Is it safe to travel with a low-lying placenta (placenta previa)?

Travel Safety with Low-Lying Placenta

Women with asymptomatic low-lying placenta can travel before 28 weeks of gestation while maintaining moderate-to-vigorous physical activity, but after 28 weeks should avoid travel requiring moderate-to-vigorous activity and limit themselves to low-intensity activities such as walking. 1

Risk Assessment Before Travel

Before making travel decisions, several critical factors must be evaluated:

• Distance from the internal cervical os matters significantly - if the placental edge is within 2 cm of the internal os, there is substantially higher risk of hemorrhage (60% vs 19% excessive bleeding during vaginal delivery) compared to placentas 2.1-4.0 cm away 2

• Prior cesarean deliveries dramatically increase risk - women with placenta previa and previous cesarean sections must be evaluated for placenta accreta spectrum disorder, with risk increasing 7-fold after one cesarean to 56-fold after three cesareans 1, 3

• History of bleeding episodes predicts future bleeding - women who have experienced one bleeding episode are at increased risk for subsequent hemorrhage 4, 1

Gestational Age-Specific Travel Recommendations

Before 28 Weeks

• Women with asymptomatic low-lying placenta can continue moderate-to-vigorous physical activity and travel 1, 3
• Serial ultrasound monitoring should be scheduled at 18-20 weeks, 28-30 weeks, and 32-34 weeks to assess for resolution 5

After 28 Weeks

• Avoid moderate-to-vigorous physical activity but maintain activities of daily living and low-intensity walking 1, 3
• Travel should be limited to destinations within close proximity to level III or IV maternal care facilities with blood banking capabilities 3, 5
• Consider distance from hospital or referral center when making travel decisions 4

After 34 Weeks

• Travel is strongly discouraged as planned cesarean delivery is recommended at 34 0/7 to 35 6/7 weeks for uncomplicated placenta previa 1, 3
• Approximately 50% of women with placenta accreta spectrum beyond 36 weeks require emergent delivery for hemorrhage 1, 3

Absolute Contraindications to Travel

Do not travel if any of the following are present:

• Active vaginal bleeding - hospitalization is required 1, 3, 5
• Diagnosed placenta accreta spectrum disorder - delivery must occur at specialized centers with multidisciplinary teams 1, 3
• Persistent placenta previa at 28-30 week ultrasound - early referral to level III/IV facility is necessary 5
• Preterm labor, preeclampsia, or rupture of membranes 3

Critical Logistical Considerations

• Proximity to appropriate medical facilities - travel destinations must have access to facilities capable of managing massive hemorrhage with blood banking and surgical capabilities 3, 5
• Time to reach definitive care - consider that transfer time influences management decisions, particularly for hemorrhage control 4
• Insurance and medical records - ensure access to prenatal records and ultrasound reports documenting placental location and distance from internal os 4

Common Pitfalls to Avoid

• Assuming resolution means no risk - even women with resolved low-lying placenta by term remain at 3.5-fold increased risk of postpartum hemorrhage compared to normal placentation 6
• Underestimating bleeding risk - digital pelvic examination must be avoided until placenta previa is excluded, as it can trigger life-threatening hemorrhage 3, 5
• Traveling too far from specialized care after 34 weeks - emergent delivery may be required with little warning 1, 3

Practical Travel Guidelines

If travel is deemed appropriate based on the above criteria:

• Carry complete prenatal records including most recent ultrasound reports with measurements of placental edge-to-internal os distance 4
• Identify level III or IV maternal care facilities at the destination before departure 3, 5
• Avoid destinations requiring flights longer than 2-3 hours or remote locations more than 30-60 minutes from appropriate medical facilities 4
• Maintain hemoglobin optimization with oral or intravenous iron supplementation as prescribed 1, 3
• Have a contingency plan for emergent delivery, as patients with placenta previa face increased risk of prepartum hemorrhage as gestational age advances 1

4, 1, 3, 5, 2, 6