Introduction: The report of low-lying placenta on sonography during pregnancy increases anxiety and raises questions about the possibility of complications during pregnancy. Let us understand in simple words about this condition of low lying placenta LLP.
What is the placenta?
The placenta is a special organ that develops alongside the baby during pregnancy. It’s an admixture of tissues contributed both from the mother as well as the baby and is a richly vascular ( blood containing ) structure with a limited lifespan of 28 weeks as during the first 12 weeks it’s still in the formative phase. It secretes hormones for pregnancy maintenance and transfers nutrition through the cord attached to the baby. It helps the baby get nutrition and to give off unwanted substances. The placenta is an active connection between the mother and the baby.
Where the placenta is normally placed?
The placenta is placed inside the womb in its upper segment. The cavity of the womb is divided into upper and lower segments and the upper part is thicker and better perfused by blood than the lower segment.
What is low-lying placenta LLP?
Placenta when situated closure to the womb opening (the cervix), in the lower segment of the womb is called low lying placenta.
What are the concerns about low lying placenta?
The low-lying placenta can be a suggestion that the placenta is eventually going to be a Previa i.e. baby comes first and then the placenta but here the placenta is ahead of the baby. Also, it has a risk of causing bleeding from the vagina in response to excessive movements, constipation, or sexual activity.LLP also may be less perfused than the placenta placed in the upper segment.LLP eventually migrates and at a later scan it will be in the upper segment
What is placental migration?
Placenta actually does not migrate but it is a relative migration. As the pregnancy grows the womb also grows and thus the distance from the lower edge of the placenta and the internal opening of the cervix on sonographic measurement increases. This is called placental migration when the LLP on sonography is found to be in the upper segment.
Can the LLP correct itself?
Yes if it’s normally attached it can migrate to the upper segment as mentioned above
What if it remains low-lying?
Some pathological conditions are associated with LLP and these are life greatening due to pathological attachment of the placenta. As we know after the birth of the baby the placenta also gets separated and is delivered. Thus placenta is a deciduous organ that is eventually shed. In pathologically adherent placenta the placenta is stuck to the womb up to its muscle cover or even beyond it or going beyond this to adjacent structures such as the urine bag or others. This condition is called MAP or morbidly adherent placenta or placenta accrete syndrome. We will discuss this in the next blog. The MAP or PAS requires regular sonographic imaging or sometimes MRI to help the doctor to diagnose
Why does this occur and can it be prevented?
LLP can be a result of any womb scarring due to previous surgeries such as pregnancy termination, multiple pregnancies, surgery for repair of fibroid removal or cesarean section, or any infection in the uterus. These are only noted in history but no proactive measure can be taken to prevent LLP. However early detection by timely sonography as suggested by your doctor helps to diagnose early and help by supportive measures to prevent disastrous complications.
What care do I need to take if diagnosed with LLP?
Do not panic
Eat well and take enough rest to improve placental function
Do not do strenuous work or lift heavyweights
Do not travel without reason and do not have intimate relations
Follow the doctor’s advice and do regular sonography surveillance.
Be happy and well informed.
Dr. Girija Wagh