavy vaginal bleeding. However, it is advisable to consult a doctor immediately if any of the following are observed:

Important:

“Light bleeding during pregnancy is very common and in most cases, I tell my patients that it’s nothing to worry about. However, if the bleeding continues for many days or gets heavier, then the need to perform an examination to determine the cause becomes vital. If it is due to a low lying placenta, then we have to determine the best course of treatment depending upon how advanced the pregnancy is and the patient’s medical history.”
– Dr. Pragnya Rao, General Physician

Vaginal bleeding in the second or third trimester:

Excessive bleeding (haemorrhage) is the biggest risk of placenta previa. Women who have a low-lying placenta at 13 weeks may witness bright red bleeding from the vagina during the second or third trimester. Bleeding caused by this may or may not be associated with pain and cramps.

“When there is minimal to no bleeding, doctors may suggest complete bed rest and refrainment from activities like sex or exercise for low-lying placenta. When there is heavy bleeding, you may be admitted to the hospital for medical care and blood transfusions when necessary.

A  C-section may be planned after 36 weeks of gestation when it’s ideally considered safe to deliver the baby. And lastly, for continuous bleeding that won’t stop, an emergency C-section will be set up, even if the baby is premature.

Fetus in a breech or unusual position:

Towards the last trimester of pregnancy, the baby is set for childbirth and comes to a head-down position to ease the process of delivery. If the baby does not attain this position or has not settled head-down, it is known to be in a breech position. Moreover, if the baby’s head fails to engage in the
pelvis at the end of pregnancy or before labour, it is evident that it is blocked from entering the opening of the cervix. This block may be caused by a low placenta.

Irregular bouts of vaginal bleeding throughout pregnancy:

Painless vaginal bleeding that is bright red in colour, occurring from time to time is also a sign and symptom of placenta previa.

Bleeding after sexual intercourse:

Sex is usually considered safe throughout pregnancy. It is absolutely safe to have sex unless you are told otherwise by a doctor or a midwife. However, bleeding after sexual intercourse could be taken as a lucid symptom of placenta previa.

Summary:
The clearest low lying placenta symptoms in Indian mothers are undoubtedly bright red bleeding that occurs anywhere between the second and the third trimester of pregnancy. Consult your doctor immediately, if you have even one of the above-mentioned symptoms.

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Chapter 3: Causes of Low Lying Placenta

What is a low lying placenta 20 weeks?

Anatomically, it is common and natural for the placenta to be low in the early stage of pregnancy in Indian mothers. Most cases show up in the low lying placenta at 14-week scan. As the uterus expands in the course of pregnancy, the placenta typically moves up to the posterior or anterior part of the uterus. It is only a cause of concern if there is an anterior or posterior low lying placenta 20 weeks or above. As mentioned earlier, the reasons for and causes for this condition are unclear. There are, however, many low-lying placenta risks and factors that contribute to its development.

Risk factors:

1. Maternal age:

According to a study conducted by the International Journal of Medical Research and Review (IJMRR) over the span of two years, women aged 35 years and above are at an increased risk of low placenta by 3.6% which is statistically significant.

The link between increased maternal age and placenta previa is the higher probability of past uterine procedures or fertility treatments which could have damaged the lining of the uterus.

2. Unusual position of the baby:

There is a significant association between the baby’s position and a placenta previa. Normally, as the baby grows, it naturally comes to a head-down position in order to facilitate childbirth. It is also observed that it is the most comfortable position for the baby during the last
trimester of pregnancy as there is sufficient space for the baby’s head. An unusual position of the baby with buttocks-down (breech) or a transverse lie is said to be a risk factor in Indian mothers identified in connection with a low placenta.

3. Second or later pregnancy:

There is no hard and fast rule that all second pregnancies cause a low placenta. However, if there was any endometrial damage during or after the first pregnancy, there is a high chance of developing the condition. The endometrium is the innermost lining of the uterus in which the embryo implants itself. In some cases, miscarriages,
C – sections, or even long hours of labour can cause damages to this lining and cause endometrial infections (endometritis). This endometrial damage through contractions, childbirth, or infections can cause placenta previa in the future. Furthermore, the risk of low lying placenta increases with each subsequent pregnancy which means that if a
woman had placenta previa in one of her pregnancy, she is at a higher risk of developing it in her future pregnancies as well.

4. Multiple pregnancies at a time:

Placental complications are three times more common in Indian women carrying multiple pregnancies at a time. This is due to the increasingly expanding and stretching of the uterus in order to accommodate the extra babies. In most cases, twin pregnancies that show placenta previa at 18 weeks
and above, still show significant progress and resolve by the 32nd week of gestation.

Lifestyle factors:

Unhealthy lifestyle determinants the reasons for low lying placenta during pregnancy. It has been observed that excessive cigarette smoking and drug use such as cocaine are causes for a low placenta. This is because excessive smoking may lead to excessive carbon monoxide hypoxemia in the blood which results in placental hypertrophy. Placental hypertrophy is clinically defined as an abnormally heavy or disproportionate placenta. If a placenta is too heavy,
it would be particularly difficult for it to move upwards due to gravitational forces.

Alcohol consumption also has a direct effect on the placenta in Indian women. Though it doesn’t technically cause placenta previa, it does cause placental abruption which is an equally serious complication during pregnancy. A placental abruption is when the placenta detaches itself from the inner walls of the uterus, thus depriving the baby of oxygen and important nutrients.

good-bad
Medical history:

As previously mentioned, damages to the endometrium put women at a higher risk of low lying placenta during pregnancy. Such damages may be a
result of previous abortions, dilation and curettage (D&C), miscarriages, C – sections
and other STDs such as pelvic inflammatory disease (PID), chlamydia or gonorrhoea. Furthermore, endometrial damages also cause another placental complication called the placenta accreta.
Placenta accreta is when the placenta settles too deep into the inner walls of the uterus.

Summary:
Surgeries, instrumentation, uterine complications and procedures, and bad lifestyle choices damage the uterine lining and
cause the formation of scar tissues within the uterine cavity, thus contributing to the causes of low lying placenta. A healthy uterine cavity and endometrium are absolutely vital for a healthy and comfortable pregnancy. Scar tissues
impede the proper conception and may cause miscarriages and serious complications during pregnancy.

Consult a gynaecologist on MFine to find out what’s causing your low placenta and get treated immediately

Chapter 4: How is Low Lying Placenta diagnosed?

When is a placenta previa diagnosed?

The first diagnosis of a posterior or anterior low lying placenta will show up in a routine ultrasound scan at around 14-16 weeks of gestation. This condition at 16 weeks is particularly common and only when the uterus expands, can the placenta move up. According to a study conducted by RCOG (Royal College of Obstetricians and Gynaecologists)
only 10% of Indian women having this condition, early in pregnancy, will go on to develop a complete placenta previa

The exact position of a placenta is vital for the benefit of the mother and the baby. Doctors must determine the location and position of the placenta in order to understand the extent to which the placenta previa will affect pregnancy and childbirth. A gynaecologist will examine you for the following signs of a low placenta:

  • A soft and relaxed uterus
  • foetus in breech position
  • Breech or transverse foetus
  • Slowing of fetal heart rate on pressing head towards the pelvis

However, if there is vaginal bleeding in the second half of your pregnancy, doctors will then closely monitor the location and position of the placenta to see if the placenta moves up naturally. This process is done by the following methods:

1. Transabdominal ultrasound:

An abdominal ultrasound is a regular scan that allows the doctor to examine the uterus, cervix, ovaries, bladder and fallopian tubes. This scan is mostly done before the transvaginal ultrasound so the doctor can determine if it is safe to conduct a transvaginal exam without disrupting or damaging the low placenta.

ultra

How it is done:

An ultrasound transducer (a probe that can help in imaging) is gently pressed against the abdomen along with a gel. The sound waves from the transducer bounce off the organs and fall back into the transducer which then converts the sound waves into a video through a computer.

2. Transvaginal ultrasound:

A vaginal ultrasound, in the case of placenta previa, is done with the utmost care and concern by doctors. A transvaginal ultrasound is the most precise method for determining the exact localization of the placenta. It is also observed that a vaginal ultrasound has multiple advantages over an abdominal ultrasound with regard to placenta previa.

  • How it is done:

A probe is covered in latex (known as a transducer) and inserted into the vagina to use high frequency sound waves to analyze and diagnose low lying placenta. The shorter distance between the transducer and the cervix, along with the higher frequency sound waves, results in a clear, precise picture of the placenta.
Having a crystal clear idea of the position of the placenta will allow the doctors to analyze the pregnancy and suggest restrictions accordingly.

Many medical practitioners usually worry that a vaginal transducer may rupture the placenta or cause serious haemorrhaging in the mother but this case is unheard of. When positioned and inserted under the right guidance and knowledge, a vaginal transducer cannot technically rupture or damage the placenta due to the anatomic relation and
placement of the cervix and the vagina. However, in case of complete placenta previa, the doctor may avoid a transvaginal ultrasound and suggest additional abdominal ultrasounds to keep a track on the placenta previa.

mointer

Important to note:

Vaginal examination is not done outside the operation theatre as it can provoke placenta separation and cause bleeding. Kindly consult a practising and recognised gynaecologist for the ultrasound.

3. Doppler ultrasound:

A Doppler ultrasound is usually used in high-risk pregnancies to keep a close track on the baby’s overall growth. The scan measures the amount of blood that flows from the placenta through the umbilical cord and around the baby’s vital organs like the brain and the heart. It also checks if the baby receives sufficient oxygen and nutrients from the placenta.

  • How it is done:

A Doppler test is done in the same manner as a regular ultrasound scan. A sonographer shall use a transducer to examine the required part of the body and images are created through the sound waves into a computer.

4. MRI (Machine Resonance imaging):

In recent times, an MRI scan is also showing good evaluation in the diagnosis and characterization of the placenta.

Coping with low lying placenta:

As a new Indian mother, it is very common to feel anxious and incompetent when the safety of your unborn child is at stake. However, it is important to believe that most cases resolve by themselves.

According to a study conducted by the National Center for Biotechnology Information (NCBI)
out of 366 cases of placenta previa, 84% of complete placenta previa and 98% of partial placenta previa was spontaneously resolved within the 34th week of gestation.

Keeping this high probability in mind, here are some ways to cope up with the uncertainty surrounding the condition:

  • Educate yourself: The first diagnosis of placenta previa usually happens after finding the condition through an ultrasound or after the first episode of bleeding. Either way, doctors will suggest bed rest.
    Being in bed rest is the perfect opportunity for you to gain more knowledge and perspective about placenta previa. This will prepare you for what to expect next. Read books, articles and focus on reading positive reviews about the condition.
  • Prepare for a C – section: Having a birth plan is widely popular and advised by all doctors and midwives. However, in the event of developing this condition, it is best to loosen the reigns and prepare yourself for a plan B. Learn the advantages of a C – section with regard to placenta previa and consider opting for surgery in order
    to bring your child into this world. The chances of internal bleeding and haemorrhaging are particularly high if women opt for a vaginal birth with this condition.

It is extremely important to mentally prepare yourself to be ready for an emergency C – section. Although this is unlikely, sudden uncontrollable or continuous bleeding may occur with this condition. When and if this happens, women will be taken for emergency C – section, even if the baby is premature. The reason for this is that the mother could bleed
to death if she is not given immediate medical attention.

  • Pamper yourself: Take it as the cloud with the silver lining and use this time to pamper yourself. Life after birth is exhausting and difficult for most Indian mothers. Read your favourite books, binge on your favourite TV shows, eat healthy and heartily and don’t forget to talk to your baby. At around 18 weeks, your baby will be able to hear its first sounds
    from outside the womb. Play soothing music that could help both you and your baby. Have your partner give you gentle massages and communicate with them if you’re feeling anxious and scared. This will not only strengthen your bond but will also help you relax and feel loved.
  • Resting: Sleeping during pregnancy can be tricky and sometimes uncomfortable. This becomes particularly challenging when a low lying placenta is diagnosed. However, it is important to note that a sleeping position for this particular condition is not different from regular positions during pregnancy.
    As per the American Pregnancy Association,
    it is perceived that a good sleeping position for a low-lying placenta is lying on the left side of the body. This is the safest and most comfortable position for you and your baby. This position will increase the flow of blood and other important nutrients to your baby through the placenta. It also helps to bend your knees and place a pillow between them so there is no pressure on the back.

Summary:
Pregnancy with this condition can be frustrating and it’s normal to frantically search for answers on how to cure low-lying placenta but with the right mindset and determination, you will be able to hold your bundle of joy in your arms. Thanks to transabdominal, transvaginal and doppler ultrasounds, this condition can be diagnosed early and resolved.
Focus on absolute positivity and get as much rest as you can get. Don’t hesitate to contact your doctor if you sense anything wrong and make sure you take all the low lying place restrictions imposed on you seriously.

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Chapter 5: Treatment options for Low Lying Placenta

There is no definite answer on how to cure low-lying placenta. Unfortunately, there is no low-lying placenta treatment or cure other than a few precautions and restrictions. These precautions will depend on the following factors:

1: Amount of bleeding

For minimal to no bleeding, doctors may suggest complete bed rest and refrainment from heavy intensity activities like sex and exercises. Patients may be advised to lie down at all times to relieve the pressure on the placenta.

For heavy (painless or painful) bleeding, women may be admitted to a hospital for medical care, blood transfusions, and to keep a close check on internal bleeding and haemorrhaging. A C – section may be planned after 36 weeks of gestation when it’s ideally considered safe to deliver the baby.

And lastly, for continuous bleeding that won’t stop, an emergency C – section will be set up, even if the baby is premature.

2: Pregnancy stage

The pregnancy stage helps doctors understand and predict the nature of the pregnancy. A low-lying placenta at 14 weeks-16 weeks, is not a cause of concern as it
still has plenty of time to resolve itself with precautions but having a low-lying placenta bleeding at 32 weeks can lead to an
emergency C – section. Doctors will suggest such precautions depending upon the stage of the pregnancy.

3: Health of mother and baby:

It is understandably important that the mother and the baby are in good health.
Pregnancies with placental abnormalities and complications are far more delicate than regular pregnancies.
Doctors will have to make sure that the mother is not anaemic or generally weak as this will ultimately hinder the
process of a full-term pregnancy. A proper diet, plenty of bed rest and a
positive perspective will keep the baby as well as the mother, out of danger.

4: Fetal position:

Since the presence of placenta previa will restrict the baby’s head to engage in the pelvis, the baby will most likely stay in an unusual or breech position. When this happens, doctors will conduct frequent scans to monitor the baby’s position and to anticipate if and the placenta does move up.

Options to manage a low placenta:

Once you understand what causes low lying placenta during pregnancy and why it occurs, it is time to accept the condition and explore your options to manage it. Here are some ways to cope and manage with placenta previa:

Indian women with placenta previa will be visiting the hospital far more times than women with no-complication pregnancies. These increased amounts of scans are to closely monitor when the abnormal placenta corrects itself and the baby’s positioning.
It is also noted that women with placenta previa are 68.8% more likely to need a blood transfusion
and intravenous fluids along with medical care, in case of light to heavy bleeding.

  • Restrictions on physical activities:

Women with this condition will be strongly advised against sexual intercourse and exercises. They are also advised to refrain from standing or sitting up for more than an hour, lifting heavy items and travelling.

  • Shots to accelerate baby’s growth:

In extreme cases, when the mother has to undergo an emergency C – section due to continuous bleeding, steroid shots like corticosteroids may be given to the pregnant mothers to help mature the baby’s lungs. Steroid shots are particularly for babies who are likely to be born early due to a pregnancy complication, roughly between 29-34 weeks of gestation. These shots
reduce the risk of lung abnormalities by a whole 50% and also reduces the risk of death in babies by 40%.

  • Plenty of rest:

As crucially mentioned above, rest is one of the best medicines if you’re wondering how to treat low-lying placenta. Bed rest shall be prescribed to minimize vaginal bleeding and decrease the probability of preterm labour. Any form of physical activity during placenta previa may provoke the opening of the cervix which can deem dangerous.
Bed rest is also advised as the positioning helps increase the blood flow to the placenta.

Pregnancies achieved through IVF are 5% more likely to develop a low-lying placenta than the 1.5% of women that conceived spontaneously. If you have opted for IVF, it is advisable to lay off heavy intensity activities from the very start of pregnancy.

Dealing with heavy bleeding:

In cases of heavy bleeding, it is important to stay calm and get to the nearest hospital at the very earliest. Upon reaching the hospital, you will be given intravenous fluids and blood transfusions depending on the amount of blood loss. You may also be given tocolytic drugs,
if you haven’t reached full-term pregnancy, as a method to delay preterm childbirth.

Once you are in your 36th week of pregnancy, it is considered safe to deliver the baby. In case of partial or complete placenta previa, a C – section will be conducted in order to keep the mother from haemorrhaging. However, if the low placenta has resolved by itself and is not in the way of the cervix,
vaginal birth is definitely possible considering if there are no other complications requiring C – section.

Summary:
– There is no low-lying placenta treatment or cure for this condition per se, but doctors will prescribe the required precautions depending on the nature of your pregnancy, health and immunity,
and position of the baby. In today’s day and age, there are multiple new-age techniques and steps taken to give utmost importance to the life of the mother as well as the baby.
– As scary and uncertain it sounds, it is also important to remember that a whopping 90% of low-lying placenta cases have resolved by themselves. So don’t fret or worry if you’re diagnosed with the conditions. Simply follow the
prescribed steps and try your best to enjoy your pregnancy because good things come to those who wait!

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Chapter 6: FAQs

Q1. When does low lying placenta causes bleeding?

As the pregnancy advances, the cervix effaces (thins out) and dilates (opens up) as a way to prepare the body for labour. The uterus stretches and expands which ultimately causes thinning of the organ.
When a woman has a low-lying placenta or a complete placenta previa, the blood vessels linking the placenta to the uterus may tear due to
effacement and dilation. This causes bleeding and can result in haemorrhaging, if not given immediate medical attention.

Q2. Can low-lying placenta cause abdominal pain?

Bright red bleeding after the 20th week of gestation is usually characterized by a placenta previa. Majority of the time, this bleeding has been observed to be painless. However, uterine contractions and pain in the abdomen or pelvis are not completely unheard of. Kindly seek immediate medical assistance if you have abdominal pain during pregnancy.

Q3. Is low-lying placenta high risk?

No, it is not generally considered high risk in pregnancy if it is diagnosed early or even in the 22nd week of pregnancy, there is still a high chance of it spontaneously resolving. Up to 90% of cases resolve by itself by the 34th week and it only affects 1 in 200 pregnant women. It is considered high risk only if it doesn’t resolve by itself by the end of the third trimester or if it is complete or partial placenta previa which might happen in 10% of cases.

Q4. Does low lying placenta affect baby growth?

Placenta previa does not restrict fetal growth or movement in any stage of the pregnancy. It may, however, block the baby’s way out during childbirth. Mothers with this condition will mostly give birth via C – section as they cannot be advised to deliver vaginally due to the risk of extensive bleeding.

Q5. Signs that low lying placenta has moved?

There is no physical sign to say when a low placenta has moved. If a woman is diagnosed with a low-lying placenta at 12 weeks, they will closely monitor her, but she can go about her day by taking general precautionary measures during pregnancy. If a woman is diagnosed with placenta previa in the mid-pregnancy 20th-week anomaly scan, she will be put to
bed rest and be closely monitored through more frequent ultrasounds to see if the placenta has moved.

Q6. Can low lying placenta cause stillbirth?

A low-lying placenta may cause heavy vaginal bleeding during pregnancy, labour or after childbirth as well. Excessive bleeding may also cause haemorrhaging in mothers which may put the baby in danger as well. This, however, does not always happen. Majority of women with the condition go on to deliver healthy babies by adapting to the precautions.

Q6. Is low-lying placenta common?

Placenta previa affects 1 out of 200 pregnant women during the last stage of pregnancy and childbirth. 1 out of 20 women is diagnosed with it in the 20th week of gestation. Thus, it may be common during pregnancy but it many cases it resolves by itself.

If you’re suffering from low-lying placenta, there’s no need to worry. Just consult the best gynaecologists on MFine to receive the best treatment!

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