Placenta Previa

The placenta usually is attached to the upper uterine wall away from the cervix. In a previa, the placenta is attached either too low on the uterine wall or completely covering the cervical opening (left). If dilation occurs, then the placenta is separated from the uterine wall causing that area to bleed. Placenta previa presents usually as painless bleeding. With the use of sonography, this condition can be detected early. Some women will be placed on complete bedrest. The mother and baby are nursed along until the bleeding becomes uncontrollable or the baby becomes intolerant to the bleeding.

Abruptio Placentae

If the placenta detaches from the wall of the uterus prematurely and before the baby is born, it is called an abruption (right). This is a serious problem because the oxygen source to the baby can be disturbed and the mother will be bleeding from the separated area. The mother usually experiences much discomfort and pain in the uterus which becomes quite rigid. An emergency cesarean is usually performed.

Aged Placenta

After 42 weeks gestation the placenta’s ability to provide nourishment and oxygen to the baby may diminish. Growth of the baby may also stop. Most healthcare providers will start to talk to you about the possibility of an induced labor to prevent any problems. This problem is generally detected by sonography and fetal monitoring, through a non-stress test. Certain pregnancies can develop “aged placentas” before their due date. This is usually associated with a baby that is much smaller than normal.

Prolapsed Cord

Another true emergency is the prolapsed cord. (left) This is a serious problem and an emergency cesarean must be performed. The cord slides out of the cervix in front of the baby’s presenting part. When the uterus contracts and pushes the baby down, pressure on the umbilical cord can diminish the blood flow to the baby and can cause serious problems. This does not happen often. It is most likely to occur if it is a preterm birth, a breech presentation or if the baby’s head is not well engaged into the pelvis when the membranes rupture.

Cord Compression

There are times when the cord can be wrapped around the baby’s neck, looped around the body or caught between the baby’s head and mother’s bony pelvis. With a contraction the cord may be pinched and a decreased oxygen supply is delivered to the baby. This can be seen on the fetal monitoring device. This compression can sometimes be relieved with a simple change of position with the laboring mother. Oxygen is usually given to the mother as well as positioning her on her left side. Some patients are placed in Trendelenberg position. This position occurs when the head of the bed is dropped well below the foot of the bed. If the distress persists and is not relieved with any of the above techniques, then your healthcare provider will consider an assisted delivery given the head is low enough in the pelvis. If it is not, then a cesarean will be performed.