Placenta previa - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Placenta previa (PP) is an uncommon complication of pregnancy. Usually diagnosed on routine ultrasound done for other reasons, but may present with painless vaginal bleeding in the second or third trimester.
Classified as PP if the placenta is directly covering the cervical os, or as low-lying placenta if the placental edge is <2 cm from the cervical os.
Bleeding in PP may be (or become) torrential, and appropriate monitoring should be performed. Digital vaginal examination should not be performed on women with active vaginal bleeding until the position of the placenta is known with certainty.
Most seen on early ultrasound will resolve spontaneously.
Cesarean section will generally be necessary in all cases of PP persisting after 36 weeks' gestation. Cesarean sections may be complicated by excessive bleeding and the need for cesarean hysterectomy (or uterine artery embolization, or other interventional radiology procedure), and should only be performed by experienced physicians.

Placenta previa (previously known as complete previa) at 32 weeks

From the teaching collection of Janet R. Albers, MD

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Placenta previa (previously known as complete previa) at 22 weeks
Placenta previa (previously known as complete previa) at 32 weeks

Citations

Key Articles

Jain V, Bos H, Bujold E; Society of Obstetricians and Gynaecologists of Canada. Guideline no. 402: diagnosis and management of placenta previa. J Obstet Gynaecol Can. 2020 Jul;42(7):906-17.e1.[Abstract]
Royal College of Obstetricians and Gynaecologists. Placenta praevia and placenta accreta: diagnosis and management. Green-top guideline no. 27a. Sep 2018 [internet publication].[Full Text]
American College of Obstetricians and Gynecologists / Society for Maternal-Fetal Medicine. ACOG SMFM obstetric care consensus #7: placenta accreta spectrum. Dec 2018 [internet publication].[Full Text]
Shipp TD, Poder L, Feldstein VA, et al; Expert Panel on GYN and OB Imaging, American College of Radiology. ACR appropriateness criteria: second and third trimester vaginal bleeding. J Am Coll Radiol. 2020 Nov;17(11s):S497-504.[Abstract][Full Text]

Referenced Articles

1. Jain V, Bos H, Bujold E; Society of Obstetricians and Gynaecologists of Canada. Guideline no. 402: diagnosis and management of placenta previa. J Obstet Gynaecol Can. 2020 Jul;42(7):906-17.e1.[Abstract]
2. Royal College of Obstetricians and Gynaecologists. Placenta praevia and placenta accreta: diagnosis and management. Green-top guideline no. 27a. Sep 2018 [internet publication].[Full Text]
3. Reddy UM, Abuhamad AZ, Levine D, et al. Fetal imaging: executive summary of a joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, American Institute of Ultrasound in Medicine, American College of Obstetricians and Gynecologists, American College of Radiology, Society for Pediatric Radiology, and Society of Radiologists in Ultrasound Fetal Imaging Workshop. J Ultrasound Med. 2014 May;33(5):745-57.[Abstract]
4. American College of Obstetricians and Gynecologists / Society for Maternal-Fetal Medicine. ACOG SMFM obstetric care consensus #7: placenta accreta spectrum. Dec 2018 [internet publication].[Full Text]
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36. Dashe JS, McIntire DD, Ramus RM, et al. Persistence of placenta previa according to gestational age at ultrasound detection. Obstet Gynecol. 2002 May;99(5 Pt 1):692-7.[Abstract]
37. Shipp TD, Poder L, Feldstein VA, et al; Expert Panel on GYN and OB Imaging, American College of Radiology. ACR appropriateness criteria: second and third trimester vaginal bleeding. J Am Coll Radiol. 2020 Nov;17(11s):S497-504.[Abstract][Full Text]
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46. American College of Obstetricians and Gynecologists. ACOG practice bulletin no. 181: prevention of Rh D alloimmunization. Obstet Gynecol. 2017 Aug;130(2):e57-70.[Abstract][Full Text]
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48. Bhide A, Prefumo F, Moore J, et al. Placental edge to internal os distance in the late third trimester and mode of delivery in placenta praevia. BJOG. 2003 Sep;110(9):860-4.[Abstract]
49. Oppenheimer L, Holmes P, Simpson N, et al. Diagnosis of low-lying placenta: can migration in the third trimester predict outcome? Ultrasound Obstet Gynecol. 2001 Aug;18(2):100-2.[Abstract]
50. Predanic M, Perni SC, Baergen RN, et al. A sonographic assessment of different patterns of placenta previa "migration" in the third trimester of pregnancy. J Ultrasound Med. 2005 Jun;24(6):773-80.[Abstract]
51. Olive EC, Roberts CL, Nassar N, et al. Test characteristics of placental location screening by transabdominal ultrasound at 18-20 weeks. Ultrasound Obstet Gynecol. 2006 Dec;28(7):944-9.[Abstract]
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58. Gayet-Ageron A, Prieto-Merino D, Ker K, et al. Effect of treatment delay on the effectiveness and safety of antifibrinolytics in acute severe haemorrhage: a meta-analysis of individual patient-level data from 40 138 bleeding patients. Lancet. 2018 Jan 13;391(10116):125-32.[Abstract][Full Text]
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80. Yang Q, Wen SW, Oppenheimer L, et al. Association of caesarean delivery for first birth with placenta praevia and placental abruption in second pregnancy. BJOG. 2007 May;114(5):609-13.[Abstract]
81. Kennare, R, Tucker G, Heard A, et al. Risks of adverse outcomes in the next birth after a first cesarean delivery. Obstet Gynecol. 2007 Feb;109(2 Pt 1):270-6.[Abstract]
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83. Ananth CV, Demissie K, Smulian JC, et al. Relationship among placenta previa, fetal growth restriction, and preterm delivery: a population-based study. Obstet Gynecol. 2001 Aug;98(2):299-306.[Abstract]
84. Ananth CV, Smulian JC, Vintzileos AM. The effect of placenta previa on neonatal mortality: a population-based study in the United States, 1989 through 1997. Am J Obstet Gynecol. 2003 May;188(5):1299-304.[Abstract]
85. Salihu HM, Li QL, Rouse DJ, et al. Placenta previa: neonatal death after live births in the United States. Am J Obstet Gynecol. 2003 May;188(5):1305-9.[Abstract]
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90. Silver RM, Landon MB, Rouse DJ, et al. Maternal morbidity associated with multiple repeat cesarean deliveries. Obstet Gynecol. 2006 Jun;107(6):1226-32.[Abstract]
91. Tanimura K, Yamasaki Y, Ebina Y, et al. Prediction of adherent placenta in pregnancy with placenta previa using ultrasonography and magnetic resonance imaging. Eur J Obstet Gynecol Reprod Biol. 2015 Apr;187:41-4.[Abstract]
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