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Complications - high risk

Vaginal Bleeding Later in Pregnancy

The placenta is the link to the mother’s blood supply and it is important in providing nourishment to the fetus. Problems with the placenta – as described below – occur in less than 1% of all pregnancies. Later in pregnancy, vaginal bleeding may be a sign that there is something wrong with the way the placenta is attached to the lining of the uterus.

Placental abruption

This means the placenta has torn away or separated from the lining of the uterus. There is risk of placental separation with high blood pressure, trauma (as from a motor vehicle accident or a blow to the abdomen), smoking, premature rupture of membranes (bag of water breaking before its time), and cocaine use.

Symptoms of abruption

This may include dark red vaginal bleeding, cramping, and a tender belly (uterine tenderness). In small tears, the mother is at risk for anemia and infection. In larger tears, the risks include severe bleeding and related problems of loss of oxygen to the brain and heart. The baby will similarly be affected by loss of oxygen that may lead to slow growth (intrauterine growth retardation), premature birth, and cerebral palsy.

Placenta Previa

placental variations This means the placenta has attached to the uterine lining in a lower portion of the uterus, sometimes right over the cervix. Normally, the placenta attaches at the top of the uterus (uterine fundus). Often by mid-pregnancy, a lower attached placenta moves up the uterine wall, away from the cervix. When the placenta remains very low in the uterus - this is called placenta previa. There are risks of excessive bleeding associated with this condition, and a cesarean delivery is usually necessary.

Types of placenta previa

Marginal previa
This is when the placenta is attached very near the cervix. During labor, it may move upward or block the cervix.
Partial previa
The placenta partially covers the internal opening of the cervix
Total previa
The placenta fully covers the cervix.

Risk factors for placenta previa

Previous pelvic surgery such as cesarean section
History of miscarriage, abortion or ectopic pregnancy
Multiple births
pregnancy with multiples
closely spaced pregnancies
conditions such as high blood pressure, diabetes, uterine tumors (e.g. fibroids) drug addiction, smoking and advanced maternal age.

For the mother, the problems with placenta previa are bleeding, anemia and infection. For the baby, premature birth, slowed growth, and anemia are potential complications.