Silent danger in late pregnancy: Placenta previa — what every mother must know
I still remember Ms. Sharma, a healthy 30‑year‑old in her second pregnancy, who arrived in my clinic after a sudden episode of painless bleeding at 34 weeks. She was terrified and kept asking, “Is my baby safe? Will I need a C‑section?” Her scan showed a low‑lying placenta that had not moved. That moment — calming her, explaining risks, and planning delivery — is why I want to write clearly about placenta previa and how we plan safe deliveries for it.
Why this matters now (urban India)
Placenta previa is more commonly diagnosed today because of routine mid‑pregnancy ultrasounds in urban centres like Noida. Rising repeat C‑section rates and advanced maternal age in city women have increased risk. Timely planning, good antenatal care and delivering in a prepared hospital radically improve outcomes for you and your baby.
What is placenta previa? (patient‑friendly)
Placenta previa means the placenta implants in the lower uterus, near or covering the cervical opening. We classify it as:
– Complete (covers the cervix),
– Partial,
– Marginal (edge at cervix),
– Low‑lying (within 2 cm of the cervix).
Many low‑lying placentas move upward as the uterus grows. Ultrasound (transvaginal if needed) is the best, safe test to locate the placenta.
Risk factors seen in India
– Previous C‑section(s) — the most important risk in my clinic.
– Prior uterine surgery (myomectomy, dilation & curettage).
– Increasing maternal age and multiparity.
– Smoking or substance use (less common here but relevant).
– Multiple pregnancies and assisted reproduction.
Warning signs you must never ignore
– Any vaginal bleeding in pregnancy, especially after 20 weeks.
– Painless bleeding is typical, but pain may occur with placental abruption.
– Heavy bleeding with clots, dizziness, fainting or rapid pulse.
– Reduced fetal movements, contractions or severe abdominal pain.
When to see your gynecologist immediately
– Any vaginal bleeding, even a small stain.
– Sudden gush of blood, fainting, breathlessness.
– Reduced fetal movements for more than a few hours.
If you are at risk (prior C‑section or ultrasound showing low placenta), keep your phone number with the clinic and head straight to the hospital if bleeding starts.
Doctor‑recommended management — practical and evidence based
My approach balances safety for mother and baby while avoiding unnecessary early delivery.
Initial evaluation and tests
– Detailed history and obstetric ultrasound with placental localisation (repeat scans from 28‑32 weeks).
– Transvaginal scan when needed — safe and precise.
– Complete blood count, blood group and antibody screen, liver and kidney tests.
– Crossmatch and reserve blood if bleeding occurs or if placenta previa persists.
– Non‑stress tests / biophysical profile if bleeding or after 36 weeks.
Hospital care vs home care
– Small, painless light bleeding with stable mother and baby: expectant outpatient care with strict instructions.
– Recurrent or heavy bleeding, contractions, or haemodynamic instability: admission to a well‑equipped hospital.
Medical measures I recommend
– Iron and folic acid, nutrition to build haemoglobin.
– Intravenous fluids and blood transfusion when indicated.
– Corticosteroids for fetal lung maturity if delivery likely before 37 weeks (as per ACOG and WHO guidance in threatened preterm cases).
– Tocolytics are generally avoided when bleeding is due to placenta previa; we treat bleeding and plan delivery.
Delivery planning: nature of delivery and timing
Most women with complete placenta previa require a planned Caesarean delivery because the placenta blocks the birth canal. For marginal or low‑lying placentas that migrate upwards, vaginal delivery can be possible — only if the placenta is well away from the cervix on late ultrasound and there is no bleeding.
Timing
– Planned Caesarean is often scheduled between 36 and 37 weeks if placenta previa persists without active bleeding — this aligns with ACOG recommendations to reduce emergency deliveries.
– If there is significant bleeding, earlier delivery or emergency Caesarean may be necessary.
– WHO and FOGSI emphasise delivering in a facility with blood bank, anesthesia and surgical support.
In the operating theatre
We prepare with crossmatched blood, senior anaesthesia support, and a multidisciplinary team. Techniques to control bleeding include uterotonics, uterine balloon tamponade, uterine artery ligation/embolisation, and as a last resort, hysterectomy. Counselling about these possibilities is part of my pre‑op discussion.
Prevention and long‑term planning
– Avoid unnecessary primary C‑sections when safe; each C‑section raises the risk of placenta previa in future pregnancies.
– Good spacing between pregnancies and informed decisions about uterine surgery reduce risk.
Practical tips from my clinic
– Keep antenatal records and recent ultrasound handy.
– Pack an emergency bag with ID, antenatal card, phone numbers and a small amount of cash.
– Arrange a compatible blood donor if you have risk factors and live far from a tertiary hospital.
– Maintain iron‑rich diet (green leafy vegetables, legumes, pulses, jaggery, citrus for iron absorption).
– Avoid intercourse, heavy lifting or strenuous activity if placenta is low.
– Know your hospital route and have a plan for rapid transport.
Guidelines I follow
In my practice I follow ACOG recommendations on timing of delivery and steroid use for preterm risk, WHO guidance on facility preparedness and maternal safety, and FOGSI India protocols for high‑risk pregnancy and institutional delivery. These guide my decisions but I individualise care to each mother and family.
Conclusion — you are not alone
Placenta previa is a serious condition but with timely diagnosis, calm planning and delivery in the right hospital it has an excellent chance of a safe outcome. I have looked after many mothers like Ms. Sharma who went on to have healthy babies after careful monitoring and planned delivery. Stay vigilant, keep appointments, and seek help immediately for any bleeding. Trust your team — we prepare so you can breathe easier.
Frequently asked questions
1) Can placenta previa resolve on its own?
Yes, many low‑lying placentas migrate upwards as the uterus grows, especially if diagnosed early. Repeat scans after 28–32 weeks clarify this.
2) Will I definitely need a C‑section?
Complete placenta previa almost always needs a C‑section. Marginal/low‑lying placentas may allow vaginal birth if the placenta moves away from the cervix on later scans.
3) Is bleeding always painful?
No. Painless bright red bleeding is typical. Any bleeding should prompt immediate contact with your doctor.
4) Can I prevent placenta previa in future pregnancies?
Avoiding unnecessary primary C‑sections and careful counselling about uterine surgeries reduce risk. Some risk factors aren’t avoidable.
5) What should I carry to the hospital if I have placenta previa?
Antenatal records, recent ultrasound reports, ID, contact numbers, packed bag, and any arranged blood donor details.
Dr Uma Mishra
MD, Obstetrics & Gynecology
High Risk Pregnancy Care Expert | Normal Delivery Specialist
Leading Gynecologist in Noida
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Website: https://www.drumamishra.com
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