Placenta Previa and Birth Injury
Under normal circumstances, the placenta connects to the uterine wall far from the uterine opening or else migrates out of the way as the pregnancy progresses. In certain cases, the placenta may partially or completely cover the cervix. This is called a placenta previa. Where there is a placenta previa, there is a risk for severe hemorrhagic bleeding (in both the mother and baby) and birth asphyxia (also known as HIE or hypoxic-ischemic encephalopathy) in the child. In cases of placental previa, a C-section is often necessary. This condition is often diagnosed when mothers notice spotty bleeding on-and-off during the second half of their pregnancy. Medical staff can confirm the presence of placenta previa using an ultrasound.
What Is Placenta Previa?
The placenta is an organ that connects the developing baby to the uterine wall during pregnancy. The umbilical cord is attached to the placenta and is how the baby receives oxygen and nutrients. Normally, the placenta will connect to the wall of the uterus far away from the uterine opening, either at the top or side. Sometimes, however, the placenta grows so close to the opening of the uterus that it may partially or completely block the mother’s cervix (or “cervical os”), which is the opening to the birth canal. This is known as placenta previa and it’s estimated to occur in approximately 1 in every 200 pregnancies.
If the placenta is right on the border of the cervix, it’s called a marginal or partial previa. If the placenta covers the cervix completely, it’s called a complete or total previa. A low-lying placenta is near the cervical opening but not covering it and often moves upward in the uterus during pregnancy.
Dangers and Complications of Placenta Previa
When diagnosed early in pregnancy, placenta previa is usually not a problem since as the baby grows, the placenta expands and lifts up and away from the cervix on its own. This is known as “placental migration.” If the placenta remains close to or completely covers the cervix later in pregnancy, however, delivery by C-section is generally required as cervical opening and uterine activity during vaginal delivery can cause hemorrhagic bleeding in the mother and possibly even the baby. It has long been recognized that placenta previa may cause life-threatening hemorrhage in less than fifteen minutes.
In addition to hemorrhage, other complications of placenta previa include:
- Preterm birth. Severe bleeding may prompt an emergency C-section prior to full-term which puts the baby at risk for complications related to premature birth such as breathing problems, low birth weight and birth injuries such as cerebral palsy and hypoxic-ischemic encephalopathy (HIE).
- Abnormal fetal presentation (e.g., breech birth).
- Post-birth bleeding. After a baby is delivered by c-section, the obstetrician delivers the placenta and the mother is given Pitocin to promote uterine contraction. This helps to stop the bleeding from the area where the placenta was implanted. 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 the contractions aren’t as effective at stopping the bleeding.
- Placenta accreta. This is a severe obstetric complication involving an abnormally deep attachment of the placenta into the uterine wall that does not easily separate. This can cause massive bleeding that can require multiple transfusions and a hysterectomy to control the bleeding and may lead to fetal hypoxia (birth asphyxia).
- Placental abruption (the placental lining has separated from the uterus of the mother).
Signs, Symptoms and Treatments for Placenta Previa
The first sign that placenta previa may be present is bleeding during the second half of pregnancy. The amount of blood varies from light to heavy and it usually stops prior to treatment. However, it almost always begins again days or weeks later. 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 patient may be treated on an outpatient basis. However, 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.
Risk Factors for Placenta Previa
The exact cause of placenta previa is unknown although risk factors have been identified. They include:
- Women who have already delivered at least one baby
- Multiple pregnancy
- Previous surgeries involving the uterus, such as C-section, surgery for uterine fibroids, and D&C
- Prior placenta previa
- Age 35 or older
- Recurrent abortion
Placenta Previa and Medical Malpractice
The serious nature of placenta previa requires careful evaluation, monitoring and preparedness by an obstetrician. If a doctor fails to diagnose or treat
placenta previa, the baby may experience severe birth asphyxia and hypoxic-ischemic encephalopathy (HIE), which can cause brain damage and cerebral palsy.
Some examples of situations that constitute medical malpractice:
- 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.
Placenta Previa Lawyers & Hypoxic-Ischemic Encephalopathy (HIE) Attorneys
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. Many of our clients have come from Michigan, Ohio, Tennessee, Wisconsin, Arkansas, Mississippi, Washington D.C., Texas, Pennsylvania, and other states. 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 Precia
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.