Literatus: Ahead of the child

IN BUSINESS, competition defines profitability. And going ahead of your competition is the name of the game.

In obstetrics, however, particularly in pregnancy management, a placenta going ahead of the baby can spell trouble for both the mother and the child. The condition is called placenta previa or “preceding placenta.”

It is a complication of pregnancy wherein the placenta grows in the lowest part of the womb, and in its complete form (type IV), completely covers the cervix. That sets up the mother to bleed severely in the latter part of pregnancy.

The danger of placenta previa cannot be overemphasized. It increased the risk of death for both the mother and the baby before childbirth via severe vaginal bleeding. Blood transfusion is often needed. Premature delivery can happen. And the newly born child may face growth restrictions later on.

While relatively uncommon at 0.5 percent of all pregnancies, it has increased worldwide. In England alone, its incidence ran at 6.3 per 1,000 births in 2010.

Factors of highest risk include advanced maternal age, multiple pregnancies, large
number of children, smoking, and illegal use of drugs. It also includes previous womb surgery such as caesarean section (CS).

A team of seven researchers from the UK conducted a review of all studies on placenta previa resulting from CS performed in first delivery, noting in the process important information that childbearing Filipino women may find helpful.

First, Asians (Filipinas included) have the lowest susceptibility to placenta previa (Caucasians have the highest).

Second, a very high risk for placenta previa is found in mothers who had CS in their previous delivery.

Third, diabetic mothers are very high risk. Diabetics create high levels of glucose in the infant bloodstream, stimulating excessive formation of urine that is deposited into the amniotic sac as amniotic fluid. Fetal urine is a major source of amniotic fluid. When the amniotic fluid index reaches more than 24 centimeters, a troubling condition called Polyhydramnios now exists. It literally means “excessive amniotic fluid,” and it is the highest relative risk factor so far toward placenta previa.

Lastly, very short intervals of childbirth (less than a year) as well as long intervals of more than four years are also high risk factors.

Ipek Gurol-Urganci of the Department of Health Services Research and Policy (London, UK), and her colleagues, estimated in their report in BMC Pregnancy and Childbirth (2011) that for every 359 CS deliveries, an additional case of placenta previa at second birth is likely to happen.

It is easy to be enriched by children. An English proverb goes: “Children are poor men’s riches.”