Last August, we found out that we were pregnant with our second child, Jack. To both get a better idea of when we could expect him and to ascertain his gender, we went for an ultrasound in November when we got a firmer due date and confirmation that we were expecting Jack and not “Maggie”.
What we didn’t find out during the exam, but which came later after the doctor had reviewed the ultrasound imagery in the days following the exam, is that Martina had complete praevia (previa – American English).
Praevia is a condition that means the placenta is covering the cervix. For those who need a basic biology lesson, the uterus (womb) contains both the foetus and the placenta which sustains the baby. The two are connected by the umbillical cord and the placenta is attached to the uterine wall, where it passes blood, oxygen and nutrients back and forth between the mother and the baby.
You can think of the uterus like a balloon, in that it’s a muscle which grows in a balloon-shape and has a small opening at the bottom called the cervix, where the baby will be delivered through.
The concern with praevia at full-term is that the placenta is blocking the cervix, so when the baby is ready to be born, he can’t come through the cervix without rupturing the placenta. The placenta is a massive organ and rupturing it can be fatal for the mother and the complications during the birth can also be fatal for the child.
Early on in pregancy, the embryo – and in turn the uterus – are very small. As such, there isn’t much room for the placenta to grow and it is very conceivable that it will be on or near the cervix because there’s only so many places it can go.
In our case, we were diagnosed with total praevia (cervix completely blocked by the placenta, as opposed to partial praevia where the cervix is only partially blocked) at about 16 weeks. After a very emotional discussion with our midwife, we decided to do a more thorough ultrasound study at a women’s health hospital. This was scheduled for 4 weeks after our first ultrasound.
On hearing the news, we were quite disheartened, uncertain and afraid of what it meant for us. Delivering vaginally with complete praevia is not an option, so it would mean a C-section in a hospital, both of which we were completely against. We decided to just wait and see what the second ultrasound said before starting to plan or even think about having to give birth in a hospital.
When our 20-week ultrasound at the specialist women’s hospital rolled around, we were eager and nervous about what we would find. After a thorough 45-minute ultrasound, doing a complete skeletal survey, we waited for the doctor to review the images. After seeing him shortly thereafter, he happily notified us that there was no indication of praevia and that the placenta was nowhere near the cervix.
After all was said and done, we looked into the matter a bit more (we intentionally didn’t do much research between 16 and 20 weeks to avoid scaring ourselves) and it turns out that many diagnoses of praevia completely rectify themselves, especially when the diagnosis comes early on in the pregnancy (before 20 weeks). This can either be because of mis-diagnosis or just because the placenta moves, or grows up away from the cervix. Back to my balloon analogy, if you imagine drawing a dot on an empty balloon near the neck and then blowing it up the dot will move away from the neck as the balloon expands.
The placenta can still feasibly move out of the way of the cervix before 28 weeks before you need to start considering alternatives, so if you get a diagnosis of praevia, don’t fret. Be encouraged that in most cases (I’ve heard as much as 90%), it resolves itself without intervention. It’s just another example of American medical professionals being overly-cautious to protect themselves from litigious people. If anything, I think it probably does more harm than good by causing the parents to worry about what it may mean for their birth and their child. Thankfully, our episode only lasted four weeks, but I encourage you to remain in high spirits because the chances are that all will be well.