From the Guidelines
If you've experienced a pregnancy loss at 15 weeks with placenta previa, you should seek immediate medical care if you haven't already to manage potential bleeding and prevent complications. After a pregnancy loss with previa, a condition where the placenta covers the cervix, you may experience bleeding that requires medical management, as noted in the context of placenta accreta spectrum disorder 1. Your healthcare provider will need to ensure all pregnancy tissue has been expelled or removed to prevent complications like infection or hemorrhage. The physical recovery typically takes 4-6 weeks as your uterus returns to its pre-pregnancy size and bleeding subsides. Emotional recovery varies greatly between individuals, and professional mental health support is often beneficial. Follow-up appointments with your healthcare provider are important to monitor your physical recovery and discuss future pregnancy planning when you're ready. Key factors to consider in future pregnancies include the increased risk of placenta previa and placenta accreta spectrum disorder associated with prior cesarean deliveries, as highlighted in guidelines from the American College of Radiology 1 and the American Academy of Family Physicians 1. Given the potential for increased risk in future pregnancies, close monitoring and planning with an experienced healthcare provider are crucial, as emphasized in the management of placenta accreta spectrum disorder 1. It is essential to prioritize your health and the health of future pregnancies by seeking medical care immediately after a pregnancy loss and following up regularly with your healthcare provider. Some important considerations for future pregnancies include:
- The risk of placenta previa increases with the number of prior cesarean deliveries, occurring in 9,17, and 30 of 1,000 women with one, two, and three or more cesarean deliveries, respectively 1.
- The risk of placenta accreta spectrum disorder also increases with prior cesarean deliveries and placenta previa, underscoring the need for careful planning and monitoring in future pregnancies 1.
- Regular follow-up ultrasounds may be recommended to monitor the placenta and cervix in future pregnancies, especially if there is a history of placenta previa or accreta spectrum disorder 1.
From the Research
Placenta Previa and Fetal Demise
- Placenta previa is a condition where the placenta covers the cervix, which can cause bleeding and other complications during pregnancy 2.
- In cases of placenta previa, fetal demise can occur, and management of the condition is crucial to prevent further complications 3, 4, 5.
Management of Fetal Demise with Placenta Previa
- Expectant management of fetal demise complicated by placenta previa during the midtrimester may induce fetal/placental atrophy and decrease uterine blood flow to facilitate vaginal delivery 4.
- Uterine artery embolization (UAE) may be an option for patients with placenta previa who desire vaginal delivery after intrauterine fetal death (IUFD) in a second-trimester pregnancy 5.
- Induction of fetal demise prior to uterine evacuation may be an option for women undergoing advanced pregnancy termination 6.
Considerations for Delivery
- Vaginal delivery may be possible after fetal demise in cases of placenta previa, but it depends on various factors, including the amount of bleeding and the presence of other complications 3, 5.
- Cesarean delivery may be recommended in cases where placenta previa persists into the late third trimester or if there are other complications 2.