« P-Funk | Main | Why I look »
10/06/2004
Placenta previa primer
Introduction
Plenty of you have asked me, "Julie, what's placenta previa?"
Okay, no one has asked. Perhaps you already know. Perhaps you just couldn't care less. Or perhaps you have recently discovered an exciting new research tool called the Internet, much as I have. But since I cannot bear to keep this vast wealth of knowledge all to myself, I will explain.
Placenta previa describes the position of the placenta in relation to the cervix. In normal pregnancies, the placenta clings to the fundus, the upper part of the uterus. When instead it implants lower, closer to the cervix, you've got yourself a previa (fig. 1).
Figure 1. You are so screwed.
There are three types: marginal, in which the placenta is located near the cervical opening; partial, in which the placenta partially covers the cervix; and total or complete, in which the cervix is entirely covered.
Incidence
True placenta previa persists in 1 in 200 live births, and 1 in 1,500 first-time mothers. Now, keeping my earlier lucky streak in mind, can any of the mathematicians among us crunch the numbers and figure out whether I should be buying a Powerball ticket?
Look, you can't win if you don't play.
Diagnosis
Low-lying placenta is often detected early in pregnancy via ultrasound. As the pregnancy progresses, however, it is common for the placenta to migrate (a misleading term, since the placenta does not actually fly south for the winter). With the growth of the uterus, the placenta is pulled safely away from the cervix in the vast majority of these cases. This suggests that early diagnosis is not an especially useful tool for predicting later complications.
The later the diagnosis of placenta previa, and the more complete the coverage of the cervical os, the more likely it is to persist until delivery. When a complete placenta previa is identified after 20 weeks or so, it is unlikely to resolve.
If placenta previa is undetected by ultrasound, it often remains undiagnosed until it manifests itself as bright red bleeding late in the pregnancy.
Causes
The causes of placenta previa are unknown, though some risk factors have been identified (fig. 2).
| Risk factor | Does it apply? |
| Smoking | No |
| 6 or more births | Ahahahahahahahaha. Uh, no |
| Previous C-sections | No |
| Cocaine use | Not, um, [cough] in the last 10 years. [Clearing throat.] |
| Multiple pregnancy | No |
| Previous uterine insult, including D&Cs | Yes, but they totally weren't fun so they shouldn't count. |
| IVF | Shit shit shit fuck piss |
Symptoms
The hallmark of placenta previa is bright red bleeding in the second or third trimester. Only about 10% of women with placenta previa reach term without bleeding. The bleeding is generally caused by changes in the uterus and cervix as the body prepares for delivery, although it can also be incited by intercourse or vaginal examination.
The average gestational age at the start of bleeding is 32 weeks; with complete previa the onset of bleeding tends to be earlier. (The relationship between the onset of bleeding and neonatal complications is inversely proportional: The earlier the mother bleeds, the greater the risk of premature birth.)
The initial bleed is usually minor and tends to stop on its own. It is almost invariably followed by a later bleed of greater severity. The bleeding is usually unaccompanied by pain, although one in five women will experience symptoms of premature labor such as contractions.
Nearly 100% of women diagnosed with placenta previa will, at one time or another, freak the fuck right out.
Effects
The danger to the mother is minimal if she's getting proper care. The main risk is from hemorrhage, which can generally be treated with transfusions and fluid replacement as necessary. (And, no, "fluid replacement" does not mean "a succession of frosty-cold shots of Grey Goose." Try "large-bore IV," jackass.)
The risk to the baby is greater. The mortality rate for previa babies seems to hover somewhere near 10%, triple the neonatal mortality rate overall. 60% of these deaths occur from conditions related to premature birth. Premature delivery will occur in about two-thirds of previa cases.
Aside from complications of prematurity, previa babies also seem to experience a higher incidence of growth restriction and congenital physical anomalies.
Treatment
There is no treatment that can move the placenta out of harm's way, but feel free to think really hard about, you know, the slow inexorable progress of glaciers, the geological wonder of plate tectonics, et cetera.
In the absence of bleeding, expectant management is indicated. Patients may be advised to restrict their activities, eliminating exercise, lifting, strenuous movments, and especially sexual intercourse. Pelvic and rectal examinations are strictly contraindicated. Because the placenta could easily get nicked by careless noodling, nothing should be introduced into the vagina (fig. 3).
Figure 3. Wait, did I say you're screwed? No. You'd better not be.
If the patient remains asymptomatic, a scheduled C-section is performed once amniocentesis has established adequate fetal lung maturity.
If there's bleeding, on its first occurrence mother and baby will be evaluated. Upon cessation of bleeding, if their condition is stable, and if the mother can be counted on to be psychotically compliant, and if she lives close enough to a hospital to crawl there on her own in the dead of a midwinter night, tangled in her blood-soaked sweatpants and Steely Dan T-shirt, bed rest at home may be prescribed.
Upon subsequent and more serious bleeding episodes...
- If the baby shows no signs of distress and the pregnancy is significantly pre-term, the mother may be given blood transfusions and medication to prevent premature labor. She may also be treated with steroids to hasten the maturation of the baby's lungs. Hospitalization until delivery is generally required. (Medical personnel are advised to be aware of the likelihood of a recurrence of the earlier freak-the-fuck-right-out, as later flare-ups are invariably more severe.)
- If the pregnancy is close to term, and amniocentesis shows that the baby's lungs have sufficiently matured, a C-section may be performed. The baby will probably be fine.
- If the pregnancy is not close to term, but the mother and/or baby are in significant distress, a C-section may be performed. The baby might not be fine.
Conclusion
Now aren't you glad you asked?
About the Author
Julie, who knows how to use Google, is currently working on a book proposal (working title: So You Have Placenta Previa, You Poor Sad Bastard: A Dry, Factual, and Not-At-All-Alarmist Guide). She is available upon request for thought-provoking lectures and reassuring patient consultations.
Comments (87)
Verify your Comment
Previewing your Comment
This is only a preview. Your comment has not yet been posted.
As a final step before posting your comment, enter the letters and numbers you see in the image below. This prevents automated programs from posting comments.
Having trouble reading this image? View an alternate.
How did that bit go again ... ah, yes. LA LA LA LA LA!
I'm so fucking sorry you have to go through this. It sucks.
I’m no mathematician but damn girl I say go out and buy that Powerball ticket! I mean really what are the odds?
Impressively informative....and scary as hell. Wishing you peace, my friend.
Oh come on, surely you can squeeze the VW beetle in there?
Sucks that you're dealing with this. PP, GO AWAY!!!
It's George Washingon I miss most keenly, our Founding Father I sadly regret.
As if we needed any more evidence that the universe is unfair and bad and ill-tempered.
You already know that I'm really sorry this is happening to you. Still, I laughed the whole way through your post.
Is that wrong?
Okay now I know way more than I hope I ever need to know about pp. Let's hope I will never have a practical need for such knowledge unless its for winning the final question is some very generous quiz show.
I am so sorry that you have to worry about this now. ITS NOT FAIR (if you could see me I'm shaking my fist at the sky and weeping, okay maybe not but it would be dramatic don't you think).
I just have wonder though, why the rocking chair?? Are you not allowed to rock on it as well or is external use permitted and just internal use prohibited. Inquiring minds want to know.
Vaughn
Oh my Gawd that was funny. I'm sorry I laughed but you wrote it so well. I know it's scary but I trust you've got a good O.B. and you're going to refrain from George Washington so I'm putting my money on a healthy, full term baby.
Thank you! I tried to explain it to Mark but I wasn't doing a very good job. Now he can see diagrams and everything. I'm so sorry you have to deal with this shit on top of everything else.
I can't help but notice that the penis in Figure 3 had no testicles. No wonder you had such a hard time getting pregnant. I mean, you'd think the doctors would have picked up on that earlier. Hmm.
...thinking placenta-migrating thoughts for you...
Crap.First I must admit that I had heard of and had a somewhat vague understanding of placenta previa before you posted, but my google search did not turn up such results as yours. The results I found were much drier. You've got some career potential here.
Second, I must admit. I laughed.
Third, buy the powerball ticket.
Fourth, akeeyu made me pee.
Sorry sorry sorry sorry.
That placenta's ass needs to get in gear and moooooove aside. That is, if the placenta has an ass.
This is abso-fucking ridiculous. I am so sorry you can't even have a nice, peaceful pregnancy...sending you supportive thoughts.
If you eat lots of chocolate...maybe the placenta will move for you.
On another note, stop googling that stuff. I had a huge panic attack after researching fetal abnormalities. Sometimes knowledge IS NOT the best weapon.
Sending you positive placenta moving thoughts...
Julie, you sweet dumb kid, the dollar bills are not supposed to be inserted. Although I suspect that this innocent misunderstanding has most likely made you the most popular pregnant stripper in New England.
Just have them tuck 'em under the g-string strap.... criminey christmas it's like I gotta do everything around here... and stay away from those Cooper Minis, sure they LOOK small...
Oh, and that placenta previa is really fucking scary. I hate that you are being scared by it.
So fucked up that you are dealing with this right now...
xxoo
Oh Julie,
After everything else you've already been through. I'm so sorry, so very sorry.
I'm sending a lot of prayers your way that in your case, since you must have this happen to you (Fuck you G-d), that it is the best possible scenario and the least scariest.
Sending you lots of love and prayers my friend.
xxxooo
Your advanced use of tables and graphics is frankly...sexy. I'm so sorry...I'll try my best not to get you aroused.
My friend. I am so sorry you are going through this, and in awe of your strength, your humor in the face of this, and your beauty. I love you so much.
What was an umbrella doing in your cooch anyways? Ouch, mama.
Yeesh. This is insane. I don't know what to do except send really really good, no-matter-what-you're-not-fucking-screwed-I-don't-care-what-you-say vibes your way.
Hang in there, li'l buckaroo.
I was so mesmerized by the stern yet come-hither glare of our first President that, yes, I DID NOT EVEN NOTICE the penis. Or its, erm, lack of sidekicks.
You stir up these disquieting emotions within me, Julie, and I know not whether to be ashamed more for guffawing my way through such serious. Medical. Information, or for understanding immediately that you have made the regrettable mistake of confusing a hand-crank eggbeater with a hand-cranked vibrator.
Which, I should note, is still available for purchase.
It's a good thing I'm reading this on the internet. It's a very serious subject and must be approached with the utmost tact. SO STOP BEING SO DAMNED FUNNY!
Kidding. But thank you for making scary topics easier to talk/think about.
yes... now we know why it took you so long to get knocked up. Not only does the penis not have balls... despite the fact that it looks as though it even comes with instructions... but the umbrella, if inserted correctly, also acts as barrier birth control. That is.. unless it's really windy up in there and it tips over backwards, spilling it's contents.
Love,
Brenda
PS... yankees suck!
When it rains, it pours, huh? Too bad you can't insert a bumber. Shoot.
But what about those teensy little drink umbrellas? Douche with rum and pineapple juice and violá! A new way to enjoy the "margarita-in-your-mouth" style of bartending.
When it rains, it pours, huh? Too bad you can't insert a bumber. Shoot.
But what about those teensy little drink umbrellas? Douche with rum and pineapple juice and violá! A new way to enjoy the "margarita-in-your-mouth" style of bartending.
Wow, thanks for all the info... i never really knew that much about pp. So sorry that you have to be going thru this after everything!!! Take care of yourself.
P.S. at my first glance at this post, I thought the side-by-side uteri were ears.
Doctor, I've been experiencing some hearing loss with this pregnancy.
Well, let's see... Egads! You've got "placenta orecchia." Very serious case, since both the placenta and the fetus are now securely attached to your outer ear!
What? Doctor, I can't hear you!
P.S. at my first glance at this post, I thought the side-by-side uteri were ears.
Doctor, I've been experiencing some hearing loss with this pregnancy.
Well, let's see... Egads! You've got "placenta orecchia." Very serious case, since both the placenta and the fetus are now securely attached to your outer ear!
What? Doctor, I can't hear you!
It was only funny the first time.
I know I shouldn't be laughing, as this is no laughing matter, but I am laughing. Loudly. And I've snorted once or twice, too. I feel very emotionally invested in this pregnancy. You and Batman are in my daily thoughts. :)
Perhaps the VW bug could ease the placenta back into place? I mean, if you're willing to use your vagina as a drive-through and all...
So sorry that you're having to deal with this immense load of bullshit after everything else you've already been through. Argh.
Good vibes to you and your wombmate!
OK, am officially bestowing honorary doctor of medicine on you!
Most excellent article! (Very well researched)
Hoping you get all the boring parts!
I had pp, and I too looked it up on Google after I staggered from the docs office. This was supposed to reassure me - big mistake. I learnt far too much about the os (after of course thinking, WTF is an os?). My self-proscribed treatment was lying down as much as possible while singing "Move on Up".
Wishing you a barrel of good things.
Well written and totally informative!
I'm sorry I'm laughing, but you did such a damn good job of finding humor in something that is totally not fucking fair. Isn't there some kind of "Doctor" out there that can acupuncture/acupressure/meditate that placenta back where it belongs? There really should be.
Oh, c'mon, you're supposed to laugh! Rocking chairs! In the vagina! What's not hilarious about that?
The only way I know how to get through some of this stuff is to make it ridiculous. Enjoy the absurdity with me, and don't feel bad for a moment.
Come now...an egg beater? Really....this is going to far!! I'm sorry to say that I am busting my gut laughing here and now I feel bad because I shouldn't be laughing at someone's medical issues. oh what to do? laugh or not? OK Julie - you've made me laugh and all I've got to say now is onward and upward you crafty, conniving little placenta....get your ass where it should be.
ps I think you are a very talented writer. e pluberus unum
Given that pregnancy after IF causes chronic freaking out and pregnancy complications cause acute freaking out, the vodalessness seems especially cruel.
Is there any tradition about "Mommy's first postpartum shot"? My Google skills pale before yours, so I don't know, but it seems only right.
PS blah blah drinking isn't a proper coping mechanism blah blah, just in case someone earnest reads this
What about spending a fair amount of time standing on your head? Gravity is your friend.
I will give up George Washington too as a show of support:)
Sucks this is happening but wishing all the best for you & Batman.
I like the word "fundus". It implies that your uterus is so jovial that there's a constant party, possibly attended by Paris Hilton and Tara Reid. Sorry your placenta is being naughty.
Julie - I thought even more about this post last night. You've taken such a scary thing, found humor, and given us a way to talk about it. If one of us finds ourselves facing the same thing, it will still be scary as hell, but better because we've already talked about it.
"A fun, fact-filled account on placenta previa...a must-read for....well, for everyone." --GR Times
Since you're not using that rocking chair, can I? Also, the penis might not have been missing his mates, they may have just been a bit long, ya know?
How is it possible that I am howling with laughter and going "Oh FUCK. Oh really. Oh fucking SHIT, really?" at the same time? Let's hope Batman is busy writing his/her manifesto and won't wish to emerge for another 18 weeks or so....
I think that you should develop this into a PowerPoint lecture and go on the road. Once you're allowed to move about again.
Here's hoping the dang placenta nudges over!
I had no idea you were shoving rocking chairs up your kuze. If I had known, I'd have offered you the glider that we're looking to unload. It's much more comfortable than that rocking chair, and it arrived too late in my pregnancy for it ever to have been shoved up there. So you'd be the first.
Anyway, it seems you're a lot like me in that you like to do lots of research. Generally, I think that's a good thing. As a matter of fact, I did a Yahoo! on the traits describing the rash currently on my daughter's bum, and correctly diagnosed her as having a yeast infection. So it's good to know that there's a lot of good information out there. However, when you're in the midst of having a scary condition, it's not always the best thing (while researching my daughter's rash I discovered some rather horrible and obscure things that could be causing it, and of course my brain just HAD to go there). Statistics can be very scary and open to wide interpretation. As I think an OB/Gyn posted a week or so ago--something to the effect that a lot of the scary outcomes that you hear about with PP are in women who didn't know they had it, and you do know and are being treated accordingly.
This is all just "for what it's worth." I'm an information junkie myself and probably won't let up until I've Googled the universe's most basic elements and charted them into oblivion.
I've always heard the test of true comedy is the kind that can make you laugh, then cry, then laugh again. You are a true comedian. Saying prayers for you and Batman!!!
Wow. You make my poor-me-my-neighbor-hates-me post look rather petty. I'm sorry to hear about the PP, and will send up happy thoughts for you and Batman. Good thing you know how to take care of you guys! Undiagnosed PP is what skews the stats.