Pregnancy: Placenta Previa (cont.)

Bleeding is the primary symptom of placenta previa and occurs in the majority (70%-80%) of women with this condition. Vaginal bleeding after the 20th week of gestation is characteristic of placenta previa. Usually the bleeding is painless, but it can be associated with uterine contractions and abdominal pain. Bleeding may range in severity from light to severe.

An ultrasound examination is used to establish the diagnosis of placenta previa. Either a transabdominal (using a probe on the abdominal wall) or transvaginal (with a probe inserted inside the vagina but away from the cervical opening) ultrasound evaluation may be performed, depending upon the location of the placenta. Sometimes both types of ultrasound examination are necessary.

It is important that the ultrasound examination be performed before a physical examination of the pelvis in women with suspected placenta previa, since the pelvic physical examination may lead to further bleeding.

Treatment of placenta previa depends upon the extent and severity of bleeding, the gestational age and condition of the fetus, the position of the placenta and fetus, and whether the bleeding has stopped.

Cesarean delivery (C-section) is required for complete placenta previa and may be necessary for other types of placenta previa. A Cesarean delivery is usually planned for women with placenta previa as soon as the baby can be safely delivered (typically after 36 weeks' gestation), although an emergency Cesarean delivery at any earlier gestational age may be necessary for heavy bleeding that cannot be stopped after treatment in the hospital (see below).

Women who are actively bleeding or who have bleeding that cannot be stopped will be admitted to the hospital for further care. If there has been little or no bleeding or the bleeding has stopped, bed rest at home may be prescribed. Home care is not always appropriate, and women who remain at home must be able to access medical care immediately should bleeding resume. Women with placenta previa in the 3rd trimester of pregnancy are advised to avoid sexual intercourse and exercise and to reduce their activity level.

Women with placenta previa who experience heavy bleeding may require blood transfusions and intravenous fluids. In some cases, tocolytic drugs (medications that slow down or inhibit labor), such as magnesium sulfate or terbutaline (Brethine) are necessary. Corticosteroids may be given to enhance lung development in the fetus prior to Cesarean delivery.

Source: MedicineNet.com
http://www.medicinenet.com/pregnancy_placenta_previa/article.htm