Placental complications can be some of the most serious and fearful complications in pregnancy. The placenta is a spongy structure, full of blood, that provides nutrients to and removes waste from a growing foetus. Several complications can affect it, some based on where the placenta is (like placenta previa), based on if the placenta is attached properly (like in placental abruption and placenta accreta), and others based on if the placenta is completely expelled during labour (like in retained placenta). Regardless of the exact cause, you’ll need to carefully follow the instructions of your OB-GYN regarding what to do about your placental complications.
Placenta previa is a placental complication where the placenta lies too close to the opening of the uterus. This can lead to bleeding and might cause a baby to be born prematurely.
Placenta accreta is a complication in which the placenta grows too deeply into the uterine wall, becoming embedded and not falling off after birth. This often leads to severe bleeding.
Placental insufficiency is a complication in which the placenta can’t transfer enough blood, oxygen, and nutrients to a growing foetus, and as a result the baby is usually born smaller or less healthy than normal.
Placental abruption is a very dangerous condition where the placenta detaches from the uterine wall before the baby is born. It is a medical emergency for both the mother and the baby.
Normally, the placenta is expelled 30 minutes after a baby is born, but in retained placenta this doesn’t happen. Some parts (or all) of the placenta are left inside the womb, which can lead to severe bleeding or infections.
Symptoms of placental complications can range widely, but can include:
Sometimes, like in placental insufficiency, complications have no apparent symptoms.
Placental complications have a variety of causes. Placenta previa occurs when a fertilized egg gets implanted at lower position in the womb than normal. Placenta accreta occurs due to abnormal growth of the placenta into the muscular layer of the uterus. Placental insufficiency happens when there’s not enough blood supply to the placenta and the foetus doesn’t get access to nutrients it needs to grow. Placental abruption occurs when changes in the blood vessels (usually caused by high blood pressure) allow the placenta to detach from the uterus before labour, leading to tremendous loss of blood. Retained placenta can happen when the uterus doesn’t contract enough to push it the placenta out, when the cervix (the opening of the uterus) closes before the placenta can come out, or due to placenta accreta.
Risk factors for placental complications include:
Placental complications are often diagnosed by a doctor using an ultrasound and physical exam. The ultrasound can help to visualize the placenta, as well as the baby. The doctor may do a vaginal exam, including reaching in to feel for the location and consistency of the placenta. A foetal heart rate assessment might also be done, to check the status of the baby.
For severe types of placental complications, like placental abruption, the treatment is usually immediate delivery of the baby. This delivery might be vaginal or C-section, depending on your preferences and the advice of your doctor. For many other less severe placental complications, the treatment might just be watchful waiting. For placenta accreta or placental insufficiency, your doctor might ask you to make some lifestyle adjustments. Your doctor will probably also request additional prenatal visits. Lastly, for retained placenta and placental complications that happen after birth, your doctor might either remove the placenta manually or do a surgery to get it out.