What is placenta previa. How does it affect pregnancy. What are the risk factors for developing placenta previa. How is placenta previa diagnosed. What treatment options are available for placenta previa. Can placenta previa resolve on its own. When is a cesarean delivery necessary for placenta previa.

Understanding Placenta Previa: A Comprehensive Overview

Placenta previa is a pregnancy complication that occurs when the placenta partially or completely covers the opening of the cervix during the last months of pregnancy. This condition can lead to severe bleeding before or during labor, posing risks to both the mother and the baby. To fully grasp the implications of placenta previa, it’s crucial to understand the role of the placenta and how its positioning can affect pregnancy outcomes.

The Role of the Placenta in Pregnancy

The placenta is a vital organ that develops in the uterus during pregnancy. Its primary functions include:

• Providing oxygen and nutrients to the developing fetus
• Removing waste products from the baby’s blood
• Producing hormones necessary for pregnancy maintenance

Typically, the placenta attaches to the upper part of the uterus, allowing for a clear path through the cervix during delivery. However, in cases of placenta previa, this normal positioning is disrupted.

Types of Placenta Previa: Understanding the Variations

Placenta previa can manifest in different forms, each with varying degrees of severity and potential complications. The main types include:

1. Complete placenta previa: The placenta entirely covers the cervical opening
2. Partial placenta previa: The placenta partially covers the cervical opening
3. Marginal placenta previa: The placenta’s edge is near the cervical opening but doesn’t cover it
4. Low-lying placenta: The placenta is close to the cervix but not covering it

Is the type of placenta previa a determining factor in treatment decisions? While all types require medical attention, the specific management approach may vary depending on the extent of cervical coverage and associated bleeding.

Recognizing the Symptoms of Placenta Previa

Identifying the signs of placenta previa is crucial for timely intervention and appropriate management. The primary symptom is sudden, painless vaginal bleeding, which can range from light to heavy. Other symptoms may include:

• Cramping or sharp pains in the abdomen
• Intermittent bleeding that starts, stops, and begins again over days or weeks
• Bleeding after sexual intercourse
• Bleeding during the second half of pregnancy

Do all cases of placenta previa present with symptoms? Not necessarily. Some cases may be asymptomatic and discovered only during routine ultrasound examinations. However, any vaginal bleeding during pregnancy should be promptly evaluated by a healthcare provider.

Risk Factors for Developing Placenta Previa

While the exact cause of placenta previa is not always clear, several factors can increase the likelihood of its occurrence. These risk factors include:

• Previous uterine surgeries (e.g., cesarean delivery, myomectomy, dilation and curettage)
• Multiple pregnancies (twins, triplets, etc.)
• Advanced maternal age (over 35 years)
• Smoking during pregnancy
• Prior placenta previa or miscarriage
• Abnormally shaped uterus
• Large placenta
• Asian ethnicity
• Multiparity (having given birth before)

Can lifestyle changes reduce the risk of placenta previa? While some risk factors are unavoidable, maintaining a healthy lifestyle, quitting smoking, and carefully planning pregnancies after uterine surgeries may help reduce the risk.

Diagnostic Approaches for Placenta Previa

Accurate diagnosis of placenta previa is essential for proper management and treatment. Healthcare providers typically use the following methods to diagnose and monitor the condition:

Routine Ultrasound Screening

The first signs of placenta previa often appear during the routine 20-week ultrasound. However, it’s important to note that a low-lying placenta at this stage is not uncommon and often resolves on its own as the pregnancy progresses.

Transvaginal Ultrasound

This is the preferred and most accurate method for diagnosing placenta previa. A probe is inserted into the vagina to provide a detailed view of the cervix and placental position.

Transabdominal Ultrasound

While less precise than transvaginal ultrasound, this non-invasive method can still provide valuable information about the placenta’s location.

MRI (Magnetic Resonance Imaging)

In some cases, an MRI may be used to obtain a clearer image of the placenta’s position, especially if there are concerns about placental invasion into the uterine wall.

How often should ultrasounds be performed in cases of suspected placenta previa? The frequency of ultrasounds will depend on the individual case, but typically, follow-up scans are conducted at 32 weeks to reassess the placenta’s position.

Treatment Strategies for Placenta Previa

The management of placenta previa depends on several factors, including the severity of bleeding, gestational age, fetal health, and the position of the placenta and baby. Treatment approaches can be broadly categorized as follows:

Conservative Management

For cases with minimal or no bleeding, conservative management may be recommended, which typically includes:

• Pelvic rest: Avoiding sexual intercourse and limiting activities that may strain the pelvic floor
• Reduced physical activity or bed rest
• Regular monitoring of maternal and fetal health
• Possible hospitalization for closer observation

Medical Interventions

In cases of more significant bleeding or other complications, medical interventions may be necessary:

• Corticosteroid injections to accelerate fetal lung development if preterm delivery is anticipated
• Iron supplements or blood transfusions to address anemia from blood loss
• Tocolytic medications to prevent preterm labor if bleeding is controlled

Surgical Management

In severe cases or when conservative measures fail, surgical intervention may be required:

• Planned cesarean delivery: Typically scheduled after 36 weeks of gestation
• Emergency cesarean delivery: Performed in cases of uncontrollable bleeding or fetal distress

Can placenta previa be treated without surgery? While some cases may resolve on their own or be managed conservatively, cesarean delivery is often necessary to ensure the safety of both mother and baby, especially in cases of complete placenta previa or significant bleeding.

Potential Complications and Long-Term Implications

Placenta previa can lead to various complications for both the mother and the baby. Understanding these risks is crucial for appropriate management and informed decision-making:

Maternal Complications

• Severe hemorrhage before, during, or after delivery
• Increased risk of postpartum hemorrhage
• Higher likelihood of requiring a hysterectomy
• Increased risk of placenta accreta (abnormal placental attachment)
• Anemia due to blood loss
• Increased risk of infection

Fetal Complications

• Preterm birth and associated risks
• Intrauterine growth restriction
• Fetal distress due to maternal blood loss
• Higher risk of congenital abnormalities

Are there long-term effects of placenta previa on future pregnancies? Women who have had placenta previa in one pregnancy have an increased risk of recurrence in subsequent pregnancies. Additionally, the higher likelihood of cesarean delivery may impact future reproductive choices and pregnancy management.

Preventing and Managing Placenta Previa: A Holistic Approach

While not all cases of placenta previa can be prevented, certain measures can help reduce the risk and improve outcomes:

Preconception Care

• Quitting smoking and avoiding alcohol
• Maintaining a healthy weight
• Managing chronic health conditions
• Planning pregnancies with appropriate spacing

Prenatal Care

• Attending all scheduled prenatal appointments
• Following healthcare provider recommendations for activity levels and pelvic rest
• Reporting any vaginal bleeding promptly
• Managing stress and maintaining emotional well-being

Postpartum Care

• Following up with healthcare providers as recommended
• Discussing future pregnancy plans and potential risks
• Addressing any psychological impacts of a high-risk pregnancy

How can healthcare systems improve the management of placenta previa? Implementing standardized protocols for diagnosis and treatment, providing comprehensive patient education, and ensuring access to specialized care can significantly improve outcomes for women with placenta previa.

Advances in Research and Future Directions

The field of maternal-fetal medicine continues to evolve, with ongoing research aimed at improving the diagnosis, management, and outcomes of placenta previa. Some areas of current interest include:

• Developing more accurate predictive models for placenta previa
• Investigating the role of genetic factors in placental disorders
• Exploring new imaging techniques for earlier and more precise diagnosis
• Studying the long-term effects of placenta previa on maternal and child health
• Investigating novel interventions to promote placental migration

What potential breakthroughs could change the landscape of placenta previa management? Advancements in minimally invasive surgical techniques, stem cell therapies, and personalized medicine approaches hold promise for improving outcomes and reducing the need for invasive interventions in cases of placenta previa.

In conclusion, placenta previa represents a significant challenge in obstetric care, requiring vigilant monitoring, timely intervention, and a multidisciplinary approach to management. By understanding the causes, recognizing the symptoms, and implementing appropriate treatment strategies, healthcare providers can significantly improve outcomes for affected mothers and babies. Ongoing research and advancements in medical technology continue to enhance our ability to diagnose, treat, and potentially prevent this condition, offering hope for improved maternal and fetal health in the future.

Placenta Previa

Placenta previa occurs when the placenta covers the opening of the cervix during the last months of pregnancy. This condition can cause severe bleeding before or during labor.

The placenta develops in a pregnant person’s uterus during pregnancy. This sac-like organ provides the developing baby with food and oxygen. It also removes waste products from the baby’s blood. The placenta is also referred to as “afterbirth” because it exits the body after the baby is born.

During pregnancy, the uterus stretches and grows. It’s normal for the placenta to be low in the uterus in early pregnancy. As the pregnancy continues and the uterus stretches, the part of the uterine the placenta was stuck to moves, usually away from the cervical opening.

By the third trimester, the placenta should be near the top of the womb. This position allows the cervix, or the entrance to the womb at the bottom of the uterus, a clear path for delivery.

If the placenta attaches instead to the lower part of the uterus, it can cover part or all of the internal opening or “os” of the cervix. When the placenta covers the cervical os during the last months of pregnancy, the condition is known as placenta previa.

Most pregnant people with placenta previa will require pelvic rest. This typically includes abstaining from having sexual intercourse, limiting any procedures like an obstetrical check for dilation, and possibly restricting any exercises that may strain the pelvic floor.

The main symptom of placenta previa is sudden light to heavy bleeding from the vagina. Any bleeding can be representative of problems with the placenta and needs investigation by a physician. Specific symptoms may include:

• cramps or sharp pains
• bleeding that starts, stops, and begins again days or weeks later
• bleeding after intercourse
• bleeding during the second half of pregnancy

Risk factors for the development of placenta previa include:

• unusual position of the baby, including breech (buttocks first) or transverse (lying horizontally across the womb)
• previous surgeries that involve the uterus: cesarean delivery, surgery to remove uterine fibroids, dilation and curettage (D&C)
• pregnant with twins or other multiples
• prior miscarriage
• large placenta
• abnormally shaped uterus
• having already given birth to one child
• prior diagnosis of placenta previa

Pregnant people who are smokers, who are older than 35, or who are of Asian descent are also at higher risk of developing placenta previa.

Usually, the first signs of placenta previa will show up during the routine 20-week ultrasound. These initial signs are not necessarily a cause for worry, since the placenta is often lower in the uterus during the early part of a pregnancy.

The placenta usually corrects itself. According to the Royal College of Obstetricians and Gynaecologists, only 10 percent of people with low-lying placenta at 20 weeks will have a low-lying placenta at their next ultrasound. Only .5 percent will have placenta previa at the end of their pregnancy.

If you experience any bleeding in the second half of your pregnancy, doctors will monitor the position of the placenta using one of these preferred methods:

• Transvaginal ultrasound. Your doctor places a probe inside the vagina to provide an inside view of your vaginal canal and cervix. This is the preferred and most accurate method for determining placenta previa.
• Transabdominal ultrasound. A healthcare technician places gel on your abdomen and moves a handheld unit called a transducer around your abdomen to view the pelvic organs. The sound waves make a picture on a TV-like screen.
• MRI (magnetic resonance imaging). This imaging scan will help clearly determine the placenta’s location.

Doctors will decide how to treat your placenta previa based on:

• the amount of bleeding
• the month of your pregnancy
• the baby’s health
• the position of the placenta and the baby

The amount of bleeding is a doctor’s main consideration when deciding how to treat the condition.

Minimal to no bleeding

For cases of placenta previa with minimal or no bleeding, your doctor will likely suggest pelvic rest. This means refraining from putting anything into your vagina during pregnancy in order to prevent medical complications.

You’ll also be asked to avoid sex and likely exercise as well. If bleeding occurs during this time, you should seek medical care as soon as possible.

Heavy bleeding

In the case of heavy bleeding, your doctor will advise scheduling a cesarean delivery as soon as it’s safe to deliver — preferably after 36 weeks. If the C-section needs to be scheduled sooner, your baby may be given corticosteroid injections to speed up their lung growth.

Uncontrollable bleeding

In the case of uncontrolled bleeding, an emergency cesarean delivery will have to be performed.

During labor, the cervix will open to allow the baby to move into the vaginal canal for birth. If the placenta is in front of the cervix, it will begin to separate as the cervix opens, causing internal bleeding.

This can necessitate an emergency C-section, even if the baby is premature, as the pregnant person could bleed to death if no action is taken. Vaginal birth also poses too many risks for the pregnant person, who could experience severe hemorrhaging during labor, delivery, or after the first few hours of delivery.

A placenta previa diagnosis can be alarming for people who are expecting a baby. Here are some ideas for how to cope with your condition and how to prepare yourself for delivery.

Get educated. The more you know, the more you’ll know what to expect. Get in contact with other people who have been through placenta previa births.

Be prepared for your cesarean delivery. Depending on the type of your placenta previa, you might not be able to have a vaginal birth. It’s good to remember the ultimate goal — the health of you and your baby.

Rest. Pelvic rest is important while you are experiencing this condition. Additionally you should not engage in any strenuous activity or heavy lifting. You can use the time wisely by catching up on small projects, such as:

• putting together a photo album
• writing letters
• reading about your upcoming lifestyle change

Pamper yourself. Indulge in small pleasures, such as:

• buying a new pair of comfortable pajamas
• reading a good book
• watching your favorite TV program
• keeping a gratitude journal

Be sure to rely on your circle of friends and family for conversation and support.

Von Willebrand Disease: Types, Causes, and Symptoms

Von Willebrand Disease: Types, Causes, and Symptoms

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Medically reviewed by Graham Rogers, M. D. — By Lydia Krause — Updated on March 31, 2017

What is von Willebrand disease?

Von Willebrand disease is a bleeding disorder. It’s caused by a deficiency of von Willebrand factor (VWF). This is a type of protein that helps your blood to clot. Von Willebrand is different from hemophilia, another type of bleeding disorder.

Bleeding happens when one of your blood vessels breaks. Platelets are a type of cell that circulates in your blood and clumps together to plug broken blood vessels and stop bleeding. VWF is a protein that helps platelets clump together, or clot. If your levels of functional VWF are low, your platelets won’t be able to clot properly. This leads to prolonged bleeding.

According to the Centers for Disease Control and Prevention, von Willebrand disease affects up to 1 percent of the general population in the United States.

Three main types of von Willebrand disease exist:

Type 1

Type 1 is the most common type of von Willebrand disease. It causes lower-than-normal levels of VWF to occur in your body. You still have small amounts of VWF in your body to help clot blood. You’ll likely experience mild bleeding problems but be able to live a normal life.

Type 2

If you have type 2 von Willebrand disease, you have normal levels of VWF but it won’t work properly due to structural and functional defects. Type 2 is divided into subtypes, including types:

• 2A
• 2B
• 2M
• 2N

Type 3

Type 3 is the most dangerous type of von Willebrand disease. If you have this type, your body won’t produce any VWF. As a result, your platelets won’t be able to clot. This will put you at risk of severe bleeding that’s difficult to stop.

If you have von Willebrand disease, your symptoms will vary depending on which type of the disease you have. The most common symptoms that occur in all three types include:

• easy bruising
• excessive nose bleeds
• bleeding from your gums
• abnormally heavy bleeding during menstruation

Type 3 is the most severe form of the condition. If you have this type, you have no VWF in your body. This makes episodes of bleeding difficult to control. It also raises your risk of internal bleeding, including bleeding in your joints and gastrointestinal system.

Men and women develop von Willebrand disease at the same rate. But women are more likely to experience symptoms and complications due to the increased risk of bleeding during menstruation, pregnancy, and childbirth.

A genetic mutation causes von Willebrand disease. The type of von Willebrand disease that you have depends on whether one or both of your parents have passed a mutated gene on to you. For example, you can only develop type 3 Von Willebrand if you’ve inherited a mutated gene from both of your parents. If you’ve only inherited one copy of the mutated gene, you’ll develop type 1 or 2 von Willebrand disease.

Your doctor will ask you questions about your personal and family history of abnormal bruising and bleeding. Type 3 tends to be the easiest to diagnose. If you have it, you’ll likely have a history of severe bleeding starting early in life.

Along with taking a detailed medical history, your doctor may also use laboratory tests to check for abnormalities in your VWF levels and function. They may also check for abnormalities in clotting factor VIII, which can cause hemophilia. Your doctor can also use blood tests to learn how well your platelets function.

Your doctor will need to collect a sample of your blood to conduct these tests. Then, they’ll send it to a laboratory for testing. Because of the specialized nature of these tests, it may take up to two or three weeks to receive your results.

If you have von Willebrand disease, your treatment plan will vary, depending on the type of condition you have. Your doctor may recommend several different treatments.

Nonreplacement therapy

Your doctor may prescribe desmopressin (DDAVP), which is a drug recommended for types 1 and 2A. DDAVP stimulates the release of VWF from your body’s cells. Common side effects include a headache, low blood pressure, and fast heart rate.

Replacement therapy

Your doctor may also recommend replacement therapy, using Humate-P or Alphanate Solvent Detergent/Heat Treated (SD/HT). These are two types of biologics, or genetically engineered proteins. They’re developed from human plasma. They can help replace the VWF that’s absent or working improperly in your body.

These replacement therapies aren’t identical and you shouldn’t use them interchangeably. Your doctor may prescribe Humate-P if you have type 2 von Willebrand disease and are unable to tolerate DDAVP. They may also prescribe it if you have a severe case of type 3 von Willebrand disease.

Common side effects of replacement therapy with Humate-P and Alphanate SD/HT include chest tightness, rash, and swelling.

Topical treatments

To treat minor bleeding from small capillaries or veins, your doctor may recommend applying Thrombin-JMI topically. They may also apply Tisseel VH topically after you undergo surgery, but it won’t stop heavy bleeding.

Other drug therapies

Aminocaproic acid and tranexamic acid are drugs that help steady clots formed by platelets. Doctors often prescribe them to people who are undergoing invasive surgery. Your doctor may also prescribe them if you have type 1 von Willebrand disease. Common side effects include nausea, vomiting, and clot complications.

Drugs to avoid

If you have any form of Von Willebrand disease, it’s important to avoid drugs that can increase your risk of bleeding and complications. For example, avoid aspirin and nonsteroidal anti-inflammatory drugs, such as ibuprofen and naproxen.

Most people who have type 1 von Willebrand disease are able to live normal lives with only mild bleeding issues. If you have type 2, you’re at an increased risk of experiencing mild to moderate bleeding and complications. You may experience worse bleeding in the case of infection, surgery, or pregnancy. If you have type 3, you’re at risk of severe bleeding, as well as internal bleeding.

No matter what type of von Willebrand disease you have, you should let your healthcare providers know about it, including your dentist. They may need to adjust their procedures to lower your risk of bleeding. You should also let trusted family members and friends know about your condition in case you have an unexpected accident or need life-saving surgery. They can share important information about your condition with your healthcare providers.

Last medically reviewed on March 31, 2017

How we reviewed this article:

Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.

• Bharati, K. P., & Prashanth, U. R. (2011, January-February). Von Willebrand disease: An overview. Indian Journal of Pharmaceutical Sciences, 73(1), 7-16
  ncbi. nlm.nih.gov/pmc/articles/PMC3224412/
• Mayo Clinic Staff. (2014, January 2). Von Willebrand disease
  mayoclinic.org/diseases-conditions/von-willebrand-disease/basics/definition/con-20030195
• Von Willebrand disease. (2014, June 11)
  ncbi.nlm.nih.gov/pubmedhealth/PMH0063054/
• Von Willebrand disease (VWD): Data and statistics – NCBDDD. (2015, March 20)
  cdc.gov/ncbddd/vwd/data.html

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Medically reviewed by Graham Rogers, M.D. — By Lydia Krause — Updated on March 31, 2017

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Ministry of Labor and Social Protection of the Russian Federation: Official website

Working hours should provide (Article 100 of the Code): flexible schedule, part-time work),

alternation of working and non-working days, which are established by the internal labor regulations, collective agreement, agreements, and for employees whose working hours differ from the general rules established by the given employer, by an employment contract.

Features of the regime of working time and rest time for transport workers, communications workers and others with a special nature of work are determined in the manner established by the Decree of the Government of the Russian Federation of December 10, 2002 No. 877.

Working hours – the time during which the employee, in accordance with the internal labor regulations and the terms of the employment contract, must perform labor duties, as well as other periods of time that, in accordance with the Code, other federal laws and other regulatory legal acts of the Russian Federation, refer to to working time.

Normal working hours may not exceed 40 hours per week (Article 91 of the Code).

For certain categories of workers, labor legislation provides for the establishment of reduced working hours (Article 92 of the Code):

and other categories of employees established by the Code and other federal laws (for example, pedagogical, medical workers).

The legislation also provides for the possibility of establishing part-time work both by agreement of the parties to the employment contract, and by virtue of the direct obligation of the employer (at the request of a pregnant woman, one of the parents with a child under the age of 14 and in other cases provided for in Article 93 of the Code ).

At the same time, the reduced duration of daily work is established (Article 94 of the Code): 15 to 16 years old – 5 hours, 16 to 18 years old – 7 hours;

90,005 employees aged 14 to 16 who receive general education or secondary vocational education and combine education with work for no more than 2.5 hours during the academic year,

90,005 employees aged 16 to 18 who receive general education or secondary vocational education and combine education with work for no more than 4 hours during the academic year;

to other categories of employees in accordance with the Code and other federal laws.

The duration of work on the eve of a non-working holiday is reduced by one hour (Article 95 of the Code).

The duration of work (shift) at night is reduced by one hour without further working off (Article 96 of the Code).

The employer has the right to involve employees to work outside the working hours established for this employee:

• for overtime work in the manner prescribed by Article 99 of the Code;
• if the employee works on irregular working hours (Article 101 of the Code).

The legislation provides for the possibility of establishing work in irregular working hours, flexible working hours, shift work, as well as dividing the working day into parts.

The Code also provides for the possibility of introducing a summarized recording of working hours so that the length of working time for an accounting period (month, quarter and other periods) does not exceed the normal number of working hours. The accounting period cannot exceed one year, and for accounting for the working time of employees employed in work with harmful and (or) dangerous working conditions, three months (Article 104).

This mode of working hours is established when, due to the conditions of production (work) for an individual entrepreneur, in an organization as a whole or in the performance of certain types of work, the established for this category of workers (including workers engaged in work with harmful and (or ) dangerous working conditions) daily or weekly working hours.

In this case, if due to seasonal and (or) technological reasons for certain categories of workers employed in work with harmful and (or) dangerous working conditions, the established working hours cannot be observed during the accounting period of three months , an industry (inter-sectoral) agreement and a collective agreement may provide for an increase in the accounting period for recording the working time of such employees, but not more than up to one year.

The normal number of working hours for the accounting period is determined on the basis of the weekly working hours established for this category of employees. For employees working part-time (shift) and (or) part-time working week, the normal number of working hours for the accounting period is reduced accordingly.

The procedure for introducing the summarized recording of working time is established by the internal labor regulations.

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