How A Woman With Placenta Previa, Fibroid Gave Birth To A Healthy Baby

How A Woman With Placenta Previa, Fibroid Gave Birth To A Healthy Baby
Representational image/Freepik

The patient was advised "complete bed rest" as activities like walking fast or lifting weights could have triggered bleeding and increased the chances of premature delivery.

Written by Prerna Mittra |Updated : November 23, 2023 10:01 AM IST

Just recently, a particularly-challenging gynaecological case reached Kharghar's Motherhood Hospital, when a 32-year-old woman came in with placenta previa and a huge fibroid -- measuring 10x10 cm (the size of a handball) -- while being pregnant. A team of doctors led by Dr Shaifali Patil, consultant-obstetrician and gynecologist assisted her throughout the pregnancy, helping her deliver a healthy baby weighing 2.7 kg.

The patient, a resident of Navi Mumbai and a banker by profession, was thrilled to learn about her second pregnancy. But, during a routine checkup in her fifth month, it was found that she had complete placenta previa, a condition where the placenta is located in the lower segment of the uterus, covering the cervix. She was also carrying a large fibroid.

Further examination through sonography confirmed the placenta had not moved to the upper segment of the uterus. The woman was recommended treatment at Motherhood Hospital in Kharghar.

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Dr Patil explained that complete placenta previa is a condition where the placenta partially or completely covers the opening of the uterus. The overall prevalence of placenta previa is 5.2 per 1,000 pregnancies. It can cause vaginal bleeding during pregnancy or labour; excessive bleeding can lead to anemia, shock, and emergency surgery. The baby may experience oxygen and nutrient deprivation that increases the risk of premature birth. There may also be a risk of the placenta attaching deeply to the uterine wall, requiring a hysterectomy.

What causes placenta previa?

The reasons can be many: lower egg implantation, uterine lining abnormalities (fibroids, scarring), placental abnormalities, and multiple babies or pregnancies (twins, previous deliveries). In this patient's case, it was the low implantation of the gestational sac. Which means, the fertilized egg attaches itself to a lower part of the uterus. It is a rare and dangerous condition, the doctor added.

What are uterine fibroids?

Myoma, also known as uterine fibroids, are non-cancerous growths that develop in the uterus. They are made up of muscle and fibrous tissue and vary in size and location. Their presence causes discomfort, placental complications, preterm labour, and abnormal bleeding.

The patient was advised "complete bed rest" as activities like walking fast or lifting weights could trigger bleeding and increase the chances of premature labour and delivery.

[caption id="attachment_1035743" align="alignnone" width="1200"]Pregnancy complications, low-lying placenta, placenta previa, fibroids, case of placenta previa, placenta previa and successful delivery, placenta previa and fibroid during pregnancy, huge fibroid during pregnancy, case study Representational image/Freepik[/caption]

In the 33rd week of her pregnancy, this patient experienced a sharp abdominal pain with difficulty in urination and bowel movement. She was suffering from, what is known as, 'red degeneration', a condition where degenerative changes are seen in the fibroid during pregnancy. She was administered paracetamol and antacid injections, and discharged after two days. In the 36th week, when the patient went into labour, an antenatal checkup revealed the possibility of bleeding. A C-section delivery ensured the safety of both the mother and her baby, a girl. Later, an open myomectomy was performed to remove the placenta and myoma.

It should be noted that an open myomectomy, if not properly managed, can cause bleeding during the procedure, a potential risk of miscarriage due to damage to the uterus or placenta, higher risk of infection affecting both mother and fetus, and an increased risk of uterine wall weakening and subsequent rupture during labour or future pregnancies.

"Regular antenatal checkups, proper nutrition, and close monitoring are essential components of managing high-risk pregnancies like this one," said the doctor, adding that it is still possible to conceive naturally while having a fibroid in the uterus, as in this patient's case, the fibroid was at a different location or was "subserosal", meaning the fibroid developed on the outside of the uterus under the 'serosa', the smooth outer layer.