Placenta praevia

Placenta praevia is when the placenta attaches very close to your cervix, or covers it entirely.

Placenta praevia can mean it is not possible to have a vaginal birth, as the low-lying placenta blocks your baby's exit from your uterus.

Terms your midwife or doctor may use are:

• placenta previa — when the placenta covers the cervix
• low-lying placenta — when the placenta is close to the cervix (within 2cm) without covering it
• normal placental location — the placenta is more than 2cm from the cervix

The most common symptom of placenta praevia is painless vaginal bleeding that occurs after 28 weeks of pregnancy.

Bleeding may be light in the beginning and may get heavier later in your pregnancy. Some people with placenta praevia do not notice any symptoms.

You may experience some pain with placenta praevia, especially if labour has begun or your placenta is beginning to separate from your uterus.

Placenta praevia often happens without a clear or obvious reason. It can be more common if you:

• have had placenta previa before
• have had a caesarean before or have scar tissue on your uterus from past surgery
• smoke or use drugs
• are older than 35 years
• are having twins or triplets
• have had a short time between pregnancies
• have diabetes (Opens in new tab) or high blood pressure

It is unusual to have placenta praevia during your first pregnancy. There is nothing specific you can do to prevent it.

If you experience any vaginal bleeding, you should contact your doctor or midwife straight away. Painless vaginal bleeding may be a symptom of placenta praevia. 
Tell them you have a low-lying placenta. Some medical centres are open outside of normal business hours for urgent appointments.

Vaginal bleeding during the last trimester of pregnancy is often due to a problem with your placenta. If you experience any bleeding during your pregnancy, especially during the last trimester, contact your doctor or midwife for advice.

Placenta praevia is usually diagnosed with an ultrasound.

Your doctor may identify a low-lying placenta in an early scan. However, the placenta can ‘move up’ away from your cervix as your pregnancy progresses. As your uterus expands, and your baby grows, the placenta's position can change. This means, if an ultrasound early in your pregnancy shows a low-lying placenta, it may resolve (get better) later on.

If your placenta is low or covering your cervix, you will be offered extra ultrasounds later in your pregnancy (around 32 to 34 weeks of pregnancy) to check on the final position of your placenta.

If your placenta is in a normal position early in your pregnancy, it's likely that it will remain in a normal position until the end of your pregnancy.

Some people do not find out about placenta praevia until labour starts.

Understanding the diagnosis of placenta praevia

You may find the diagnosis of placenta praevia upsetting. Perhaps the type of birth you hoped for is no longer possible. You may now need to have your baby in the hospital to stay safe.

Ask your midwife if you can talk through the diagnosis with someone.

If you are feeling anxious about your pregnancy there are support services available, such as PANDA (Opens in new tab) (Perinatal Anxiety & Depression Australia) or COPE (Opens in new tab) (Centre of Perinatal Excellence).

Often, there is no clear cause. There is nothing you can do to prevent placenta praevia.

It's important to keep your routine antenatal appointments throughout your pregnancy. This helps your health team find and address any problems early. In this way, you and your baby have the best chance of a safe, uncomplicated birth.

To find a maternal, child and family health service near you, use the Pregnancy Birth and Baby Service Finder tool.

Placenta praevia can't be treated directly, but regular monitoring can help reduce your chance of complications. Your doctor or midwife can advise you on the safest method and time to birth your baby.

Your care depends on:

• if you have vaginal bleeding, and how much
• if labour has started
• how far along your pregnancy is

Your healthcare team will explain the treatment options so that you can provide informed consent. 

Monitoring  

If you bleed during pregnancy, you may need to stay in hospital for monitoring until the bleeding settles down. This may happen more than once during your pregnancy if you have placenta praevia.

Your midwife or doctor may recommend monitoring and may advise you to plan to birth your baby in a major hospital with the appropriate medical support. This is so that you will have access to the right care in case you start bleeding.

Your health team will offer you additional ultrasound scans to check on the location of your placenta. Knowing the exact location of your placenta can help you, your obstetrician and midwife plan for a safe birth.

If you have continuous bleeding during your pregnancy, your midwife or doctor will recommend fetal monitoring with a cardiotocograph (CTG). The CTG records your baby's heart rate and response to movements and contractions. Your midwife and doctor will watch for any changes in heart rate to check your baby's wellbeing.

Anaemia

If you have placenta praevia and experience bleeding, your doctor may monitor you for anaemia throughout your pregnancy.

You may need:

• regular blood tests
• to take iron tablets
• a blood transfusion before, during or after the birth if your bleeding is heavy

Early birthing

If you have heavy vaginal bleeding during your pregnancy, your doctor may recommend birthing your baby early ('pre-term' or 'premature'). If you are less than 34 weeks pregnant, your doctor may offer you steroid injections to help prepare your baby's lungs for birth.

Caesarean birth

Your doctor may recommend birthing your baby via caesarean, as the placenta may block your baby's safe exit through your cervix. A caesarean can also reduce the risk of heavy bleeding during and after labour.

Rest

Your midwife may suggest you need extra rest. You should also avoid using tampons or having penetrative sex. 

If you don’t get medical care for placenta praevia, it can be very serious. Complications may include:

• heavy bleeding
• emergency caesarean
• blood transfusion
• premature birth
• hysterectomy (Opens in new tab) (rarely)

Your doctor or midwife can advise you on the safest pregnancy and birth options for your situation.

You may be at increased risk of placenta praevia in future pregnancies. 

If you needed to give birth urgently or if there are complications, you or your baby may need to recover for longer than expected in hospital.

Whether you had a vaginal or caesarean birth, recovery can be more difficult if your birth didn't go as planned.

If you experience unexpected problems during pregnancy and birth, you may feel disappointed, sad or distressed. It's important to speak with your medical team about how you are feeling so they can help you and your family through your recovery.

If your birth experience felt traumatic to you, then it was. It’s OK to let yourself feel what you feel.

Read more about birth trauma experiences. 

For more information and support:

• The Birth Trauma Australia (Opens in new tab) offers advice, resources, and a peer support service.
• The Centre of Perinatal Excellence (COPE) (Opens in new tab) provides information and a list of support services.
• Perinatal Anxiety & Depression Australia (PANDA) (Opens in new tab) offers support to families across Australia affected by anxiety and depression during pregnancy and in the first year of parenthood.