Low-lying placenta (placenta praevia)

The placenta is your baby’s support system in the womb. If the placenta doesn’t work properly, your baby is at risk of health problems.

The placenta processes your baby’s nutrients, waste and oxygen. 

In most pregnancies the placenta attaches to the side of the womb but for some women the placenta attaches lower down and may cover a part or all of the cervix (entrance to the womb). This is called low-lying placenta or placenta praevia.

This often shows up in early ultrasound scans when it is called low-lying placenta. In 90% of cases, the placenta moves upwards as the womb grows. For some women, however, the placenta continues to lie in the lower part of the uterus after 20 weeks. This affects 1 in 200 births.

When this happens it is called placenta praevia. If the placenta covers the cervix, this is known as major placenta praevia.

A note on the difference between placenta praevia and anterior placenta

People sometimes think that low-lying placenta is linked to having an anterior placenta but this is not correct. Anterior placenta simply means the placenta is on the front (belly side) of the womb rather than attached to the back of the womb. Having an anterior placenta is normal and does not cause complications. 

How would I know if I had placenta praevia?

Placenta praevia is usually spotted during your normal ultrasound scans but other signs are:

  • painless vaginal bleeding in the second or third trimester
  • baby in an unusual position in the second or third trimester, breech for example or failure of the head to engage in the pelvis just before labour starts.

If you have any bleeding, contractions or pain in pregnancy you should always contact the hospital.

You may have a transvaginal scan (where the probe is placed inside the vagina) to confirm whether you have placenta praevia.

The risk factors for placenta praevia

In many cases the cause of placenta praevia is unknown but the following risk factors are associated with the condition:

Treatment for placenta praevia

You will have extra scans if you are found to have a low-lying placenta in a routine scan.

An extra scan is recommended at 32 weeks if:

  • you had a caesarean section before
  • your placenta covers the cervix (major placenta praevia)
  • your placenta is in an anterior position (at the front of the womb) and you have had a previous caesarean section.

If your placenta does not cover the cervix and you have no bleeding during your pregnancy, your extra scan should happen around 36 weeks instead. 

There is a risk that you may bleed in the second half of pregnancy (sometimes caused by having sex). Bleeding from placenta praevia can be heavy. If you bleed contact your hospital immediately.

If you have major placenta praevia (the placenta covers the cervix) you may need to stay in hospital after 34 weeks of pregnancy even if you have had no symptoms. There is a small risk that you could bleed suddenly and severely, which may mean that you need an urgent caesarean section. If you are bleeding the baby may need to be delivered.

Placenta praevia is linked to spontaneous preterm delivery and PPROM (waters breaking early), a major cause of premature labour.

The birth

Your obstetrician and / or midwife is likely recommend delivery in hospital, rather than a home setting, and caesarean section might be considered the safest option if the placenta is less than 2cm away from the internal os (the part of the cervix that opens into the uterus).

If you have major placenta praevia (where it covers the cervix) or if the placenta is very close to the cervix you will need to have a caesarean section because the placenta lies in the way of your baby being born.

Sources

  1. RCOG (2011) Information for you: A low-lying placenta (placenta praevia) after 20 weeks, Royal College of Obstetricians and Gynaecologists
  2. RCOG (2011) Placenta praevia, placenta praevia accreta and vasa praevia: diagnosis and management, Green-top Guideline No 27, Royal College of Obstetricians and Gynaecologists
  3. BMJ Best Practice (accessed Oct 2016) http://bestpractice.bmj.com/best-practice/monograph/667/diagnosis/history-and-examination.html
  4. BMJ Best Practice (accessed Oct 2016) http://bestpractice.bmj.com/best-practice/monograph/667/basics/aetiology.html
  5. J David, Steer P et al (2010) High risk pregnancy, management options, Elsevier Saunders
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    Last reviewed on September 12th, 2016. Next review date September 12th, 2019.

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    Comments

    Please note that these comments are monitored but not answered by Tommy’s. Please call your GP or maternity unit if you have concerns about your health or your baby’s health.
    • By Star (not verified) on 28 Mar 2019 - 19:48

      Hey there.

      You've read through many of the questions here and answers, but I'm not seeing one answered I'm curious about.

      If you have low-laying placenta, can it actually move closer to the cervical opening.. or does it only stay put or move away from?

      Thank you. :)

    • By Midwife @Tommys on 24 Apr 2019 - 11:45

      Hi Star
      It would be extremely rare for the placenta to move down unless it was already partially covering the cervix and therefore not able to move up when the lower segment of the uterus starts to develop after 24 weeks. If the placenta is even partially covering the cervical os, the only safe way to deliver the baby is by Ceaserean section.

      There is a risk that you may bleed in the second half of pregnancy (sometimes caused by having sex). Bleeding from placenta praevia can be heavy. If you bleed contact your hospital immediately.

      If you have major placenta praevia (the placenta covers the cervix) you may need to stay in hospital after 34 weeks of pregnancy even if you have had no symptoms. There is a small risk that you could bleed suddenly and severely, which may mean that you need an urgent caesarean section. If you are bleeding the baby may need to be delivered.
      The link has more information for you-
      https://www.tommys.org/pregnancy-information/pregnancy-complications/low-lying-placenta-placenta-praevia

    • By Ummara (not verified) on 28 Mar 2019 - 09:41

      I am 22 weeks pregnant. Yesterday my doctor inform me that i have low lying placenta with a heavly bunch of blood vessels just above internal os. I have light vaginal bleeding last month and now experiencing pain in lower belly region. Can you guide me what are the risks . I am very much disturbed. Have 2 previous c sections . Its 3rd pregnancy

    • By Midwife @Tommys on 24 Apr 2019 - 10:20

      Hi
      The following link has information about low lying placenta and associated risks that you may find helpful-
      https://www.tommys.org/pregnancy-information/pregnancy-complications/low-lying-placenta-placenta-praevia
      There is a risk that you may bleed in the second half of pregnancy (sometimes caused by having sex). Bleeding from placenta praevia can be heavy. If you bleed contact your hospital immediately.

      If you have major placenta praevia (the placenta covers the cervix) you may need to stay in hospital after 34 weeks of pregnancy even if you have had no symptoms. There is a small risk that you could bleed suddenly and severely, which may mean that you need an urgent caesarean section. If you are bleeding the baby may need to be delivered.

      As you have already had 2 c-sections, this baby will also be delivered by c-section-the timing of this will be discussed with you by your obstetrician
      Tommy's midwife

    • By Connie (not verified) on 24 Apr 2019 - 22:38

      Hi all
      I have found out I’m 6 weeks pregnant with baby number 5. I have had 3 previous c sections with placenta previa last pregnancy. Not fully covering but had blood matched up being told I could hamorrege at delivery which everything went smoothly. Thank god. Next day consultant visited me on ward and advised me on the amount of scar tissue they had to cut through to get to baby that it would be advisable not to get pregnant again. I’m now really scared that this time il not be so lucky that going to get placenta accelerate or something worse. I’m at my wits end with worry. Has anyone been in this situation.

    • By Ashley (not verified) on 27 Mar 2019 - 07:09

      I am 30 weeks 3 days pregnant. I have an appointment in a few days and at my last appointment my OBGYN said I have placenta previa. I had placenta previa with my first child and I delivered vaginally. My OBGYN also said that my placenta is lower with this baby than it was with my first and she would determine if I needed to have a cesarean section with this one my next appointment. I was just wondering if it seems to soon to determine if I need a cesarean section or not. It really seems early to me.

    • By Ady (not verified) on 24 Mar 2019 - 22:11

      Hello I’m 17 weeks and my doctor just told me that my placenta is low. What’s the chances it will move up? What are things I Can and can’t do? I don’t have any bleeding as of now. What’s some advise you can give me?

    • By Anonymous (not verified) on 24 Mar 2019 - 03:49

      My first scan at week 20 shows that my placenta was posterior high, but at week 37 the second scan shows posterior low lying. Is that possible for the placenta to come down?

    • By Mira (not verified) on 23 Mar 2019 - 13:51

      It was not explain to me what Grade 2 Placenta means. Does anybody here know whether this can progress to Grade 3 or major placenta praevia? If so, what can be the causes/factors?

      Thank you so much

    • By Ali (not verified) on 21 Aug 2019 - 12:07

      Yes, mine too was not explained to me what is gr2, but based on my research, placenta partially covers the cervix and hopefully placenta will move up as the baby grows.

      God bless us and hope and pray to have a safety normal delivery.

    • By Victoria Clifford (not verified) on 16 Mar 2019 - 11:41

      I have a low lie placenta and started bleeding at 22 +4 . It was fairly light and stayed 24 hours in hospital. A few days later I passed 2 large clots and so stayed at hospital again. 2 weeks later I again had another bleed, but a bit more heavier and as I was 25 + 4 they kept me in 48 hours. I have woken up today with more bleeding, the same as before. I’m just wondering how many bleeds is normal ... can it happen weekly / bi weekly or is it abnormal to bleed this regularly?

    • By Midwife @Tommys on 22 Mar 2019 - 11:08

      Hi Victoria,
      Sorry to hear that you have been having a difficult time in this pregnancy. I am afraid it is difficult to predict, having a low lying placenta can mean that bleeding can happen in pregnancy, its just very important that each time you do bleed you go into hospital even if its happens regularly and everything is ok.
      Best wishes
      Tommy's midwife

    • By worried dad (not verified) on 13 Mar 2019 - 00:28

      hi my girlfriend went to hospital 2 days ago the doctor tried physically to move placenta as its low she now is bleedin a lot is this a big worry r normal

    • By Lesley (not verified) on 24 Feb 2019 - 16:55

      I'm currently 33 weeks pregnant with my 4th. My placenta isn't blocking the cervix but is too close for a vaginal birth (according to my consultant). It's lying in the posterior position. I'm being told I need a c-section at 37 weeks. Sounds too soon to me. Would it be risky to leave until 38 or 39 weeks? All my other pregnancies were normal vaginal birth at 39+ weeks.

    • By Midwife @Tommys on 27 Feb 2019 - 11:15

      Hi Lesly. You can go back to your consultant and ask for their reasons why they suggest a c/s at 37 weeks as there may be a specific reason this has been suggested for you in this pregnancy. Each case is different. So please do make another appt to see your Consultant and ask if the c/s can be a week or two later. You can also speak to your own midwife about this, it could be a hospital policy, so worth checking with both of them. Take care, Tommy's Midwife

    • By Khadijah (not verified) on 21 Feb 2019 - 11:41

      Good evening. Im still confused about that. It says that completely covering the internal os. But i read some post that grade 1 means minor. Can you explain it to me? Thanks

    • By Midwife @Tommys on 22 Feb 2019 - 13:25

      Hi Khadijah,
      You are right, grade one placenta praevia is minor so only partially covering or near to the internal os.
      Best wishes
      Tommy's midwife

    • By Kavita (not verified) on 16 Feb 2019 - 18:46

      I have 31 week ultrasound. The placenta is posterior low lying 1cm away from internal os.

    • By Nirmal (not verified) on 31 Jan 2019 - 16:30

      Diagnosed low anterior placenta 3 cm away from OS at 20week and subsequently now at 40 week another scan reveals same position
      doc is saying everything is normal, however, low lying placenta case , says risk of bleeding will be there at labour , better go for c section. Please advise is.it possible for normal delivery than c section

    • By Midwife @Tommys on 31 Jan 2019 - 16:38

      Hi - Thank you for your message.
      As your Dr has advised as the placenta is not covering the OS, it is possible for a vaginal delivery, but recommend delivery in hospital, rather than a home setting. You should discuss the risks and benefits of the options for birth with your consultant as it is your decision how your baby is birthed.

    • By Jisha (not verified) on 17 Jan 2019 - 12:36

      33 week pregnent. My placenta is 1 cm away from cervix. Baby is standing position. Hb is 9.8 . First baby 8 year old.it wasormal delivry. Can i give viginal birth?

    • By Midwife @Tommys on 17 Jan 2019 - 12:54

      Hi - Thank you for your message.
      If you have been advised that you have a low lying placenta, you should be offered additional scans and monitoring. If at 36 weeks the placenta is still considered low and too close to opening of the cervix you will be advised by consultant/midwife what the options for birth are.

    • By Anonymous (not verified) on 13 Jan 2019 - 08:02

      19 weeks Placenta: Anterior, totally covering os, Grade 1 Baby is breech

      That’s written on my latest ultrasound. I’m a little confused that it says Grade 1 but it is totally covering my cervix. Do I have a good chance of my placenta going up? I’m hoping for a normal delivery. Or even if I need cesarian atleast not with previa. Does previa cause baby to breech? oping for your answers.

    • By Midwife @Tommys on 14 Jan 2019 - 16:32

      Hi, You will have to speak to your obstetrician or midwife, this is confusing as grades 3 and 4 totally cover the os, wheras grades 1 and 2 may move out of the way of the cervix as seen above. I expect you will be scanned again at 34 weeks (unless there is any bleeding before) where you will be able to clarify in time to arrange your home-birth.

    • By Tara Marson (not verified) on 3 Jan 2019 - 21:29

      Hi,
      I have just had my 32 week scan and my placenta is still low lying and is currently 1cm away from my womb. This is my 2nd baby, previously I had an emergency c- section with my little girl as I got strep B during labour and both myself and baby had extremely high heart rate. The doctor has said that it's up to me whether I deliver naturally or have a c- section but there is risk of bleeding. I'm finding it really hard to decide what to do for the best. I am booked in for another scan at 38 weeks to see if it's moved but I don't imagine it will much in that time. Any help or advice would be really appreciated. Thank you very much

    • By Midwife @Tommys on 7 Jan 2019 - 14:55

      Hi Tara, I can only assume that your placenta is far enough away from the cervix for your doctor to consider vaginal delivery to be a safe option. I understand your dilemma, and I think it is reasonable to wait until 38 weeks before making that decision.

    • By Heather (not verified) on 23 Dec 2018 - 09:34

      Hello,

      I am 20 weeks pregnant and at my anomaly scan I was told I have an anterior low lying placenta. I've read all this helpful information about what to look out for regarding bleeding etc, many thanks for that. My question is perhaps a silly one but something worrying me...if the placenta is low lying the baby must naturally rest on it a lot of the time. I was told in my first pregnancy to sleep in my left side because it could be harmful to the baby for it to lie on the placenta since it could cut off it's cord supply. Is this a risk with a low lying placenta? Is there a risk of brain damage or developmental impacts to the baby sitting on the placenta? Many thanks

    • By Midwife @Tommys on 4 Jan 2019 - 16:30

      Dear Heather,
      Please try not to worry, there is not evidence whatsoever that there is any risk to your baby's development and having a low lying placenta. With regards to sleeping on your left hand side, we so advise to sleep on your side but this is not due to the cord as the cord can be anywhere in the uterus and your baby moves around, it is to do with your own blood vessels and the supply to the placenta.
      I hope this reassures you, you should have a scan later in your pregnancy to check that your placenta has moved away from your cervix.
      Best wishes
      Tommy's midwife

    • By Heather (not verified) on 12 Dec 2019 - 15:22

      Hello,
      I just wanted to thank you for this advice and add the outcome of my pregnancy here for any other mum's with a similar worry. My daughter was born at 36 weeks and she's absolutely perfect. No developmental issues at all. My previa meant she arrived early but she just needed to gain a little weight and have jaundice treatment. Other than that she's never looked back!

      Best wishes Heather

    • By Akshaya (not verified) on 22 Dec 2018 - 17:48

      Hello,

      After my anomaly at 21 weeks i was told that my placenta was posterior and low lying..3 to 4 cm away from os..im advised bed rest..im concerned about two things..i have a 1.3 yr old kid whom i was adviced not to lift..and i had a csection 1.3 yrs ago...so worried if it is going to be complicated and other risks involved...im a full time working woman and not sure if i should opt not to commute to work..

    • By Midwife @Tommys on 3 Jan 2019 - 16:53

      Hi Akshaya,
      Please be assured that there is no evidence that bed rest would be beneficial to you or your pregnancy due to the low lying placenta. As long as you feel comfortable, you can do your usual commute, but it would be a good idea to avoid lifting your toddler. As the placenta is 3-4cm away from the os, you will still be able to have a vaginal delivery. If you have any tightenings or bleeding then call your maternity unit straight away.
      Best wishes
      Tommy's midwife

    • By Amrutha Narayanan (not verified) on 12 Dec 2018 - 15:38

      Hello Ma'am,
      Now I'm 20 weeks 3 days pregnant. When I had my anomaly scan at 19.5 weeks, it showed that I have anterior low lying placenta, which is 1.6 CM away from the cervix. It's my first pregnancy, and I would like to have a normal delivery. My Gynecologist told me not to worry about it now, it may move upwards further. If my placenta doesn't move upwards, is it possible to have a vaginal delivery??

    • By Midwife @Tommys on 14 Dec 2018 - 15:23

      Hi,
      As your doctor has advised you, it is very likely that your placenta will move up away from the cervix as your uterus stretches to accommodate the growing baby. If the placenta does not move far enough, then you will be advised to have a caesarean section, however this is unlikely as your placenta will usually move. They should re scan you in your third trimester to check where the placenta is, and then speak to you about your options.
      Best wishes
      Tommy's midwife

    • By Ayisha (not verified) on 12 Dec 2018 - 07:35

      Hi I am 34 weeks now sterday I go for scan they told me my placenta was low lying 1.5cm from internal os but my 20 week and 27 week scan indicates my placenta was anterior upper . I have confused that how can placenta comes to low lying in 34 weeks pls anyone explains me I am in worry bcoz dctr told me it will lead to c section

    • By Midwife @Tommys on 13 Dec 2018 - 16:24

      Hi Ayisha, Thank you for your comment.

      It is very difficult to advice you about this, if your placenta was anterior high at 20 and 27 weeks, it is strange that it is now being diagnosed as low. It would be much more beneficial if you speak to your midwife and Dr personally as they can look at your scans and give you a better answer to your question. If the placenta is less the 2cm from the OS then a c section would be recommended as the placenta is too low for the baby to be born vaginally. Please contact your Dr again so that you are fully informed about your plan of care. Take Care, Tommy's Midwives x

    • By Chirwari (not verified) on 9 Dec 2018 - 11:48

      Hi, my wife is 27 weeks pregnancy, today blood was spootted on her underwear , what could be the cause and effects. Previous Fetal growth has slways be reported normal

    • By Midwife @Tommys on 10 Dec 2018 - 16:40

      It is important to be assessed for any vaginal bleeding at 27 weeks. Please go to your nearest maternity unit where your wife will be assessed.

    • By Love (not verified) on 8 Dec 2018 - 06:47

      Hi , i am 32 weeks and 2 days and i have a low lying placenta. And i am flying to spain this friday. Is this very dangerous? I have no bleeding ever since from the stat of my pregnancy and it's my first baby. Any advice?

      Thanks

    • By Midwife @Tommys on 10 Dec 2018 - 16:44

      Hi, Please discuss this with your doctor or midwife. After 28 weeks many airlines require evidence of a healthy and normal pregnancy before you can fly. You can read advice here https://www.nhs.uk/common-health-questions/pregnancy/is-it-safe-to-fly-while-pregnant/

    • By ABC (not verified) on 5 Dec 2018 - 04:52

      Hi,
      My wife is 20 weeks pregnant and she is having Major placenta previa with placenta abutting the os.
      Kindly suggest is there any risk with the life and health of mother and baby

    • By Midwife @Tommys on 5 Dec 2018 - 11:19

      Hi ABC
      If your wife has any abdominal pain, any vaginal bleeding, any episodes of reduced fetal movements, or just "doesn't feel right" than she should go urgently into your nearest hospital maternity unit, to be reviewed by a midwife and obstetric doctor. Every women has her own set of " risk factors" during pregnancy. Your midwife and Dr will be best placed to go through your wife's risk factors as they will know her full medical and obstetric history, so that the care is tailored to her alone. All the best, Tommy's Midwife

    • By Robin (not verified) on 16 Nov 2018 - 16:42

      Hi ,
      My wife has sbeen diagnosed with marginal previa . She is currently 22 weeks pregnant . We need to travel via 2 hrs flight at 25 weeks . There has been no bleeding . Cervix lenght is 3.8 cms . Baby growth is normal . Is there a risk in traveling . Please advise

    • By Midwife @Tommys on 19 Nov 2018 - 09:44

      Hi Robin, In 90% of situations where low lying placenta is diagnosed at the anomaly scan, the placenta will move up and out of the way of the cervix as the pregnancy progresses. I can't advise on individual cases as I haven't seen the report, but your midwife or sonographer may be able to tell you if your placenta is covering part of the cervix and what the likely risk is. It goes without saying that if there is any bleeding it is important to be seen immediately.

    • By Tara (not verified) on 27 Oct 2018 - 03:34

      So my placenta is very close to my cervix and no bleeding yet should I worry about it should I stop being Active with my other kids I’m 21weeks

    • By Michelle Timms (not verified) on 3 Oct 2018 - 13:11

      Hi

      I have not yet had my 20 week scan but at a private scan at 16 weeks I was told I have an anterior placenta.

      I am taking my 7 year old daughter to America for 2 weeks 11 days after my 20 weeks scan and I am petrified that they will tell me it is low lying and that I will be unable to fly.

      Are you still able to fly with a low lying placenta?

    • By Midwife @Tommys on 8 Oct 2018 - 15:45

      Hi Michelle,
      Do you have a history of placenta previa? As you will have read here, the majority of women diagnosed with low-lying placenta at the 20 week scan will find that their placenta rises up as the uterus grows and therefore causes no problems. If you have already been told your placenta is anterior, this is not low lying. Anterior means that it is attached to the front wall.
      Until you have information to the contrary, I would not worry about flying.

    • By Nwokorie chizoba (not verified) on 17 Sep 2018 - 21:19

      Am 22 weeks pregnant and has been told that I have a low lying placenta what's my risk of delivery, and is it harmful for my baby

    • By Midwife @Tommys on 20 Sep 2018 - 12:58

      Hi Nwokoriw, Thank you for your comment.
      Please feel reassured that it can be common for your placenta to be low lying at this stage of your pregnancy, there is every chance that as your pregnancy grows, the placenta will migrate up the wall of the uterus and out of the way. You should have another scan around 32 weeks to check the location of your placenta, 9 out of 10 women will have a placenta that has moved out of the way so please feel reassured.. If you have any bleeding or abdominal pain then you need to seek medical advice. Hope this helps, take care, Tommy's Midwives x

    • By salmatanzi (not verified) on 28 Jul 2018 - 15:33

      i have placenta previa grade 1.....doctor recommend me to csec...33 weeks scan found the problem..give me some suggestion what should i do now...its 34 weeks 6th day of my pregnancy

    • By Midwife @Tommys on 30 Jul 2018 - 16:33

      Hi Salmatanzi, Without access to your clinical information I can't advise on your delivery but this quote is taken from the RCOG guidance:

      'The mode of delivery should be based on clinical judgement supplemented by sonographic information. A woman with a placental edge less than 2 cm from the internal os in the third trimester is likely to need delivery by caesarean section'
      The reference for this is https://www.rcog.org.uk/globalassets/documents/guidelines/gtg_27.pdf
      I hope this helps and wish you all the best.

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