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Placenta praevia or vasa praevia refers to the placenta or fetal blood vessels, respectively, covering or being located close to the opening of the uterus. More than half of women affected by placenta praevia (51.6)% have bleeding before delivery. [12] Vasa praevia occurs in about 0.6 per 1000 pregnancies. [13]
The following have been identified as risk factors for placenta previa: Previous placenta previa (recurrence rate 4–8%), [13] caesarean delivery, [14] myomectomy [10] or endometrium damage caused by D&C. [13] Women who are younger than 20 are at higher risk and women older than 35 are at increasing risk as they get older.
The sex of the fetus may be discerned by ultrasound as early as 11 weeks' gestation. The accuracy is relatively imprecise when attempted early. [15] [16] [17] After 13 weeks' gestation, a high accuracy of between 99% and 100% is possible if the fetus does not display intersex external characteristics. [18]
Velamentous cord insertion is often diagnosed using an abdominal ultrasound. [3] [4] This is most successful in the second trimester, [13] however Color Doppler ultrasound [14] or transvaginal ultrasound [15] can be used in difficult cases, such as when the placenta is located
The anomaly scan, also sometimes called the anatomy scan, 20-week ultrasound, or level 2 ultrasound, evaluates anatomic structures of the fetus, placenta, and maternal pelvic organs. This scan is an important and common component of routine prenatal care . [ 1 ]
Histopathology of placenta with increased syncytial knotting of chorionic villi, with two knots pointed out. The following characteristics of placentas have been said to be associated with placental insufficiency, however all of them occur in normal healthy placentas and full term healthy births, so none of them can be used to accurately diagnose placental insufficiency: [citation needed]
Women who have high blood pressure or who have had a previous placental abruption and want to conceive must be closely supervised by a doctor. [ 17 ] The risk of placental abruption can be reduced by maintaining a good diet including taking folate , regular sleep patterns and correction of pregnancy-induced hypertension .
The bleeding may be due to placental abruption, uterine rupture, placenta accrete, undiagnosed placenta previa, or vasa previa. [3] Cesarean section is indicated. Post-partum hemorrhage is defined by the loss of at least 1,000 mL of blood accompanied with symptoms of hypovolemia within 24 hours after delivery.