Your placenta is your baby’s powerhouse - it nourishes the baby all through the pregnancy. An unexpected issue some women can face can be the position of your placenta. It can place itself anywhere in your uterus, sometimes, it goes downwards (low-lying placenta). If the placenta stays low in your womb, near to or covering your cervix, it may block the baby's way out. This is called low-lying placenta if the placenta is less than 2 cm from the cervix, or placenta praevia if the placenta is completely covering the cervix. Don’t worry - this blog will give you all the reassurance and details you need.

How is low-lying placenta diagnosed?

At the 18 week mark, an ultrasound scan will specifically look for the placenta placement and will reveal any issues. The position of your placenta will be rechecked at your 18- to 21-week ultrasound scan. If your placenta is significantly low, you'll be offered an extra ultrasound scan later in your pregnancy (usually at about 32 weeks) to check its position again. For 9 in every 10 women, the placenta will have moved into the upper part of the womb by this point. Placenta praevia, where the cervix is completely covered at the end of pregnancy, affects about 1 in every 200 births.

Am I likely to have placenta praevia?

Some pregnant women may have higher chances of placenta praevia. This is based on research of pregnancy medical experts. Here are the factors:

• Habit of smoking
• Have had fertility treatment to get pregnant, such as in vitro fertilisation (IVF)
• Have had 1 or more caesarean sections 
• Are 40 or older
• Are having more than 1 baby (twins or triplets)
• Have had surgery on the womb
• Have endometriosis. 

Soon after this week, you will be entering the second trimester of your pregnancy. Perhaps it has been a breeze so far, or maybe pregnancy symptoms have taken a toll on you. Next trimester will surely be calmer, as it is often called the ‘honeymoon period’ of pregnancy. At 11 weeks, your baby is the size of a fig! From here on, the baby’s growth is exponential as it increases in size drastically. Its growth is aided by the placenta; the connecting link between you and your baby. The placenta facilitates the flow of oxygen, nutrients and antibodies from the mum’s blood to the baby, and subsequently helps in draining out waste from the baby’s blood to the mum’s. When the egg implants itself in the uterus’ lining, it does so at the top or side. But for some women, the egg ends up towards the lower part, near the cervix. Following this, the placenta begins to form alongside the location of the egg. Oftentimes, the lower placed placenta will naturally migrate upwards, but in some cases, it remains in the lower portion. This is known as a low-lying placenta. If it continues to remain near the cervix and covers it entirely, it is known as Placenta praevia.

What are the types of placenta praevia?

There are several types of placenta praevia:

Marginal placenta previa: In this condition, the placenta is positioned at the edge of your cervix. It’s touching your cervix, but not covering it. This type of placenta praevia is more likely to resolve on its own before your baby’s due date.

Partial placenta praevia: The placenta partially covers your cervix. In many women, this condition resolves on its own. As the uterus grows, the distance between the cervix and the placenta may increas.

Complete or total placenta praevia: The placenta is completely covering your cervix, blocking your vagina. This type of placenta praevia is less likely to correct itself.

Each type of placenta previa can cause vaginal bleeding during pregnancy and labour. Due to the high risk of bleeding, most people will require a Caesarean (C-section) delivery.

Is placenta praevia the same as anterior placenta?

Placenta praevia is NOT the same as anterior placenta. Your placenta can grow anywhere in your uterus. An anterior placement of the placenta means the placenta has implanted in the front of your body. Think of anterior placenta as a pillow between your baby and your stomach.It's a common condition in pregnancy that may make it harder for you to feel your baby's kicks or for your doctor to find your baby's heartbeat. It does not usually cause any complications.

Can the position of the placenta point to the gender of the baby?

A study carried out in 2014 evaluated 200 placentas and found that 72.8 percent of pregnancies with girls had an anterior placenta, compared to only 27.2 percent of pregnancies with boys. 

However, there isn’t enough evidence to put any conclusive proof forward.

Can I have a normal delivery if I have a low-lying placenta?

Placenta praevia towards the end of the pregnancy could cause vaginal bleeding which could put the mum and baby at risk. A case of severe bleeding could lead to haemorrhage and prompt an emergency C-section before the full gestation period is completed. If the placenta praevia resolves on its own by the time you reach term, then a natural birth may be possible.

Is there anything I can do to prevent it?

Unfortunately, if your medical history or lifestyle choices include the points mentioned above, then there is nothing much you can do to prevent or help move the placenta upwards. It is advised that you continue a healthy diet and attend all doctors appointments and scans. One thing that you can minimise is the amount of bleeding that occurs as a result of placenta praevia. Light bleeding can be managed by avoiding exercise, sex, use of vaginal douche and tampons. Depending on the severity of the bleeding, the doctor might prescribe strict bed rest and restrict basic physical activity like walking or standing for extended periods of time. This may seem overwhelming at such an early stage in your pregnancy, but being familiar with the symptoms may help in preparing you mentally and physically for any future complications. Remember that most cases of a low-lying placenta resolve themselves, and safe delivery is possible.

Coping with Placenta Praevia

Mums and dads, it can truly be stressful whenever any complication is detected. But, as you perhaps already know, you need to stay calm. Here are some calming strategies for you:

Firstly, get a specific diagnosis. If your doctor diagnoses you with placenta praevia, ask for the specifics. Is it a low-lying placenta, a partial placenta praevia, or a total placenta praevia? 

Secondly, slow down. Don’t do brisk walks. And, definitely, no travel.   

Thirdly, understand that your future doctor's visits will change her methods. She will not do vaginal exams.  Instead, she will use ultrasounds to determine where the baby is over time, and your baby's heartbeat may need to be looked at more closely.derstand how 

Fourthly, you must invest in staying calm. Try these:

Relaxation & Yoga Nidra for Pregnancy

• Try side shavasan and get support from bolsters.
• While in Shavasan, do a 10-15 minute body scan with breath awareness.
• Listen to a short yoga nidra of ten minutes or a full length yoga nidra of 30 minutes. 

Mantra Chanting during pregnancy

• Try any holy chant/verse or hymn. 
• It creates positive, calming vibrations, improves focus and concentration, removes stress and tension and creates a positive environment.
• Chanting will help to withdraw all your distracted senses, internalising the mind very quickly.

Breath awareness during pregnancy

This simple form of meditation is a good preparatory technique and can be used before other forms of meditation. It can also be practised alone as a meditation for as long as is comfortable. 

• Sit in a comfortable position. Keep your body stable, shoulders relaxed, chest  open and eyes gently closed. 
• Play some calming music.
• Become aware of the breath. Notice if it is shallow or deep. Notice what part of the body is moving, the abdomen or the chest. 
• Notice if there is any sound with the breath. 
• Try to focus only on the breath. Try to become aware of the temperature of the breath.
• When the air is inhaled, it is a little cool, when it is exhaled it is a little warmer. Notice the difference.
• Notice if the breath is becoming smoother and deeper. Notice if there is any strain. Be aware only of the breath.
• Follow the breath with the inhalation and exhalation. Try to focus only on the breath. Continue with this practice for as long as is comfortable. 

Nature awareness & nature walking

• Nature walking is a meditative technique that has powerful properties to calm.
• Even just looking at a tree, a leaf, a flower, a bird, noticing how perfect nature makes each and everything in this world. It can bring great peace and happiness. Instead of nature walking you might prefer to sit for meditation on a rock or under a tree, sing songs or just observe life.

You can also:

• Make sure you live close to your chosen hospital/make a decision to change to a hospital close by (within 20 mins ride time)
• Have your hospital bag ready even if you are not full term.
• Call your doctor if you notice any vaginal bleeding or contractions.
• Prepare (mentally and practically) for having a c-section.

Medication for Placenta Praevia

Since with placenta praevia, there is a risk you may give birth prematurely, you may be offered a course of steroid injections between 34 and 36 weeks of pregnancy to help your baby’s lungs to become more mature. 

If you do go into labour early, you may be offered medication to try to stop your contractions. This will give you time to have a course of steroid injections. If you have severe bleeding or progressing labour your baby may need to be delivered.

If you have vaginal bleeding, you may need to be admitted to hospital. This is because there is a small risk that you could bleed suddenly and heavily. If this happens, you may need an emergency caesarean section.

Battledore Placenta

Battledore placenta is a condition in which the umbilical cord is inserted at or near the placental margin rather than in the center. The cord can be inserted as close to 2 cm from the edge of the placenta (velamentous cord insertion). The incidence is 7% to 9% of singleton pregnancies and 24% to 33% in twin pregnancies. Complications associated with battledore placenta are preterm labour, foetal distress, and intrauterine growth restriction.

Factors that can increase the risk of a placental disorder include: High blood pressure. Smoking or using drugs during pregnancy and maternal age over the age of 40. In a normal pregnancy, the umbilical cord is attached to the center of the placenta, which allows for an equal distribution of nutrients and oxygen to the developing fetus. However, in cases of battledore (also called marginal cord insertion), the cord is attached to the edge of the placenta, which can cause complications in some pregnancies.

This condition means that the pregnancy will be monitored more closely to see if the foetus is getting a good blood supply.

There is no effective treatment to correct marginal umbilical cord insertion. Once the umbilical cord attaches abnormally there is nothing doctors can do to correct the attachment. Marginal cord insertion can be very effectively managed to a good outcome, however, as long as the condition is diagnosed well in time and carefully monitored. A C-section delivery may be advised for women with MCI.

What do I need to do if I have a low-lying placenta?

If you know you have a low-lying placenta, you should contact the hospital immediately if you have:

• Vaginal bleeding, including spotting 
• Contractions
• Pain, including any vague, period-like aches.  

If you have any bleeding, your doctor may need to do an internal examination to check where it’s coming from. Don’t get alarmed. Leave it to your doctor to handle it.

iMumz is here to comfort you at every stage. Remember, the calmer you are, the healthier your baby will be.

The iMumz Womb Care Program offers coaching and help all through pregnancy. Think you could do with that support?