Placenta Previa: Risks, Management, and Fetal Growth Concerns

Placenta previa

Hello Doctor: I am currently 27 weeks and 5 days pregnant (with intermittent brown discharge).
Four days ago, I visited an obstetrician due to a cold, and the doctor informed me that I have a condition called placenta previa.
He advised me to be cautious and mentioned that I would need a cesarean section at 7 and a half to 8 months.
However, my baby is only estimated to weigh 1130 grams.
Even if I wait another month, will the baby be big enough? If I have a cesarean delivery, will the baby survive? I understand that the doctor has my best interests at heart, as he mentioned that placenta previa could lead to maternal bleeding at any time.
I returned to my previous obstetrician for a check-up, and he confirmed that my placenta is indeed low-lying but has not yet covered the cervical opening, so there is still hope that it may move upward as the fetus grows.
Therefore, he does not recommend a cesarean at 8 months because my baby is too small.

Could you please explain why placenta previa occurs? What should I be cautious about? I am almost seven months along, but my baby is only slightly over 1100 grams.
Is that too small? How can I improve the baby's nutrient absorption to help them grow faster? What should I eat to help the baby grow? I've heard that babies with placenta previa may have poor nutrient absorption; will this have an impact? Will such a baby be unhealthy? (I have undergone amniocentesis, and the results are normal.) I am very worried about my baby's health! What is the risk of delivering the baby at full term? I have many questions, and I appreciate your answers.
Thank you very much! Xiaofang 93.09.03

Xiao Fang, 30~39 year old female. Ask Date: 2004/09/03

Dr. Zhan Deqin reply Obstetrics and Gynecology

At 28 weeks of pregnancy, the average weight of a male fetus is approximately 1380 grams, while a female fetus averages around 1200 grams.
Therefore, your fetus is not considered too small.
In the late stages of pregnancy, the fetus typically gains about 100 grams per week, and by 32 weeks, it should weigh around 1700 grams; if delivery is necessary at that point, the fetus may still be too small (but if there is continuous heavy bleeding, that may be unavoidable).
There are many causes of placenta previa, most of which are congenital, meaning the placenta is positioned poorly.
However, if it does not cover the cervical opening, it can be classified as marginal, and there may still be a possibility of vaginal delivery, but close monitoring for any bleeding is essential.
Sexual intercourse should still be avoided, and it is advisable to rest in bed, refrain from lifting heavy objects, and avoid strenuous activities.
You should visit your obstetrician at least once every two weeks, and if there is any bleeding, contact your doctor immediately.
As for diet, as long as it is nutritious, it should be sufficient.
Consuming more fresh milk is beneficial.

Reply Date: 2004/09/03

More Info

Hello, Xiaofang. Thank you for your detailed questions regarding your pregnancy and the concerns surrounding placenta previa, fetal growth, and overall health. I understand that this can be a very anxious time, and I will do my best to provide you with comprehensive information.

Understanding Placenta Previa:
Placenta previa occurs when the placenta is located low in the uterus and partially or completely covers the cervix. This condition can lead to complications, particularly bleeding during pregnancy and delivery. The risk of bleeding increases as the pregnancy progresses, especially during labor. Your doctor is correct in advising caution and monitoring, as bleeding can pose risks to both you and your baby.

Fetal Growth Concerns:
At 27 weeks and 5 days, your baby weighing approximately 1130 grams (about 2.5 pounds) is on the lower side of the average weight for this gestational age. However, fetal growth can vary widely, and many factors can influence this, including genetics, maternal health, nutrition, and placental function. It’s important to continue monitoring fetal growth through ultrasounds and regular check-ups.

Risks Associated with Placenta Previa:
The primary risk of placenta previa is bleeding, which can occur as the cervix begins to efface and dilate. If you experience significant bleeding, it may necessitate a cesarean delivery, especially if the placenta is covering the cervix. Your doctor’s recommendation for a cesarean at around 7.5 to 8 months is standard practice to minimize risks associated with vaginal delivery in cases of complete previa.

Nutritional Considerations:
To support your baby's growth, focus on a balanced diet rich in essential nutrients. Here are some dietary recommendations:
1. Protein: Include lean meats, fish, eggs, dairy, legumes, and nuts to support fetal growth.

2. Fruits and Vegetables: Aim for a variety of colors to ensure a range of vitamins and minerals.

3. Whole Grains: Choose whole grain bread, rice, and pasta for sustained energy and fiber.

4. Healthy Fats: Incorporate sources of omega-3 fatty acids, such as fish, flaxseeds, and walnuts, which are important for brain development.

5. Hydration: Drink plenty of water to stay hydrated, which is crucial for overall health and amniotic fluid levels.

Monitoring and Management:
Given your concerns about fetal growth and placenta previa, it’s essential to maintain regular appointments with your healthcare provider. They may recommend additional ultrasounds to monitor the position of the placenta and the growth of the baby. If your placenta is low-lying but not covering the cervix, there is a possibility it may move up as your uterus expands, which can allow for a vaginal delivery.

Addressing Your Concerns:
1. Will the baby be healthy? The fact that your amniocentesis results were normal is reassuring. While placenta previa can complicate matters, many babies are born healthy even in such situations.

2. What if the baby is small? Small for gestational age (SGA) babies can still be healthy. Your healthcare team will monitor your baby’s growth closely and may recommend interventions if necessary.

3. What to do if you experience bleeding? If you notice any bleeding, contact your healthcare provider immediately. They may advise you to rest and monitor the situation closely.

In summary, while placenta previa and fetal growth concerns can be worrying, close monitoring and appropriate medical care can help manage these risks. Focus on maintaining a healthy diet, staying hydrated, and following your doctor's advice. If you have further questions or concerns, don’t hesitate to reach out to your healthcare provider for personalized guidance. Wishing you a safe and healthy pregnancy!

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