The placenta is the lifeline for a developing baby. Attached to the wall of the uterus during pregnancy, it provides oxygen and nutrients to the fetus through the umbilical cord. Problems with the placenta are rare. But when they do happen, they can be life-threatening for the mother, baby, or both by causing severe bleeding or depriving the baby of nourishment.
Specialists in the Institute for Placental Medicine at NewYork-Presbyterian Queens have exceptional experience and skills caring for women with placental problems. Our team's goal is to address these disorders early, bring the pregnancy safely to term, and perform a delivery that results in a healthy baby and a healthy mother. The Institute is a major referral center for pregnant women with complications of the placenta and offers an unparalleled level of care and expertise.
A Team of Experts
Patients with placental disorders benefit from all of the healthcare providers they may need, all in one hospital. We customize a team of specialists needed for each woman's care. This team meets regularly at a scheduled multidisciplinary meeting to discuss each case. Your team may include:
- Maternal-fetal medicine physicians, who have advanced training in the care of high-risk pregnancies
- Neonatologists (doctors with specialized training in newborn care)
- Anesthesiologists (typically two in the operating room during C-section delivery)
- Gynecologic oncologists (who have experience in complicated hysterectomies)
- Urologists (who may insert stents in the patient's ureters at the beginning of the procedure to prevent damage to the urinary system)
- Physician assistants and nurses
- General surgeons
- Vascular surgeons
Types of Placental Problems
The most common placental disorders we treat are:
- Placenta previa. During early pregnancy, it is common for the placenta to be low in the uterus. By the third trimester, however, the placenta should be near the top of the uterus so the cervix (the opening to the uterus) is open for delivery. With placenta previa, the placenta grows in the lowest part of the uterus and covers all or part of the opening to the cervix.
- Placenta accreta spectrum. With placenta accreta disorders, the placenta grows too deeply into the wall of the uterus and does not detach normally. This condition can cause severe bleeding if not well treated.
- Vasa previa. With vasa previa, fetal blood vessels cross or run in close to the opening of the cervix inside the uterus. Vasa previa needs to be treated to prevent rupture of supporting membranes, which would cause life-threatening bleeding for the baby.
How We Diagnose Placental Disorders
If a prenatal ultrasound suggests you have a problem with the placenta, we will do additional testing to confirm the diagnosis. It is vital to obtain an accurate diagnosis as early in your pregnancy as possible so we can monitor you, keep you and your baby healthy, and plan for a successful delivery. Our diagnostic tools include:
- Ultrasound. We employ abdominal and transvaginal ultrasound to diagnose and monitor you and your baby throughout your pregnancy.
- Magnetic resonance imaging (MRI). Combined with ultrasound, this imaging test can provide additional information to confirm the diagnosis.
Treatment of Placental Disorders
Women with placental disorders have a C-section to deliver their babies. We use regional anesthesia so you can remain awake for your baby's birth and only sedate you if it is necessary. The operating room team places a second intravenous line in place so we can do a blood transfusion if needed. We use "cell saver" technology to collect, clean, and re-infuse your own blood in case of severe bleeding. Specific treatment approaches include:
- Placenta previa. Our team monitors patients throughout pregnancy and advises them to call 911 or go to the emergency room immediately if there is any bleeding. At 36 to 38 weeks of pregnancy, we perform a C-section to deliver the baby (earlier if there is bleeding that does not stop).
- Placenta accreta. The patient has a C-section to deliver the baby at 34 to 36 weeks, followed immediately by a hysterectomy. Our team believes this is the safest approach to prevent excessive bleeding. Most women with placenta accreta have had prior pregnancies and are therefore amenable to hysterectomy after delivery.
- Vasa previa. The goal with vasa previa is to perform a C-section before labor begins, but as late in pregnancy as possible. Labor could result in rupture of the membranes and bleeding. We typically perform the C-section between 34 and 37 weeks of pregnancy, as decided on a case-by-case basis.
Why Choose NewYork-Presbyterian Queens for Care of Placental Disorders?
Placental disorders are so rare that most ob/gyns only see a few cases in their careers. That's why it's so important to come to a hospital with a team that has as much experience as ours, a multidisciplinary team approach to care for women and their babies, and a dedication to clinical research to better understand and treat placental disorders.