Placenta 101: Let's Talk about Function, Risks, Complications, and Signs to Look For
Show Notes:
[1:11] Our reviewer of the week is, JennaK3491, and she says, “This podcast has been such a blessing for me! I have been binge listening just about every day since 32 weeks (just hit 37 weeks this week). (I’m due at the end of March 2023.) When I found out I was pregnant, I didn’t think I had so many opinions about pregnancy and birth and was honestly just going with the flow. I am the type that has to know all about what is happening to me and all about some self study research, so podcasts were perfect for me! I listen on the way to and from work, during work, while doing house work on the weekends, and basically whenever I have free time. I am planning on having an unmedicated birth in the hospital with an OB, I hired a doula and am currently doing all the things to prepare! This podcast has helped me to much gain confidence (despite the negative comments and birth stories from people around me) to have an unmedicated birth and feel good about my options and the decisions I'm about to make! I am so happy I found this podcast and have learned to much just listening! The birth stories help so much in these last few weeks in preparation mentally! Truly blessed! Thank you!”
I love this! I hope the information in this episode is helpful to you as you enter the last few weeks of pregnancy! π
Today's episode is information all about the placenta: its function, risks, complications, and how to equip yourself with knowledge in order to make the best decisions for you and your baby should you run into one of these conditions. My goal for this episode is purely informational so you can tuck this away and refer back to it IF this happens to you. π€
[3:17] I have been getting a lot of messages lately asking about allll the placenta related things. π¬ Your placenta is an amazing organ, which provides your baby with oxygen and nutrients during pregnancy and filters his or her blood. Typically, you won’t hear much about your placenta during pregnancy unless one of these “complications” I’m about to talk about arises.
[3:57] Here’s a heads up on a few of the “complications” that can happen so you will know what to expect! π (This is a great episode for your birth partner to listen to so you can both be prepared.)
[4:12] We’re going to talk about an anterior placenta. After your egg is fertilized, it travels to the uterus and implants in the uterine wall. The placenta will implant wherever it decides to land inside the uterus. If it’s towards the back, it’s called a posterior placenta, and if it’s towards the front, it’s called an anterior placenta. βοΈ
[4:55] It’s normal for your placenta to form at the front of the uterus. There’s no rhyme or reason for where it implants. It doesn’t cause any complications, and you would normally find out around your 20-week anatomy scan. Your provider would just tell you that it’s a little tricky to find baby’s heart beat. π Mom may not feel baby’s kicks for a little longer (so try lying on your side!)
[6:34] Again, it does not cause any complications, but this is just good information to know about your placenta. The only concern that comes up is if you are going to have a Cesarean birth. The provider will not want to accidentally cut into the placenta while delivering your baby. βοΈ
[7:048] Next, we’re going to talk about Placenta Previa. Typically, your placenta grows in the upper part of your uterus, but when placenta previa occurs, your placenta is partially or completely covering your cervix. π³οΈ
[8:26] Think of your uterus as a balloon. π The bottom part where you would tie off the balloon is your cervix (which is where baby will be coming out!) Full Placenta Previa covers the entire opening, which would necessitate a Cesarean. Only 1 in every 200 pregnancies will experience this.
[10:11] Some risk factors are advanced maternal age, carrying multiples, IVF, smoker, and history of Cesareans. It’s typically caught on a first or second trimester ultrasound. If placenta previa is suspected, you will have a transvaginal ultrasound ordered. (Request it if your provider does not order an ultrasound and starts pushing a Cesarean.) π©
[12:15] The reason for the transvaginal ultrasound is this is the only way to get accurate measurements, you will want to make sure to ask how many millimeters over the cervix it is. This matters when discussing any interventions your provider may bring up with you. π€
[13:06] When it is discovered, remember a few important things:
- #1 There is a difference between partial and full previa
- #2 The placenta can only move up as your uterus grows (it will naturally move up)
- #3 Most partial previas will correct all on their own and most women wouldn't have even known you had it without an ultrasound
[14:48] Often there are no symptoms. You may experience some bleeding in the 2nd or 3rd trimester.π©Έ (Any trickling of blood warrants immediate attention!) It can also cause contractions earlier on.
[15:54] Out of the women who are diagnosed with placenta previa, only about every β of women with placenta previa will experience bleeding. Having placenta previa does not necessarily mean you are going to need a Cesarean. In most mild cases, your placenta will migrate up away from your cervix as your uterus grows. Your provider will monitor the position of your placenta via ultrasounds.
[16:58] As long as your placenta moves away from the opening of your cervix you won’t need to have a Cesarean. This is definitely one of those times where the “wait and observe” saying comes into play. β°
[18:08] Next is placental abruption. It occurs when part of the placenta detaches from the uterine wall before birth! It can be a partial or complete abruption, and they’re classified as either mild or severe.β£β π₯
[19:03] A mild abruption usually does not cause any significant issues. You will be monitored a little more closely. Severe abruption is much more dangerous when a larger portion or all of your placenta separates from the uterus. This can put baby at risk of growth problems, premature birth, and stillbirth. β£β πΆπ»
[20:07] Who is more susceptible? You are older than 35, experience some kind of trauma like a car accident, are a smoker/drug use, or have high blood pressure. It occurs in about every 1 in 100 pregnancies. π
[20:50] What are the symptoms of placenta abruption? You may have some vaginal bleeding, sudden back pain, contractions, baby’s heart rate can be abnormal, uterus takes on a more globular shape and becomes firmer, uterus rises in the abdomen, a gush of blood occurs, umbilical descends more than 3 inches outside of vagina, or uterine tenderness with/without contractions.
[22:26] If your provider suspects you may be experiencing a placental abruption they will first do an ultrasound to check and see what is going on. You and baby will be monitored to see if they are in distress.
- For mild abruptions earlier than 34 weeks, bed rest is usually the treatment, either at home or in the hospital until birth.
- For a mild abruption after 34 weeks, your provider may decide it is safest for you and baby to be induced
[23:35] For a severe abruption, you will need to give birth immediately. Baby needs out sooner rather than later. A severe abruption will have a lot of blood loss for mom and sometimes complications for baby. This is usually going to be an emergency Cesarean. This is good information for Dad to know too so he can support you if this happens to you. π§
[24:54] Placenta accreta is when your placenta grows too deeply into your uterine wall. Once your baby is born, and it is time to deliver the placenta, it cannot separate as easily as it normally does, and removing it may cause severe bleeding for the mother.
[26:10] After birth, your provider will look at your placenta to ensure it is all there. They need to know if there is more placenta left in the uterus.
[27:10] There are two variations of placenta accreta:
- Placenta increta is when your placenta attaches more firmly to the uterus and becomes embedded in the organ's muscle wall
- Placenta precreta where the placenta attaches itself and grows through the uterus and potentially into the nearby organs like your bladder.
[27:43] This happens to every 1 in 500 pregnancies. You’re more susceptible if you have had a prior cesarean, you have placenta previa, advanced maternal age, or you conceived through IVF.
[28:41] Placenta accreta usually has no symptoms, however it may occur alongside placenta previa. You can experience some of those symptoms if you have a severe case of increta or precreta, you can experience back pain or pain when urinating if it were to attach to your bladder. π½
[29:33] When you have placenta accreta, after the birth the placenta will not separate from the uterine wall like it should. Mom may experience severe hemorrhaging or bleeding, when the provider tries to remove the stuck placenta. Providers often need to put they’re entire forearm through the vaginal canal to manually remove the placenta. For mothers without epidurals, this can be extremely uncomfortable. π₯΄
[31:01] If placenta accreta is discovered before labor, the provider very well may recommend mom have a Cesarean to try and manage that potential blood loss. You can choose if you want to do that or not, but there are risks and benefits to each. In extreme circumstances, mom may even need to have a hysterectomy to control blood loss. π
[33:37] Retained placenta is when a piece of your placenta does not leave the uterus. There are three variations or types of retained placentas. First is placenta adherens, and this is the most common and occurs when the uterine contractions are not strong enough to expel the uterus and results in the placenta hanging on loosely to the uterine wall. The provider will perform a fundal massage to encourage the uterus to expel the placenta. ππ»βοΈ
[36:04] Next is a trapped placenta, which is when the placenta detaches from the uterine wall, but it is not expelled from the mother’s body. This usually happens when the cervix closes before the placenta is expelled. Treatment for a trapped placenta typically involves sustained cord traction, relaxation of the uterus and cervix through nitroglycerin, or the manual removal of the placenta under general anesthesia. π
[36:54] The last variation is placenta accreta which we already talked about.
[37:00] Women are at risk of having a retained placenta if they are advanced maternal age, have a premature delivery, a long first and second stage of labor, or if they have a stillborn baby.
[37:30] The obvious sign you are dealing with a retained placenta is going to be your placenta not being expelled/delivered/born easily postpartum. Sometimes it is missed if only a small piece breaks off and remains in the uterus. You may be discharged and a few days or a week later to start having a foul smell, a fever, and some bleeding and pain. You need to go be seen immediately to have a D&C/surgery to have it removed because this can lead to serious infection. π¦
[38:26] If you are dealing with a retained placenta situation, breastfeeding can be beneficial in helping aid in expulsion. Breastfeeding causes your uterus to contract, oh those lovely after birth pains, and is the non-invasive way to help. π€±πΌ
[39:16] Since your provider might also try to manually remove the placenta, you’ll need to be aware that anytime something is inserted into your vagina you are at risk of infection. There are also some drugs/medications they can give you to help relax the uterus and aid in expulsion. Surgery would be a last resort. π©π»βοΈ
[39:56] Now I know this a lot of heavy information, but I want it to be just that though! This is awesome information for things that you may or may not be able to control, BUT if you have information about it beforehand, things will be easier to manage.
[40:45] We don’t always get to pick and choose what happens during our pregnancies or even postpartum, but we do have control over having the knowledge, recognizing signs, and being part of the decision making. Store this information away, and use the signs to keep an eye on yourself. π
[41:22] And have an excellent pregnancy! Because that’s likely exactly what you’re going to experience! π₯°Use this as JUST information!
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