Placenta Previa Treatment in Ahmedabad: Low Placenta and Accreta Care

Placenta Previa Types and Grades, and the Accreta Words Explained

The measurement I care about is the distance between the edge of the placenta and the inner opening of the cervix. A transvaginal scan measures this most accurately, and it is appropriate even when the placenta is low.

Older scan reports often grade placenta previa from I to IV, or call it marginal, partial or complete. Current guidance has replaced those grades with just two terms: low-lying placenta, where the edge is within 20 mm of the cervix, and placenta praevia, where the placenta covers it. If your report gives a grade, bring it along; a transvaginal scan gives the exact distance, and that distance is what decides the plan for delivery.

Low-Lying Placenta: Why One Seen at 20 Weeks Often Ends Up Higher

A low placenta is reported in a few per cent of anomaly scans at 18–22 weeks. By the third trimester, about 9 in 10 of these no longer cover the cervix. The placenta itself does not move. What happens is that the lower part of the womb grows and stretches more than the rest, and carries the edge of the placenta upwards as it does.

So a low placenta at 20 weeks is not a reason for alarm, nor for strict rest. I repeat a transvaginal scan at about 32 weeks, and again at about 36 weeks if it is still low and you have had no bleeding. The one exception is a woman who has had a caesarean and has a low placenta on the front wall. For her, I arrange a focused scan to look for signs of accreta.

Who Has a Higher Chance of Praevia or Accreta

• One or more previous caesareans, especially with a low placenta over the scar.
• Earlier surgery on the womb - myomectomy, hysteroscopic surgery or repeated D&C.
• Pregnancy after IVF
• Age over 35 and several previous births.
• Smoking or any tobacco use.
• Placenta praevia or accreta in an earlier pregnancy.

When the placenta is praevia over a caesarean scar, the chance of accreta is about 3% after one caesarean, about 11% after two and about 40% after three.

Placenta Previa Symptoms: The Bleeding Pattern to Look Out For

With placenta praevia the classic sign is bright red bleeding from the vagina without pain. It often happens in the third trimester - sometimes after intercourse, sometimes for no clear reason. The first bleed is often small and may stop by itself, but later bleeds can be heavier, so every episode needs to be checked in hospital.

Accreta usually gives no symptoms during pregnancy. It is suspected from your risk factors and the scan, and confirmed at delivery. Rarely, a percreta that has grown into the bladder causes blood in the urine.

Vasa praevia is a related condition in which the baby's blood vessels run unprotected across the cervix. It is more likely with a low placenta or after IVF and is found with colour Doppler. A planned caesarean before labour starts protects the baby.

Placenta Accreta Spectrum: How I Look for It Before the Birth

A careful ultrasound by an experienced operator is the main tool. The signs I look for are:

• loss of the clear zone between the placenta and the wall of the womb
• lacunae - irregular, blood-filled spaces in the placenta
• thinning of the womb muscle over the scar
• abnormal blood vessels at the surface of the bladder on colour Doppler

In the first trimester, a pregnancy that has implanted low on a caesarean scar can be an early warning. MRI is sometimes added - for a placenta on the back wall, or to map how far it has invaded. Neither test is perfect, so when suspicion is high I plan as though accreta is present. The aim is to have the right team, blood products and setting arranged before the day of delivery.

Low-Lying Placenta Precautions for Day-to-Day Life

• Come to hospital for any bleeding from the vagina, even light spotting without pain.
• Avoid intercourse and internal examinations while the placenta is praevia.
• Keep your haemoglobin above 11 g/dL with iron; if tablets are not enough, I give iron through a vein.
• Know your blood group. If you are Rh-negative, you will receive anti-D after a bleed.
• If an early delivery before 35 weeks looks likely, you will be given steroid injections.
• In the third trimester, stay within easy reach of the hospital, with an adult and transport available.
• I do not routinely advise strict bed rest, because it raises the risk of clots. Some women who bleed repeatedly are admitted for observation.

Placenta Previa Treatment and Management: How I Plan the Delivery

• Uncomplicated praevia: a planned caesarean, usually at 36–37 weeks
• Suspected accreta: an operation scheduled between 35 and 36+6 weeks, with senior obstetric and anaesthesia teams present, cross-matched blood ready, and tranexamic acid and uterotonic medicines prepared. The operation is often a caesarean hysterectomy with the placenta left in place, which is generally regarded as the most dependable way to control bleeding. In selected women, approaches that keep the womb can be considered.
• Suspected percreta or bladder involvement: delivery at a tertiary centre with urology, interventional radiology and ICU backup. I discuss this referral with you openly.

Placenta Accreta Treatment Without Hysterectomy: When It Is Considered

Placenta accreta treatment without hysterectomy is an option for selected women, and I discuss it well before the delivery date rather than in the operating theatre. The usual womb-preserving approach is to deliver the baby through a cut placed away from the placenta. The placenta, or the part that will not separate, is then left inside the womb to be absorbed gradually over the following months. Where the invaded area is small and in one place, removing that portion of the wall and repairing the womb is another possibility.

These approaches suit women who strongly wish to keep the chance of a future pregnancy, who do not bleed heavily at delivery, and who can come back for close follow-up. They carry real risks: bleeding or infection that can start weeks later, and a hysterectomy that some women still need at a later stage. They are generally carried out at a centre with interventional radiology and a large blood bank, so if this route suits you I discuss referral with you. Where controlling bleeding comes first, hysterectomy at the caesarean remains the usual plan.

Recovery, and What This Means for Future Pregnancies

Recovery after a planned caesarean for praevia is much like any caesarean, with a hospital stay of two to four days. After accreta surgery recovery takes longer and a blood transfusion is more often needed. Aftercare includes clot-prevention injections, walking early and replacing iron.

The chance of praevia in a later pregnancy is raised. After a caesarean hysterectomy, another pregnancy is not possible - I recognise how hard that is to hear and make sure you have support. If the womb is kept, a future pregnancy needs early scans to see where the placenta has implanted.

In the long run, the most effective way to prevent accreta is to avoid caesareans that are not medically needed, especially for a first birth.

Five Stages of My Placenta Care Plan

1. Mapping the placentatransvaginal and colour Doppler scans.
2. Follow-up scansat about 32 and 36 weeks.
3. Being ready for a bleedcorrecting anaemia, recording your blood group and knowing how to reach the hospital fast.
4. Team planning if accreta is suspectedtiming, anaesthesia, blood products and, if needed, referral to a tertiary centre.
5. Scheduled deliverywith neonatal support, followed by recovery, iron and clot prevention.

Reasons to See Me About Your Placenta

• Your scan report says low-lying placenta, praevia or suspected accreta.
• You have had one or more caesareans and are pregnant again.
• An early scan suggests low implantation on a caesarean scar.
• You have had earlier surgery on the womb, such as a myomectomy.
• An IVF pregnancy with a low placenta reported on scan.
• You plan travel, work or a stay out of town while your placenta is low.

Placenta Myths I Often Correct

Questions Patients Often Ask Me About Placenta Praevia and Accreta