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Women with placenta previa often present with painless, bright red vaginal bleeding. This commonly occurs around 32 weeks of gestation , but can be as early as late mid-trimester. [ 8 ] More than half of women affected by placenta praevia (51.6%) have bleeding before delivery . [ 9 ]
Besides placenta previa and placental abruption, uterine rupture can occur, which is a very serious condition leading to internal or external bleeding. Bleeding from the fetus is rare, but may occur with two conditions called vasa previa and velamentous umbilical cord insertion where the fetal blood vessels lie near the placental insertion site unprotected by Wharton's jelly of the cord. [11]
Placenta praevia or vasa praevia refers to the placenta or fetal blood vessels, respectively, covering or being located close to the opening of the uterus. More than half of women affected by placenta praevia (51.6)% have bleeding before delivery. [12] Vasa praevia occurs in about 0.6 per 1000 pregnancies. [13]
Along with placenta previa and uterine rupture it is one of the most common causes of vaginal bleeding in the later part of pregnancy. [6] Placental abruption is the reason for about 15% of infant deaths around the time of birth. [ 2 ]
Placenta previa is a condition that occurs when the placenta fully or partially covers the cervix. [13] Placenta previa can be further categorized into complete previa, partial previa, marginal previa, and low-lying placenta, depending on the degree to which the placenta covers the internal cervical os.
Causes of vaginal bleeding early in pregnancy include miscarriage (including inevitable, incomplete, or complete abortion), embryo implantation and growth outside the uterus (ectopic pregnancy), and placenta attachment at the bottom of the uterus over the cervix (placenta previa), all of which can cause significant bleeding.
Retroplacental hematomas are entirely behind the placenta and not touching the gestational sac. Subamniotic or preplacental hematomas are contained within amnion and chorion. Rare. Most patients with a small subchorionic hematoma are asymptomatic. [5] Symptoms include vaginal bleeding, abdominal pain, premature labor and threatened miscarriage. [6]
In the second or third trimester a placenta previa (a placenta partially or completely overlying the cervix) may bleed quite severely. Placental abruption is often associated with uterine bleeding as well as uterine pain. [32] Vaginal bleeding during pregnancy can be normal, especially in early pregnancy. Light spotting early on in pregnancy ...