Imagine the thrill of awaiting the arrival of your baby, the tiny heartbeat echoing in your ears during ultrasound visits, the kicks and movements that playfully nudge you from the inside. Now, imagine being told there's a complication called placenta previa that could overshadow that joy. It's a term that may sound foreign and intimidating, but for many expecting mothers, it's a reality they confront. 

Placenta previa is a condition where the placenta partially or fully covers the cervix, often leading to a necessary cesarean delivery and increasing the risk of severe bleeding and complications for both mother and baby. This condition occurs in approximately 0.5% of pregnancies, with the risk mildly higher if the woman has had it during a previous pregnancy. 

In this article, we will discuss what placenta previa is, how to identify it, and what causes it. We will also identify functional medicine labs that can help to individualize treatment for patients with this condition, along with a functional medicine overview of treatment. 

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What is Placenta Previa?

During pregnancy, an essential organ known as the placenta develops inside the uterus, primarily providing the fetus with oxygen and nutrients while eliminating waste. Usually, the placenta attaches either to the top or the side of the uterus. However, in conditions termed as placenta previa, the placenta's position is lower in the uterus, potentially partially or entirely covering the cervix, the opening of the uterus (1).  

This particular positioning can lead to complications, most notably bleeding, which can arise at various stages of the pregnancy — before, during, or even after the birth of the child. In some situations, as the uterus grows during the progression of the pregnancy, this might cause a shift in the placenta's position, possibly resolving the concern on its own. If this self-correction doesn't occur, delivering the baby safely usually involves performing a C-section (1). 

Placenta Previa Signs & Symptoms

One of the most identifiable signs of placenta previa, particularly after the 20th week of pregnancy, is bright red vaginal bleeding without associated pain. While in some instances, light spotting may precede this significant blood loss, for others, the bleeding may not become evident until the onset of labor. Moreover, certain triggers like sexual intercourse, medical examinations, or even prelabor uterine contractions can induce this bleeding. 

However, it's essential to note that many times there might be no discernible event or reason leading to the bleeding episode. Upon speculum examination, the extent of bleeding can vary from minimal to quite active, and in cases where the cervix is dilated, the placenta might be visible. Notably, a digital examination is highly discouraged as it can provoke massive hemorrhage (4).

What Causes Placenta Previa?

The precise cause of placenta previa remains unknown, though several factors associated with its occurrence have been pinpointed. During the early stages of a successful pregnancy, a fertilized egg, known as the zygote, requires an environment rich in oxygen and collagen for implantation. The blastocyst, comprising trophoblast cells and forming an outer layer of the dividing zygote, matures into the placenta and fetal membranes. In a typical gestation process, these trophoblast cells attach themselves to the decidua basalis of the endometrium. Yet, scars already present on the uterus offer an environment flush with oxygen and collagen, luring the trophoblast. Such adherence of the trophoblast to a uterine scar might lead to the placenta either concealing the cervical os or even intruding into the walls of the myometrium (1).

Concurrently, there are a host of risk factors that heighten the probability of developing placenta previa. Among these are advanced maternal age, especially being 35 years or older, having had prior pregnancies or currently expecting multiple fetuses, previous cesarean section deliveries or any surgeries that result in uterine scarring, having a history of placenta previa, undergoing treatments like assisted reproductive technology (ART) for fertility issues, and certain lifestyle choices such as smoking or cocaine use. It's important to understand that even if one or more of these risk factors are present, it doesn't necessarily confirm the onset of placenta previa in an individual (4).

Functional Medicine Labs to Help Individualize Treatment Plans For Patients With Placenta Previa

While placenta previa's direct cause remains uncertain and no specific tests can predict or prevent its occurrence, maintaining optimal health during pregnancy can potentially support better outcomes and reduced risk of complications. Functional medicine labs play a pivotal role in this context by focusing on a holistic assessment of a pregnant woman's health, ensuring that any underlying imbalances or health concerns are addressed, which may indirectly reduce complications such as placenta previa.

Micronutrient Testing

This test can help to determine if the patient has any nutrient deficiencies that might be contributing to overall health challenges. Deficiencies in vital nutrients can influence pregnancy outcomes.

Food Sensitivity Testing 

Chronic inflammation can be exacerbated by food sensitivities. Through identifying and addressing potential triggers, overall inflammation can be reduced, which might support a healthier pregnancy environment.

Stress Hormone Testing 

Chronic stress can negatively impact pregnancy outcomes. By assessing stress hormones like cortisol, interventions can be made to support stress reduction.

Additional Lab Tests

Sonography, particularly in the first and second trimesters, is used to identify placenta previa and monitor its potential resolution by the third trimester. If a patient experiences vaginal bleeding in later pregnancy stages, a transabdominal sonogram is first conducted, followed by a more precise transvaginal sonogram if placenta previa is suspected. The same ultrasonographic method helps diagnose the placenta accreta spectrum (PAS), which identifies how deeply the placenta has attached. While MRI can be useful for specific placenta previa cases, especially those positioned at the back of the uterus, it hasn't shown significant advantages over sonography in terms of diagnosis or outcomes (1).

Conventional Treatment for Placenta Previa

Upon diagnosing placenta previa, cesarean delivery is scheduled for 36 to 37 weeks, though complications might necessitate an earlier delivery. If a patient with a known history of placenta previa experiences vaginal bleeding, immediate vital and fetal monitoring begins, coupled with preparations for a potential blood transfusion. A C-section is meticulously planned, involving coordinated communication among various medical teams to prepare for potential complications, including uncontrolled postpartum hemorrhage or placenta accreta spectrum (PAS) (1).

Integrative Medicine Treatment for Placenta Previa

By adopting a well-rounded approach, integrative medicine seeks to improve overall health during pregnancy, aiming for the most beneficial outcomes for placenta previa patients.

Nutrition Guidelines For Placenta Previa Patients

When diagnosed with placenta previa, it becomes even more important for expecting mothers to ensure they're nourishing their bodies in the best way possible. Although there's no specific diet tailored for placenta previa, adopting a nutritionally balanced diet, such as the Mediterranean diet, can support overall health during pregnancy and may benefit both the mother and the baby. The Mediterranean diet is characterized by its emphasis on fresh fruits, vegetables, whole grains, lean proteins, and healthy fats.

Supplements & Herbs For Placenta Previa Patients

For a healthy pregnancy, women, especially those diagnosed with conditions like placenta previa, are advised to take a prenatal multivitamin to ensure they're receiving essential nutrients vital for both maternal and fetal health (10). 

Complementary and Integrative Medicine

Complementary and integrative medicine for placenta previa aims to ensure the healthiest possible pregnancy. Techniques generally used during pregnancy may include visiting a chiropractor, acupuncturist, or yoga instructor. Acupuncturists address imbalances in the body's energy flow, helping alleviate symptoms like nausea and insomnia. 

Chiropractors specialize in musculoskeletal issues, offering relief for pregnancy-related back and joint pain. Prenatal yoga emphasizes breathing and posture tailored for expectant mothers, aiding in stress reduction and muscle strength. Other therapies can include mind-body techniques such as deep breathing, progressive relaxation, guided imagery, and meditation. 

However, it's vital for individuals with placenta previa to consult their obstetrician or primary healthcare provider before starting any complementary therapies, as their suitability can vary based on the severity of the condition and other medical factors. Collaborating with these therapies alongside conventional prenatal care ensures a safe, holistic, and comprehensive healthcare experience during pregnancy.

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Summary

In summary, placenta previa is a condition that requires careful attention and individualized treatment. While traditional medical interventions, such as cesarean deliveries, remain essential, integrative and complementary therapies can offer additional support. Expectant mothers diagnosed with this condition benefit from a well-rounded approach that focuses on the health of both mother and baby. Ensuring open communication with healthcare providers and remaining informed about available treatments will lead to the most optimal pregnancy outcomes.