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Placenta Previa, Medical Malpractice, and Cerebral Palsy

Placenta previa can result in serious injury to mom and/or baby.  If you are pregnant, or plan to become pregnant, you should know what placenta previa is, how it is detected, and how your pregnancy should be managed if you are diagnosed with placenta previa.  This article will tell you the most important facts you should know about placenta previa.

What is the placenta?

The placenta is a flat, oval-shaped organ that attaches itself to the wall of your uterus.  The umbilical cord arises from the placenta.  The placenta begins to form soon after conception.  The average placenta is 9 inches wide and 1 inch thick.  It weighs approximately 1 pound.

What does the placenta do?

The placenta works as a "trading post" between the mother's and the baby's blood supply. Small blood vessels carrying fetal blood run from the fetus, through the umbilical cord, and into the placenta.  The placenta also contains maternal blood.  It is in the placenta where nutrients and oxygen from the mother's blood are transferred to the fetal blood, while waste products, such as carbon dioxide, are transferred from the fetal blood to the maternal blood, without the two blood supplies mixing ("placental barrier").  The placenta also produces hormones that help your baby grow.  In addition, the placenta protects your unborn baby from most bacterial infections (but not viral infections).

What is placenta previa?

The placenta attaches itself to the wall of your uterus.  Ideally, the placenta attaches itself high in the uterus, either high up on the front or back wall of the uterus.  However, sometimes, the placenta attaches itself near to or on top of the cervix at the bottom of the uterus.  When this happens, it is called placenta previa.  Placenta previa is classified into four different categories of severity:  Type I, in which the placenta encroaches upon the lower segment of the uterus but does not infringe on the cervical opening; Type II or Marginal, in which the placenta touches, but does not cover, the top of the cervix; Type III or Partial, in which the placenta partially covers the top of the cervix; and Type IV or Complete, in which the placenta completely covers the top of the cervix.

For many patients, a Type I-III placenta previa may resolve by the time the pregnancy enters the third trimester.  This resolution of a prior placenta previa is called "placental migration".

What are the risk factors for placenta previa?

If you have had a previous placenta previa, you are at increased risk of having another one.  Women who are younger than 20 or older than 30 are also at increased risk of placenta previa, as are women with large placentas, either from twins (triplets, etc.) or from conditions such as erythroblastosis.  In addition, smoking and cocaine usage appear to increase the risk of placenta previa.  It is also believed that any procedure (prior C-section, D&C, etc.) that has left scarring on your uterus increases your risk of placenta previa.

What are the signs and symptoms of placenta previa?

Some women with placenta previa have no symptoms.  However, warning signs and symptoms may include vaginal bleeding.  Vaginal bleeding associated with placenta previa can be light to heavy in volume.  It is often bright red in color.  Placenta previa may also cause symptoms similar to early labor, such as regular contractions and aches or pains in your lower back or belly.

How is placenta previa diagnosed?

Most cases of placenta previa are found when a woman has an ultrasound, either as a routine procedure, or as a result of vaginal bleeding. 

Why is placenta previa a problem?

When your body begins to prepare for labor and the delivery of your baby, your cervix will begin to open.  With placenta previa, when the cervix begins to open, the part of the placenta that covers the cervix will become detached.  The detachment of the placenta from the uterine wall is called placental abruption.  This detaching of the placenta can trigger vaginal bleeding, the extent of which is often unpredictable, and can place your life and the life of your baby at risk.

How is placenta previa treated?

Treatment for placenta previa depends on how it is affecting your health and your baby's health; how much you are bleeding; and how close you are to reaching full term.  If you have placenta previa and are not actively bleeding, you may not require hospitalization or treatment.  However, it will be important for you to avoid sexual intercourse, vaginal exams, or placing anything into your vagina.

If you are actively bleeding, you may need to be hospitalized until your baby is mature enough to be delivered.  However, if too much bleeding places you or your baby in danger, your baby may need to be delivered even before it is fully mature.  Doctors always do a C-section when there is a placenta previa, due to the risk of hemorrhage associated with vaginal delivery in the setting of placenta previa.

Medical malpractice and placenta previa

A fetus's circulating blood volume is known to be very low.  As a result, fetal hemorrhage associated with placenta previa is highly dangerous for the fetus and can lead to fetal demise or irreversible brain injury such as cerebral palsy very quickly if the fetus is not immediately delivered. 

Because of the high risk of severe maternal and fetal hemorrhage associated with placenta previa, careful obstetricians will closely monitor any woman with any degree of placenta previa that approaches complete previa and will schedule C-section delivery in all such cases well in advance of the time when any of the pre-labor cervical changes typically occur.  The failure to do so may constitute medical malpractice.

If you experienced vaginal bleeding during your pregnancy and your baby died or was seriously injured as a result, you may have had placenta previa.  A law firm experienced in handling birth injury cases, such as Berger & Lagnese, can help you determine whether your baby's injuries or death could have been prevented by proper medical care.

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