Answer
By definition a low-lying placenta is a placenta whose edge is within 2 centimeters
of the cervical opening. This should be distinguished from a placenta previa in
which the placenta is actually covering the cervical opening. If the placenta
persists in covering the cervix in the late third trimester, this can pose a risk
of life-threatening bleeding and requires delivery by Cesarean section.
In contrast, a low-lying placenta (by definition) is not covering the cervix and
should not interfer with vaginal delivery or necessarily pose an increased risk of
vaginal bleeding. Of course there are some caveats to consider. Perhaps the most
important is the precise wording of the report. Occasionally ultrasound reports
will be evasive and not clearly indicate whether the placenta is a actually
covering the cervix. If the ultrasound report is clear that the placenta is not
over the cervix, our practice generally does not recommend specialized follow up or
procedures unless the patient is actually bleeding. Of course, if one of our
patients is having bleeding, we will generally follow her more closely regardless
of placenta location.
Another consideration is gestational age. As the pregnancy progresses, the placenta
covers less surface area of the uterus on a proportionate basis. As a practical
matter, most placentas that are seen to be covering the cervix in early pregnancy
will "move" up and away as the pregnancy progresses.
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