Placenta Previa

I am generally healthy, but I am now 40 years old, have had three failed pregnancies, and have now conceived via in vitro fertilization (IVF). All of these factors qualify my pregnancy as high risk, so when I graduated from the fertility clinic, my reproductive endocrinologist urged me to find an OB-GYN who specialized in high-risk pregnancies. I had no idea how difficult my quest would be.

It turned out that most OB-GYNs do not want to deal with complicated cases (who wants to be responsible for a delivery gone wrong?), so some might tell you straight away that they do not believe they would be the best match for you and that you should look elsewhere. The doctor who did decide to keep me as a patient also did not specialize in high-risk pregnancies but said he would be willing to work in tandem with a perinatologist.

Perinatologists do not deliver babies but team up with OB-GYN doctors to ensure safe pregnancy and delivery for those with preexisting medical conditions (such as diabetes, heart disease, etc.) or in the case of suspected fetal complications. I had, in fact, visited one during week 17 of my first pregnancy, and she had been able to identify a host of abnormalities via a fetal ultrasound. She couldn’t do anything about the findings, but at least we knew what to expect.

So two years later, once again pregnant at 17 weeks, I found myself at the same perinatologist’s office for another fetal ultrasound. I was nervous, of course. The woman had given me nothing but bad news the first time, so I didn’t quite believe my ears when, after having identified all key organs and body parts, she concluded with “the baby seems normal.” And then, just as I was about to exhale in relief, she added that tiny, treacherous word—“but.”

“The baby seems normal at this point,” she said, “but it’s in breech position, and the placenta is covering the cervix.” I had no idea what that meant. She told me not to worry too much (yet) and to return for a follow-up ultrasound in five weeks. The nurse walked me out, handing me a leaflet on placenta previa.

I may have randomly encountered the term “placenta previa” in some of my readings, but I had not paid attention because I had no idea I was at risk of having that. It turned out that placenta previa is not uncommon in women who are 35 or older, especially those who have conceived via IVF, though it primarily affects women who had already delivered at least once, have had a C-section, or are carrying multiple fetuses.

The good news is that in about 90% of the cases the placenta eventually moves to the proper location as the uterus grows, and only about 1 out of 200 women have to deal with placenta previa at term. I do not think I will be one of those unlucky women, as my placenta does not cover my cervical os completely. So, chances are, my next ultrasound would not show any signs of concern.

If my placenta refuses to budge, I will most likely experience vaginal bleeding as early as in the late second trimester and will have to be on bed rest for the duration of the pregnancy. The baby will almost certainly be born prematurely and via a C-section. If it is mature enough, it will survive. If I do not lose too much blood in the process, I too will survive. The risk for demise due to placenta previa, however, is less than 1% (in the developed countries at least).

As to treatment or prevention, nothing can be done in terms of doing (or not doing) physical exercises or taking medication. If you are a smoker, though, you might want to discontinue smoking at least for the duration of the pregnancy, as smoking is one of the predisposing conditions for placenta previa. So is cocaine use. Oh, and if you are on blood thinners, like I was until my visit at the perinatologist, you probably should discontinue those as well.