Placental Complications

Understand the most common placenta issues during pregnancy, including symptoms, complications, and treatments

What is the placenta?

The placenta is a remarkable organ, albeit a temporary one, that attaches to the inside wall of your uterus during pregnancy. Placentas are disc-shaped, about 8 inches in diameter, and almost 1 inch thick. They’re mostly made up of blood vessels that serve to connect your body systems and your baby by way of the umbilical cord.

The placenta performs the following functions during pregnancy:

• Supplies your baby with nutrients and oxygen as your blood flows through the placenta
• Expels carbon dioxide and waste from your baby
• Transfers hormones that help your baby develop and grow
• Lends your immunity system by passing antibodies to your baby

Where does the placenta normally attach?

When the mass of cells that are becoming a baby implants in the uterine wall around week 4, some of these cells split away and begin forming the placenta. By week 12, the placenta takes over all baby-nurturing functions.

The placenta can attach anywhere to the wall of your uterus. The location is dictated by where the fertilized egg attaches to your uterus. These are the common locations:

• Posterior placenta. The placenta attaches to the back wall of your uterus (toward the spine). Posterior placentas are most common and considered “least likely to cause complications,” but they are associated with premature labor.
• Anterior placenta. The placenta attaches to the wall of your uterus that is closest to your abdomen. Since the placenta can move and grow during pregnancy, anterior placentas are at a slightly increased risk for placenta previa.
• Fundal placenta. The placenta attaches near the top.
• Lateral placenta. The placenta attaches to the right side or left side wall of your uterus.
• Low-Lying Placenta. The placenta attaches low in the uterus near or covering and blocking the cervix.

What is a fundal placenta, and what are the different types?

A fundal placenta is located near the top of the uterus between 2 fallopian tube openings called the fundus. The fertilized egg travels down a fallopian tube into the uterus, where it attaches to the uterus wall. The placenta develops where the egg attaches.

There are 2 different types of fundal placenta:

• An anterior fundal placenta forms at the top and continues down the uterus wall to the front of the uterus (near the belly).
• A posterior fundal placenta forms at the top and continues down the uterus wall to the back of the uterus (near the spine).

Is it better to have a fundal posterior or anterior placenta?

As far as a preference, the 2 locations fulfill their functions equally well. However, a posterior placenta is better in the sense that, with the placenta on the back wall, the mother can feel the baby’s movements and kicks earlier in the pregnancy.

Also, the position of the placenta will determine which way your baby is facing. With a posterior placenta, the baby will face your spine and allow their growth to more easily line up in the birth canal for a vaginal birth.

Is it okay for the placenta to be on top?

It does not pose any significant problems if a placenta is attached at the top of the uterus. Like any placenta, regardless of its location, it must be monitored to ensure that it’s functioning properly.

Is a fundal posterior placenta normal?

A posterior fundal placenta is normal and quite common. In some ways, it’s considered the preferred location for your placenta.

Can a placenta move during pregnancy?

The placenta gives an appearance of moving because the placenta expands along with the uterus as it increases in size to accommodate the growing baby. The placenta can expand up until about 32 weeks of pregnancy. Usually, the expansion and movement are away from the cervix.

Variations in the location of the placenta are natural, and it’s still able to do its job—most of the time. Doctors cannot change the location of a placenta or treat it, so placenta risks cannot be fixed, only monitored.

What causes placental complications during pregnancy?

These factors can increase the risk of placental complications:

Common issues with the placenta during pregnancy

To be clear—placenta issues during pregnancy are not common. Placenta previa, for example, occurs in about 1 in 200 pregnancies, and most of the time, it can be monitored for a successful outcome. However, doctors and medical providers need to be vigilant in checking a baby’s health throughout pregnancy and be ready to act if the baby is in distress (not getting enough oxygen or nutrients).

Below we’ll discuss some of the most common placenta complications during pregnancy, labor, and delivery.

Placenta previa

Placenta previa occurs when the placenta implants over or close to the opening of the uterus (also called the cervix). The cervix is shaped like a funnel, leading into the vagina. If the placenta is nearby or covering the opening to the cervix when the cervix dilates in preparation for delivery, the placenta can tear, causing bleeding or hemorrhage.

There are 3 different types of placenta previa:

• Total placenta previa occurs when the cervix is completely covered by the placenta.
• Partial placenta previa occurs when the placenta covers a portion (but not all) of the cervix.
• Marginal placenta previa occurs when the placenta is positioned at the edge of the cervix but does not cover it.

Placenta previa usually occurs during the 2nd or 3rd trimester of pregnancy and is a primary cause of vaginal bleeding in the 2nd and 3rd trimesters, which is its main symptom. Placenta previa is very dangerous because of the risk of uterine bleeding and disruption of blood flow to the baby.

Left untreated, placenta previa can cause severe maternal hemorrhage, hypotension (low blood pressure), tachycardia, and shock.

It can also lead to the following:

• Fetal distress
• Premature labor and delivery
• Emergency cesarean section (C-section)
• Hysterectomy and loss of fertility
• Death

While the cause of placenta previa is unknown, certain risk factors increase the likelihood of developing this complication. They include:

• Maternal age over 35
• Smoking cigarettes
• Using cocaine
• Uterine scarring from previous surgeries involving reproductive organs
• A previous pregnancy
• Being pregnant with multiples (twins, triplets, etc.)

If you experience bleeding during pregnancy, your doctor can confirm a diagnosis of placenta previa by performing an ultrasound. Placenta previa must be carefully managed by medical providers to avoid potentially deadly complications for the mother and baby.

Depending on how far along you are in your pregnancy, your doctor may require closer monitoring, including more frequent ultrasounds, bed rest, and a C-section delivery.

Placental abruption

Placental abruption is a serious medical complication in which the placenta partially or completely detaches from the uterine wall, and it requires immediate medical attention. It typically occurs during the 3rd trimester but can happen any time after 20 weeks of pregnancy.

The symptoms of placental abruption can occur abruptly or gradually over time and may include the following:

• Vaginal bleeding
• Uterine tenderness
• Abdominal pain
• Abnormal fetal heart rate

While doctors don’t always know why placental abruption occurs, trauma to the abdomen (from a fall, for example) is one of the most common known causes. Other risk factors may include:

• Preeclampsia or pregnancy-induced hypertension
• Smoking
• Maternal age over 35
• Being pregnant with multiples (twins, triplets, etc.)
• Uterine infection

Doctors and nurses should immediately evaluate any symptoms of placental abruption. Because it’s not possible to reattach the placenta to the uterine wall once it detaches, treatment depends on the severity and location of the separation and the age of the pregnancy.

Mild cases may require close monitoring and bedrest in the hospital, while more severe cases may require your doctor to induce labor and deliver the baby early.

Placenta accreta

Occurring in about 1 in every 533 pregnancies in the U.S., placenta accreta is a serious complication in which the placenta is attached too deeply into the wall of the uterus, causing all or part of the placenta to remain attached to the uterus after childbirth. It can lead to severe bleeding and death if left untreated.

Other complications can include:

• Premature labor and delivery
• Loss of fertility
• Damage to your uterus and other surrounding organs
• Problems with blood clotting
• Lung failure
• Kidney failure

If you’re diagnosed with placenta accreta during pregnancy, your doctor will likely recommend a C-section delivery as well as surgery to remove your uterus, known as a hysterectomy. Having a hysterectomy may be necessary to prevent the potentially life-threatening blood loss that can occur if your placenta attempts to separate from your uterine wall after delivery.

Who’s most at risk for placenta accreta?

Placenta accreta often forms over uterine scars, so previous C-sections increase the risk. Other risk factors include:

• Placenta previa
• Maternal age over 35
• A previous childbirth
• Getting pregnant through in vitro fertilization (IVF)

Unfortunately, placenta accreta often doesn’t cause any symptoms during pregnancy, although some women with placenta accreta may experience mild bleeding during their 3rd trimester. Because of this, it’s vital that doctors look for and diagnose placenta accreta during routine prenatal ultrasounds.

Retained placenta

A retained placenta refers to a situation where a portion of the placental tissue remains inside the mother’s uterus for 30 minutes or more after birth. Placenta accreta is one type of retained placenta. The other two types include:

• Placenta adherens. Occurs when the placenta doesn’t detach from the uterine wall.
• Trapped placenta. Occurs when the placenta detaches but becomes trapped behind a closed cervix.

Symptoms of retained placenta include heavy bleeding and cramping. In some cases, parts of the placenta may remain unnoticed, leading to infection, prolonged bleeding days or weeks later, and, in severe cases, uterine damage that might affect future pregnancies.

Treatment depends on the type of retained placenta. In some cases, manual removal by a health care provider is required, while others may need medications to help expel the placenta. If manual removal or medication is not successful, surgical removal, such as a dilation and curettage (D&C), may be necessary to prevent infection and control bleeding.

Protecting mothers and babies

Some dangers cannot be prevented. Others can.

Ultrasound can pick up most placenta problems. As early as 8 weeks, the placenta can be seen on abdominal scans. Most placental problems develop in the third trimester, so the good news is there’s usually plenty of time to keep you and your baby safe. Proper medical monitoring can save lives—but negligent monitoring or treatment can turn a placental problem into birth injury or death.

Contact an experienced birth injury lawyer

Birth injuries can lead to serious health consequences that require costly, life-long treatment and rehabilitation. If you believe your child suffered a birth injury because of a doctor’s medical negligence, you owe it to yourself and your child to get the compensation they need to live their life to the fullest.

If you have questions about the birth injury lawsuit process or want help filing your claim, contact attorney Laura Brown at Brown Trial Firm. Laura has years of experience in birth injury law, helping families like yours all across the U.S. get the compensation they deserve.

Contact her today for a free consultation of your case.