Placenta praevia

Placenta praevia is when the placenta attaches very close to your cervix, or covers it entirely.

Placenta praevia can make a vaginal birth impossible, as the placenta will block your baby's exit from your uterus.

Terms used by medical professionals are:

• placenta previa — when the placenta covers the cervix
• low-lying placenta — when the placenta is close to the cervix (within 2cm) without covering it
• normal placental location — the placenta is more than 2cm from the cervix

The most common symptom of placenta previa is painless vaginal bleeding that occurs after 28 weeks of pregnancy.

Bleeding may be light in the beginning and may get heavier throughout your pregnancy. Some people with placenta praevia do not experience any symptoms.

You may experience some pain with placenta praevia, especially if labour has begun or the placenta is beginning to separate from the uterus.

There is no obvious cause for placenta praevia, but it's more common if you:

• have had placenta previa before
• have had a caesarean before
• smoke
• are older than 35 years
• are having twins or triplets
• have scar tissue on your uterus from past surgery
• have diabetes or high blood pressure

If you experience any vaginal bleeding, you should contact your doctor or midwife straight away. Tell them you have a low-lying placenta. Some medical centres are open outside or normal business hours for urgent appointments. Some medical centres are open outside or normal business hours for urgent appointments.

Vaginal bleeding during the last trimester of pregnancy is often due to a problem with your placenta. If you experience any bleeding during your pregnancy, especially during the last trimester, contact your doctor or midwife for advice.

If the bleeding is heavy and if you have pain or contractions with the bleeding call triple zero (000) and ask for an ambulance or go to your nearest hospital emergency department.

Placenta praevia can be diagnosed with an ultrasound.

Your doctor may identify a low-lying placenta in an early scan that 'moves up' as your pregnancy progresses, and your baby and placenta increase in size. As your uterus expands, the placenta's position can change. This often moves the placenta up and away from your cervix.

If your placenta is low or covering your cervix, you will be offered extra ultrasounds later in your pregnancy (around 32 to 34 weeks of pregnancy) to check on the final position of your placenta.

If your placenta is in a normal position earlier in your pregnancy, it's likely that it will remain in a normal position until the end of your pregnancy.

There is nothing you can do to prevent placenta praevia. It's important to keep your routine antenatal appointments throughout your pregnancy. This helps your health team find and address any problems early, so you and your baby have the best chance of a safe, uncomplicated birth.

To find a maternal, child and family health service near you, use the Pregnancy Birth and Baby Service Finder tool.

Placenta praevia can't be treated, but regular monitoring can help reduce your chance of complications. Your doctor can advise you on the safest method and time to birth your baby.

If you bleed during pregnancy, you may need to stay in hospital for monitoring until the bleeding settles down. This may happen more than once during your pregnancy.

Your doctor may recommend monitoring and may advise you to plan to birth your baby in a major hospital with the appropriate medical support. This is so that you will have access to the right care in case you start bleeding.

Your health team will offer you additional ultrasound scans to check on the location of your placenta. Knowing the exact location of your placenta can help you, your obstetrician and midwives plan for a safe birth.

If you have placenta praevia and experience bleeding, your doctor may monitor you for anaemia throughout your pregnancy.

You may need:

• regular blood tests
• to take iron tablets
• a blood transfusion before, during or after the birth if your bleeding is heavy

If you have continuous bleeding during your pregnancy, your doctor will recommend fetal monitoring with a cardiotocograph (CTG). The CTG records your baby's heart rate and response to movements and contractions. Your midwife and doctor will watch for any changes in heart rate to check your baby's wellbeing.

If you have heavy vaginal bleeding during your pregnancy, your doctor may recommend birthing your baby early ('pre-term' or 'premature'). If you are less than 34 weeks pregnant, your doctor may offer you steroid injections to help prepare your baby's lungs for birth.

Your doctor may recommend birthing your baby via caesarean, as the placenta may block your baby's safe exit through your cervix. A caesarean can also reduce the risk of heavy bleeding during and after labour.

If placenta praevia is not medically managed, it can be serious. Complications may include:

• heavy bleeding
• emergency caesarean
• blood transfusion
• premature birth
• hysterectomy (rarely)

Your doctor or midwife can advise you on the safest pregnancy and birth options for your situation.

If you needed to give birth urgently or if there are complications, you or your baby may need to recover for longer than expected in hospital.

Whether you had a vaginal or caesarean birth, recovery can be more difficult if your birth didn't go as planned.

If you experience unexpected problems during pregnancy and birth, you may feel disappointed, sad or distressed. It's important to speak with your medical team about how you are feeling so they can help you and your family through your recovery.

Learn more about the emotional impact of birth trauma.

PANDA (Perinatal Anxiety & Depression Australia) supports families across Australia affected by anxiety and depression during pregnancy and in the first year of parenthood. Call 1300 726 306.

For more information and support:

• The NSW Government has a fact sheet for Placenta Previa.
• The Birth Trauma Australia offers advice, resources, and a peer support service.
• The Centre of Perinatal Excellence (COPE) provides information and a list of support services.

You can also call:

• Perinatal Anxiety & Depression Australia (PANDA) on 1300 726 306 to speak with a counsellor. They are available Monday to Friday, from 9am to 7.30pm Australian Eastern Time.

Do you prefer to read in languages other than English?

• The NSW Government offer a Having a baby book in English and other languages.