Placenta Previa and Birth Injury
The placenta is a disk-shaped organ that supplies the growing baby with nourishment, blood, and oxygen through the umbilical cord. Normally, it is implanted near the top or on the side of the uterus, and makes its way through the birth canal after the infant has been delivered. It is part of the “afterbirth.” Placenta previa is a condition in which the placenta lies unusually low in the uterus, where it partially or completely covers the mother’s cervix and may block the baby’s passage out of the womb. When diagnosed early in pregnancy, placenta previa is usually not a serious problem: as the baby grows, the placenta expands and lifts up and away from the cervix on its own. This is known as “placental migration.” However, in the third trimester, placenta previa can lead to life-threatening hemorrhagic bleeding in the mother and injuries such as hypoxic-ischemic encephalopathy in the baby. In many cases, placenta previa necessitates delivery by C-section. Placenta previa is estimated to occur in approximately one in every 200 pregnancies.
Types of Placenta Previa
There are two types of placenta previa:
- Complete or total previa, in which the placenta covers the cervix entirely
- Marginal or partial previa, in which the placenta is on the border of the cervix
Additionally, some women have what is called a low-lying placenta, which is when the placenta is very close to, but not obstructing, the cervical opening. This often moves upward in the uterus during pregnancy without medical interference.
Signs, Symptoms, and Treatments for Placenta Previa
Typically, the first sign of placenta previa is bleeding during the second half of pregnancy. The bleeding can vary from minimal to profuse. Many women with placenta previa will stop bleeding and then begin again. Contractions may or may not be present. An ultrasound is done to confirm the diagnosis of placenta previa.
If the baby is preterm (< 37 weeks gestation) and bleeding is not present/has subsided, then immediate delivery is unnecessary and the mother may be treated on an outpatient basis. Medical professionals should carefully monitor patients with placenta previa, and provide emergency care if their bleeding becomes more persistent.
If the baby is reasonably mature (> 37 weeks gestation) and the mother is in labor, or if hemorrhaging is present, immediate delivery of the fetus via C-section is necessary to prevent hypoxic-ischemic encephalopathy and other injuries.
Complications of Placenta Previa
Placenta previa can lead to several complications that threaten the health of the mother and baby:
- Preterm birth: Severe bleeding may prompt an emergency C-section prior to full-term. This puts the baby at risk for complications related to premature birth, including breathing problems, low birth weight, and birth injuries such as cerebral palsy and hypoxic-ischemic encephalopathy (HIE).
- Abnormal fetal presentation (e.g., breech birth).
- Maternal bleeding/hemorrhage: After a C-section delivery, the obstetrician delivers the placenta and the mother is given Pitocin to promote uterine contractions. With Pitocin, the upper part of the uterus (where the placenta is normally located), is able to contract around open vessels well enough to prevent bleeding. In patients with placenta previa, however, the placenta is implanted in the lower part of the uterus, which doesn’t contract as well as the upper part, and so excessive bleeding can occur.
- Placenta accreta: This is a severe obstetric complication involving an abnormally deep attachment of the placenta into the uterine wall. Removing the placenta can cause massive bleeding. To control this bleeding, the patient may need multiple transfusions and a hysterectomy. Placenta accreta can also lead to fetal hypoxia (birth asphyxia) with resultant hypoxic-ischemic encephalopathy (HIE).
- Placental abruption: This means that the placental lining has separated from the uterus. It can deprive the baby of oxygen and critical nutrients, as well as cause heavy bleeding in the mother. Placental abruption can cause HIE and other injuries.
Risk Factors for Placenta Previa
The exact cause of placenta previa is unknown, although risk factors have been identified. They include:
- Having previously given birth
- Multiple pregnancy (twins, triplets, etc.)
- Previous surgeries involving the uterus, such as a C-section, surgery to remove uterine fibroids, or dilation and curettage (D&C)
- Prior placenta previa
- Age 35 or older
Placenta Previa and Medical Malpractice
The serious nature of placenta previa requires careful evaluation, monitoring, and preparedness by an obstetrician. Failure to properly diagnose or treat placenta previa can be very dangerous for both mother and baby.
Some examples of situations that constitute medical malpractice in cases of placenta previa:
- Failure to perform an ultrasound to diagnose placenta previa.
- Failure to continuously monitor the baby during an emergent placenta previa situation, resulting in fetal hypoxia (birth asphyxia) to the baby.
- Vaginal delivery attempted when complete previa exists.
- Digital pelvic exam performed when complete previa is present, causing hemorrhaging.
- Delayed emergency C-section.
Trusted Legal Help for Placenta Previa, Hypoxic-Ischemic Encephalopathy (HIE), and Birth Injury Cases
The birth injury lawyers at Reiter & Walsh ABC Law Centers have many years of experience in birth injury cases, including placenta previa cases. If you experienced placenta previa during your pregnancy and your child was physically or mentally injured as a result, we can help you. Our skilled attorneys and exceptional medical experts will work tirelessly to get you the compensation you and your family are entitled to for health care, medical expenses, special education, assistive devices, loss of income, and pain and suffering. We’ve helped clients across the United States receive compensation for lifelong care. We are located in Michigan, but many of our clients have come from Ohio, Tennessee, Wisconsin, Arkansas, Mississippi, Washington D.C., Texas, Pennsylvania, and other states. We will travel to your hometown as necessary. Should you pursue a case with our team, you will not be charged anything until we win your case.
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Video: Hypoxic-Ischemic Encephalopathy (HIE) Attorneys Discuss Placenta Previa
In this video, hypoxic-ischemic encephalopathy attorneys Jesse Reiter and Rebecca Walsh discuss the causes of HIE, which include placental problems such as placenta previa.
Related Reading on Placenta Previa and Birth Injury
- Reddy UM, Abuhamad AZ, Levine D, et al. Fetal imaging: executive summary of a joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, American Institute of Ultrasound in Medicine, American College of Obstetricians and Gynecologists, American College of Radiology, Society for Pediatric Radiology, and Society of Radiologists in Ultrasound Fetal Imaging workshop. Obstet Gynecol 2014; 123:1070.
- Lam CM, Wong SF, Chow KM, Ho LC. Women with placenta praevia and antepartum haemorrhage have a worse outcome than those who do not bleed before delivery. J Obstet Gynaecol 2000; 20:27.
- Love CD, Fernando KJ, Sargent L, Hughes RG. Major placenta praevia should not preclude out-patient management. Eur J Obstet Gynecol Reprod Biol 2004; 117:24.
- Rosen DM, Peek MJ. Do women with placenta praevia without antepartum haemorrhage require hospitalization? Aust N Z J Obstet Gynaecol 1994; 34:130.
- Ononeze BO, Ononeze VN, Holohan M. Management of women with major placenta praevia without haemorrhage: a questionnaire-based survey of Irish obstetricians. J Obstet Gynaecol 2006; 26:620.
- Spong CY, Mercer BM, D’alton M, et al. Timing of indicated late-preterm and early-term birth. Obstet Gynecol 2011; 118:323.
American College of Obstetricians and Gynecologists. ACOG committee opinion no. 560: Medically indicated late-preterm and early-term deliveries. Obstet Gynecol 2013; 121:908.
- Yoong W, Karavolos S, Damodaram M, et al. Observer accuracy and reproducibility of visual estimation of blood loss in obstetrics: how accurate and consistent are health-care professionals? Arch Gynecol Obstet 2010; 281:207.