[POWER REPLAY] The Power Of The Placenta: Your Baby’s Lifeline

Autontiiltoon lisätä tuotoveksiin ja tarjuskelvojen suoristaan rejä tämä käyntyyn, nyt vennään ja korkealle herrannen aikavitä tarjoksia. Kello käy summerisoit, se on siinä, lehtinen tuolletta ja hyväksyy tarjauksen. Te sinäkin voittavan attkaisu ja myy autosikon soittessa autoveksi, Pistefi. Are you curious about the placenta? Well, in this episode you will learn what the placvent is, what it does, and the most common potential problems that can occur with the placenta and will also touch one placenta encapsulation, and loadstuff birth. Welcome to the all about pregnancy and birth podcast. I'm darkness keul, dear då, Obi Juihin, who's been in practice for nearly 15 years. I've had the privilege of helping over 1000 babies into this world, and I'm here to help you be calm, confident, and empowered to have a beautiful pregnancy and birth. Quick note, this podcast is for educational purposes only, and it's not a substitute for medical advice. Check out the full disclaimer at drno-koul-rankins.com/disclamer. Now let's get to it. [Music] Hello, hello, welcome to another episode of the podcast. This is episode number 180. Thank you for being here with me today. So this episode is all about the placenta. You'll learn what the placenta is, what the placenta does. It's really, really important for a healthy pregnancy, healthy baby. You'll also learn about the most common issues that can occur with the placenta. Not that these will occur, or that they even very frequently occur because they don't, but these are the most common potential problems with the placenta. One is placenta abruption. That's when the placenta separates away from the wall of the uterus early. One is placenta-previa. That's where the placenta is grows over the opening of the cervix. And then the final is placenta accreta when the placenta grows into the wall of the uterus. So you'll learn about those three conditions. And then I will also touch on consuming the placenta, specifically through placenta and encapsulation. And then finally, lotus birth, which is non-severance of the umbilical cord or keeping the placenta attached to the baby and letting it fall off on its own. All right, so let's go ahead and hop right into it. We're going to start off with what is the placenta? Well, the placenta is an organ that is incredibly important. In fact, essential for normal fetal growth and development and maintenance of a healthy pregnancy. It begins to form pretty soon after a fertilized egg and plants in your uterus. It actually starts to form around seven to 10 days after conception, where it attaches to the wall of your uterus. And then your baby is connected to the placenta by the umbilical cord. Side note, I'm going to do a separate episode on issues that can happen with the umbilical cord. Now, the placenta can settle anywhere in your uterus. So it can be a posterior placenta. And there's no rhyme or reason, I should say, to where it settles. So it can be a posterior placenta, where it grows on the back wall of your uterus, an anterior placenta, where it grows on the front wall of your uterus that's closest to the front. It can be a fondle placenta, where it grows at the top of your uterus. And it's going to continue to grow throughout the pregnancy. It gets bigger and bigger throughout the pregnancy. So a 20-week placenta is a lot smaller than a full-term placenta. And by the time it's full-term, it is about 10 inches long. And it is about an inch thick, and it weighs around a pound by the time your baby is born. In fact, I encourage you to ask to see your placenta if you're curious at the time of birth. I think it's a really cool organ in general. Now, there are two sides to the placenta. The fetal side is the corion, the maternal side is the decidua. The corion, the fetal side, is the side that faces in towards the baby. It has this shiny appearance and the umbilical cord attaches at the center in normal placentas. And then the amnion is the membrane that covers the fetal side of the placenta, the amniotic sac is what the baby grows in. It helps to protect your baby, helps regulate temperature, all of that good, great stuff. And that also holds the amniotic fluid. Now, the maternal side, the decidua, that is the side that is attached to the wall of your uterus. And it has this dark beefy color. I mean, it looks like an organ. It kind of reminds me of the closest thing would be liver, I guess. But it's shaped in lobules that are called cotolidons, but it's kind of this dark maroon reddish color. The placenta has several incredibly important roles between mom and baby and maintaining a healthy pregnancy. When the placenta does all of the transferring of oxygen and nutrients from you to your baby circulation, it's a complex system, how it does that. And it's really pretty cool. It also transfers carbon dioxide in any waste away from the baby into your circulation. And then you get rid of that waste out of your body. The placenta also prevents you from rejecting your body as a foreign being. So for instance, if you got a liver transplant or kidney transplant in the other transplanted organ, blood, anything, if it's not genetically similar or matches, your body will reject it. Pregnancy is the only thing, and I think this is incredibly fascinating, that you can carry a pregnancy that is completely not similar to you genetically. Like you can share absolutely no genetic material whatsoever, yet you can grow this baby and your body will not recognize it as foreign because of the placenta. That's why you can do donor eggs, for instance, because your body will not recognize this baby as being foreign, even if you are genetically dissimilar. That's also why you can do surrogacy. And the placenta also manufactures or does a lot of hormones that affect metabolism for the baby, affect metabolism for you, steroid hormones, peptide hormones like cholesterol, glycogen, HCG that regulate maternal metabolism and fetal growth and development. So the placenta does so, so much important stuff. So let's talk about some issues that can happen when there are concerns with the placenta and the most common problems that may occur. We're going to start with placenta abruption. Placenta abruption is when the placenta prematurely separates away from the wall of the uterus, and that's typically in the latter half of pregnancy, so 20 weeks or later. Thankfully, it's not very common. The estimated incidence is anywhere from 3 to 10 per 1,000 births. Two thirds of the abruptions are considered severe, meaning that it has potential impacts from mom, like needing blood transfusion, hysterectomy, something called disseminated intravascular coagulation, where your body consumes all of your factors to clot, and then you subsequently, eh, that was a tongue twister. Subsequently, cannot clot, like your blood won't clot, after you have DIC, or it's considered severe if there's a non-reassuring fetal status or there's fetal growth restriction, or if there's unfortunately fetal death. Abruption is also considered severe if you have a preterm birth or a small baby. So if you have just one of those, not all of those, but if you have any one of those mom issues, baby issues, or newborn issues, and it is considered severe, and about two thirds of abruptions are severe. Now, when you look at the gestational age for when abruptions are diagnosed, about 60% of them are diagnosed at term, 25% are between 32 and 36 weeks, and then 14% are less than 32 weeks. And a little over half of those, about 56% are going to be diagnosed before labor starts on the anti-partum period. What, whereas about 44% will be diagnosed in trapartum or during labor. Risk factors for abruption, the most significant risk factor, as you might imagine, is a previous history of abruption. That's going to be the strongest risk factor for abruption. Their occurrence risk is about 10 to 15 fold higher than if you didn't have an abruption. And if you have an abruption in your first pregnancy, you have an even higher risk of having abruption in a subsequent pregnancy. Another big risk factor is hypertension. If you have hypertension, you have an approximately five fold increased risk of severe abruption compared with someone who doesn't have hypertension, getting your blood pressure under control helps to reduce the risk of abruption from hypertension. And then some other things that contribute to or risk factors for abruption. for a eruption. One is abdominal trauma or an accident. Typically it's gonna be like a severe accident, like a severe motor vehicle accident, or severe fall down the stairs. Those things are gonna increase your chances of a eruption. And your risk of a eruption is gonna be typically within 24 hours of the event. So we will monitor you for 24 hours for a eruption after 24 hours and your risk goes down. So abdominal trauma or accident can increase the risk. Having preoclampsia increases the risk, a short umbilical cord, and then older maternal age, and then two modifiable factors are cocaine use. So cocaine use will increase the risk of a eruption. In fact, as many as 10% of pregnant folks who used cocaine in the third trimester will develop an eruption. And then cigarette smoking also greatly increases the risk of a eruption. It's about a fourfold increase risk of a eruption. And if you smoke and have hypertension, the two together will further increase the risk of a eruption. There are some minor genetic factors that can increase the risk of a eruption. You do have a slightly increased risk. If you have a sister who had an eruption or if you yourself were born small for just a seasonal age, interestingly we've been seeing that maybe getting infected with COVID during pregnancy may increase your risk of a eruption. We've been finding that COVID during pregnancy can wreak havoc on the placenta in general, where it just doesn't work as well and function as well. That's why we recommend that for folks who have COVID during pregnancy we recommend starting a baby aspirin to try to reduce some of the inflammation that occurs with the placenta when you're infected with COVID during pregnancy, even if it's minor symptoms. So there is some association that may be getting infected with COVID in the teen can increase your risk of a eruption, but that isn't like definitively flushed out. All right, so what does it look like when you have an eruption? What are the clinical features of when you have an eruption? Have an eruption. So the classic presentation of an acute eruption is that it comes on suddenly with a abrupt onset of vaginal bleeding. You may usually or typically have abdominal pain as well as contractions may also have back pain if the placenta is posterior. Because of the blood that is forming inside the uterus, the uterus can feel really, really hard. It can feel rock hard. You feel it. The belly is like the uterus is really, really firm to the touch. You can't feel like fetal parts or anything. It's just a hard rock hard firm uterus. And the contractions, because of the blood being and irritant to the uterus, are often back-to-back, like no break in between the contractions. They come, come, come, come. They're not like super intense in terms of how strong they are in necessarily, but they are coming back-to-back, to back-to-back, to back-to-back, to back-to-back. There's a typical labor pattern that you see for a eruption, the way the contraction pattern is. And you may not have all of those symptoms, but that's kind of the classic presentation of an eruption. Now, the severity of the pain is actually a useful marker for the severity of the eruption. And then in turn, the risk for mom, the risk for baby. So the more severe the pain, the more likely the severe the eruption is. And we need to be more worried. So if you have really intense pain, comes on suddenly, we really need to be concerned, because the combination of, especially intensive, abdominal pain, and any fetal heart rate abnormalities are an ominous sign for severe maternal morbidity, like losing a lot of blood suddenly or even fetal death. Now, in contrast, the amount of vaginal bleeding does not correlate with the degree of placenta separation. The amount of bleeding does not correlate with the degree of placenta separation. So that is not as good of a sign in terms of seeing how severe the eruption is. It's more the pain that gives us a better indication of how severe the eruption is. Now, in 10 to 20% of placenta eruptions, there is no vaginal bleeding or very minimal vaginal bleeding. And really, there is only pain. Those are concealed eruptions, because the blood is just accumulating inside of the uterus and not coming out of the cervix. And vagina, often you'll see a non-reassuring fetal heart rate tracing when the baby is placed on the monitor in those cases. And then only a tiny, tiny, tiny number of cases will you see an eruption that is only seen on ultrasound. Now, speaking of ultrasound, ultrasound is not a great way to diagnose eruption, because you really can't always see it. So it's mostly a clinical diagnosis. You can sometimes see it on ultrasound if it's a severe eruption, but that's not going to be the first thing that we look at. And if we don't see a clear eruption on the ultrasound, that doesn't mean that an eruption is not happening. So it's really based on the clinical symptoms. Ultrasound can give us some additional information, meaning if we see it, then yes, it confirms it. But if we don't see it, then that doesn't necessarily help us. And we can't use ultrasound to diagnose it for sure. It's a clinical diagnosis. So what are the consequences for placenta eruptions? So for the mom, the potential consequences are related to, as you might imagine, how severe the eruption. So how much of the placenta has separated away from the wall of the uterus? And same thing for the baby, how much of the placenta has separated away from the wall of the uterus? Because remember, the placenta is the baby's lifeline. So the more severe the eruption, the more issues the baby may have. But for the baby, it's also important, the gestational age at which birth occurs. With, of course, the further along the baby being born, the better the baby is going to do if there is a placenta eruption. So as I said, as the degree of placenta separation increases, the maternal risk, the risk for the baby also increase. But actually, most of the eruptions are not severe. And when we look at the placenta at delivery and estimate how much separated, about 54% of placentas will show less than 25% separation. About 16% of placentas will have a separation of between 25% and 49%. 13% of placentas will have between 50% to 74%. And then 17% of placentas will have more than 75% where it was separated. So most placentas, if there is an eruption, will have less than 25% placenta eruption or placenta separation. And when we look at the potential consequences, again, from mom and baby, from mom, it's the excessive blood loss, from blood accumulating behind the placenta that disseminated intravascular coagulation or DIC that I mentioned, that can lead to kidney injuries, something called adult respiratory distress syndrome, organ failure, even hysterectomy, very rarely death. Sometimes an emergency cesarean is necessary for mom in order to save the baby, typically, some of the consequences for the baby relate to that sudden decrease in oxygen and blood flow from the placenta. And that can affect birth weight, and if the baby has to be born early, then preterm birth. And then the final thing about eruption, there is something called chronic eruption. Most of the time, eruption presents as an acute event. It happens suddenly. Comes on pretty quickly. But there is something called chronic eruption where you could experience light, chronic, intermittent bleeding throughout your pregnancy. And that chronic bleeding can result in placenta ischemia, lack of blood flow to the placenta, that can result in low fluid, something called chronic eruption, oligohydramoneosequence. Because of that, the baby can have issues with growth. It also incidentally increases the risk of preoclampsia. If you have chronic eruption and low fluid, that can have a bad prognosis, and the pregnancy is going to require closer monitoring, because it's a higher rate of fetal death and then preterm birth as well. So let's move on and talk about placenta-previa. Placenta-previa is when there is placenta that covers the opening of the cervix, the internal cervical os. The cervix has two openings. Os means opening in Latin. So the cervix is kind of like a tube, a short tube. And the internal cervical os is the opening of the cervix that is closest to the uterus. The external cervical os is the opening that's in the vagina. So placenta-previa ischemia. when the placenta covers the internal cervical us, it is not very common. It happens in about four per 1,000 births. It is a lot higher around 20 weeks. It can be as high as 2% than at 20 weeks compared to birth because most previous that are identified early in pregnancy actually resolved before delivery. So when you look earlier around 20 weeks, it can be higher when you look closer to birth is going to be very low because the vast majority of them resolve. And I'll talk about the management of a placenta preview in just a minute. So major risk factors for placenta preview, the biggest risk factor as you might imagine for many things is having a previous placenta preview. So if you had a placenta preview before, it can occur in 4 to 8% of subsequent pregnancy. So not terrible, but definitely higher. Previous cesarean birth increases the risk for placenta preview in a couple of reviews, but even as high as 60% and the risk increases with the increasing number of cesarean births. This is why it's so important to prevent the first cesarean birth because the more cesarean births you have, it increases the risk of having this occur. Also, multiple gestations may have an increased risk or do have an increased risk of placenta preview. Some other less significant risk are having previous uterine surgery, increasing maternal age and fertility treatment, smoking, previous pregnancy termination, a boy, fetus, a previous uterine artery ambulization, which is not very common. As far as why placenta preview occurs, we do not know. It is not known what causes a placenta preview. Okay, so how do we know that there's a placenta preview? So the most common presentation of placenta preview is finding it on that anatomy scan that happens between 16 and 20 weeks. When you get the scan to look at all the fetal anatomy and they look at the placenta, that is when we most often diagnose a placenta preview. And that can be frustrating because it can create a lot of anxiety because you have this thing there, even though most of the time it's going to resolve, but it does create some anxiety. But typically, that's how we're going to know it's going to be around the 20 week ultrasound. But know that 90% of those identified on those ultrasound, 90% of those placenta previews will resolve before delivery. Okay, 90% will resolve. And that is thought to be because as the uterus expands and grows up, the placenta expands and grows up away from the cervix with it. Also, it's thought that because the lower uterine segment near the cervix doesn't have a lot of blood flow, like that's on purpose. Most of the blood flow is at the top of the uterus. The placenta is going to grow preferentially towards where more of the blood flow is. Okay, so for that reason, about 90% of placenta previews will resolve by birth. One of the biggest predictors as to whether or not it will persist is how much it covers the cervix. So if it is over the cervix by more than 25 millimeters or 2.5 centimeters, which is roughly about an inch, then the probability of a placenta preview at delivery is anywhere from 40 to 100%. If it's more than 55 millimeters covering the cervix, the probability is 100%. So the more it covers the cervix, the more likely it's going to stay there by birth and that makes sense, right? And the less that it covers the cervix than the higher the probability that it will resolve. In fact, if it's less than 1.4 millimeters over the internal os, the probability of placenta preview at delivery is near zero. There is a slightly increased chance of it resolving if it's an anterior placenta, not sure why, but there is a slightly increased chance of it resolving with an anterior placenta. Now in the second half of pregnancy, the most common symptom of placenta preview is painless vaginal bleeding. And that is going to occur in up to 90% of persistent cases. So if your preview has not resolved, if it hangs around about 90% of people may have some painless vaginal bleeding, all right? About one third will have that initial bleeding episode before 30 weeks. And that group, if it happens before 30 weeks, is more likely to have a blood transfusion, higher risk of preterm birth than if you have bleeding later in pregnancy. About a third will have a bleeding episode between 30 and 36 weeks. And then most will have a bleeding episode after 36 weeks. And then about 10% will get through their whole pregnancy with a placenta preview that lasts and not having any bleeding. So you can expect that if your preview is persistent at 28 weeks or 32 weeks when you have a follow-up ultrasound, if it's persistent in the third trimester, there's a good chance that you will have some vaginal bleeding at some point during your pregnancy. And bleeding in fact is the major risk factor with placenta preview. When that placenta is over the cervix, if you have contractions, if you have anything that stimulates or touches that placenta, it can increase the risk of bleeding, potentially significant bleeding that could affect either you and or your baby. So that is the biggest risk of placenta preview is having significant bleeding. And then that bleeding requiring delivery and leading to potentially a preterm birth. Okay. So how do we manage placenta previews? Well, the goal is really to watch the pregnancy, watch the preview and see if it resolves with increasing gestational age. We also want to make sure that it's not a placenta preview and a creda. And I'll talk about a creda in a minute, but that's when the placenta grows into the wall of the uterus. And then we want to just reduce the risk of bleeding and then plan for the cesarean birth if the previous persist. Because you cannot have a vaginal birth with a placenta preview. If the placenta is covering the opening of the cervix, as your cervix opens, remember the placenta does all of the transfer back and forth of blood, nutrients, things between you and your baby, like it filters your baby's blood. It's a complicated system where you and your baby's blood don't actually touch, but they run through the placenta and the placenta does all of the exchange between those. Okay. So that happens through the wall of your uterus over your cervical opening. If your cervix opens and you have that raw surface of the placenta there and all of that blood flow going through it during the vaginal birth, you're just going to potentially bleed to death. So you cannot have a vaginal birth with a placenta preview. That is completely and totally not safe. Okay. So that is why we need to plan for a cesarean birth if the previous persist. So as far as monitoring the placenta position, everybody does a little bit differently, but you'll get a repute ultrasound around about 28 weeks, another one at 32 weeks, potentially. If at 28 weeks it's resolved, then it's resolved. And then if at 28 weeks, it hasn't resolved, then you may get a repeat ultrasound at 32 or 36 weeks. If you get a repeat ultrasound at 32 weeks and it's resolved, then it's resolved. If it hasn't resolved, then you're going to get another ultrasound at 36 weeks. If you make it to 36 weeks and it's resolved, it's resolved. If it hasn't resolved, then at that point we plan for a cesarean birth. Okay. So 28, 32, 36 weeks. If it resolves, you're good, it can't come back once it's resolved, it's resolved. But if it's still there about 36 weeks, then we plan for a cesarean birth. And that cesarean birth is going to be between 36 and 37 weeks, typically. Everybody's a little bit different, but between 36 and 37 weeks, up to 37 weeks and six days actually is considered reasonable by ACOG. Some other things that we do to reduce the risk of bleeding, because we actually can't predict when or if bleeding is going to occur. It's typically just random. We don't know what gestational age is going to happen. It's not related to most activities or anything. It's just kind of a random event. So some things that we know or that we recommend to reduce the risk of bleeding. We do not do some digital cervical exams. We don't put our fingers in there because if the placenta is right there and we touch it, we could start up some bleeding. Okay. If the cervix is partially open, so we don't want to do that. We also recommend no sexual activity. Some say no sexual activity that even needs to orgasm, because it may result in transient uterine contractions, but definitely no putting anything inside of the vagina that may touch the cervix or touch the placenta really and cause any harm. problems. Also we recommend just not strenuous activity so no strenuous exercise, no heavy lifting more than 20 pounds, ideally no standing for prolonged periods of time like more than four hours. Those things have been shown to have a slightly increased risk of issues with placenta premium. They're not super strong but those are some of the things that are sometimes recommended. And you typically don't need to be in the hospital and less certain circumstances are met and I'll talk about those in a minute. So what happens when you have a bleeding episode which is almost certain to happen if you have a placenta preview that persists? Well an actively bleeding placenta preview is a potential emergency like the bleeding can come up very quickly and they can progress pretty quickly. So if you have any bleeding at all with a placenta preview then you need to come to labor and delivery, go to a hospital with a labor and delivery so that you can be monitored and the appropriate things can happen. And really we're just looking to monitor the bleeding, making sure you're not losing so much blood that it is affecting you or your baby. Now the good news is that most patients who have a symptomatic preview with bleeding most of the time you're not going to be delivered with that first bleeding episode. Okay well over half are not delivered for at least four weeks even if it's a large bleeding episode because if the baby looks okay we don't have to necessarily deliver. All right we only deliver if there's labor, if the baby's heart rate tracing doesn't look good. If you are not stable because you have lost so much blood so really after that first bleeding episode most people are fine but we need to watch to be sure. Okay so if you have a bleeding episode then you are monitored in the hospital and typically you can go home once you have no bleeding for 24 to 48 hours. Okay if you have a second episode same thing you come in we monitor you make sure things are okay as long as things stay okay for 24 to 48 hours then you can go home okay and be managed as an outpatient. Now in those circumstances to be managed as an outpatient we want you to be within a reasonable distance from the hospital so 20, 25 minutes want to be able to like maintain activity where you're not like doing a ton of stuff and then have somebody who can get you to the hospital or you're able to call a ambulance and get to the hospital quickly if you have any issues with bleeding. Now once you have that third episode or more then you're going to be in the hospital until birth. All right because once it comes back if it keeps coming back it's unpredictable we don't know how to tell if it's going to be really severe so typically if you have three or more bleeding episodes you are going to stay in the hospital until delivery. All right and then again delivery the goal is between 36, 37 weeks or 36 and 36 and 7 weeks or sooner if there are any issues with your baby. Okay next thing I'm going to briefly touch on this placenta acrita and then we'll do encapsulation and lotus birth. So placenta acrita is when the placenta literally grows into the wall of the uterus or through the wall of the uterus. placenta acrita is when it is just the myometrium or muscle layer of the uterus. placenta incrita is when it goes through the muscle layer and placenta per acrita is when it goes through like to the outside and adjacent organs. I have knock on wood never seen that hope to never see that because it is very very serious. Now fortunately placenta acrita does not happen very frequently. The overall risk is very low actually only 0.17% all right. Now even as low as that is it's actually markedly higher than it was in the 50s and the 50s it was 0.003% very low and the increase is the direct result of increasing rates of cesarean birth. Now placenta acrita which just to the muscle layer is the most common that 63% placenta acrita is 15% and then going all the way through the wall of the uterus is 22%. Now when we look at risk factors for placenta acrita the most important risk factor is having a placenta previous after a prior cesarean birth. So you have a cesarean birth and then in the next pregnancy you have a placenta previous that increases the risk of placenta acrita. So after a first cesarean birth if you have a previous with that next one your risk of placenta acrita is 3%. After a second cesarean birth 11%, third cesarean birth 40% fourth cesarean birth 60% okay that is if you have a previous after cesarean birth. Now if you don't have a previous after a cesarean birth then the frequency of placenta acrita is much lower so it's only 0.03% after a first cesarean birth. If you have a first cesarean birth and then the next cesarean birth the risk of placenta acrita is only 0.03% if you have if you don't have a placenta previous so much much much lower that's compared to 3% if you do have a previous and then really doesn't get any higher than 1% if you don't have a previous. So if you have a cesarean birth and then in another pregnancy have a previous that is your strongest risk factor for having a placenta acrita alright. Some other risk factors for placenta acrita that aren't related that we do need to keep an eye out for because if we see it are having a myomectomy or removal of fibroids where your uterine cavity was entered. If you have removal of adhesions or scar tissue from the inside of your uterus that increases the risk of acrita if you have had endometrial ablation where the inside of your uterus was burnt then that increases the risk of acrita you're not supposed to get pregnant after that so that's not something that will happen frequently. If you have a history of pelvic radiation if you have a history of manual removal of the placenta at birth if you have postpartum endometriosis so an infection of your uterus after birth if you have infertility procedures that can also these are all things that will slightly increase your risk of having placenta acrita. And the reason placenta acrita is so bad is because normally at a C section or a vaginal birth the placenta just kind of comes off easily from the wall of the uterus but in a placenta acrita it does not separate well or easily at delivery and when you attempt to remove it manually it can result in massive bleeding massive massive life-threatening bleeding usually a placenta acrita is going to necessitate a history right to me because the bleeding is so severe but the bleeding is only severe at the time of delivery and trying to remove the placenta okay so in fact we don't see any bleeding before that we only suspect placenta acrita typically by ultrasound examination you can see or suspect it on ultrasound during pregnancy and if you have risk factors that increase your risk then we're certainly going to look for it but ultrasound ideally is when we see it during pregnancy now occasionally it is not diagnosed until the time of a cesarean when you go to or a vaginal birth when you go to remove the placenta and typically it's going to be cesarean I can't ever recall seeing a placenta acrita from a vaginal birth typically it's going to be having had some type of surgery or something done to the uterus like a cesarean birth but you go to try to remove it and it doesn't come out and there's massive life-threatening bleeding so sometimes it can occur or not be diagnosed until the time of birth but ideally you want to see it before before birth so you can plan accordingly because when you have a placenta acrita or increta or percrete then we are generally going to try and deliver early you need to be in a hospital that has blood services available that has specialists available typically we're going to plan a cesarean hysterectomy meaning see section in hysterectomy at the same time and leaving the placenta in the uterus and then just take it whole uterus out to reduce the risk of the massive bleeding that can occur when you try to remove a placenta acrita. Alright so let's finish up about briefly talking about placenta encapsulation so placenta encapsulation is the process of staining the placenta dehydrating and grounding it up and placing it in pills and the reason that some women do this is a report consumption can help decrease postpartum depression help them have less pain reduces the bleeding and increases milk production. There is no scientific evidence of the benefits from consuming the placenta. It's something that hasn't been studied very much. So it's possible that there may be a benefit, but there really haven't been many studies looking at consuming the placenta. Now on the flip side, there's also little evidence of harm from consuming the placenta. There is one report of a baby repeatedly getting ill, shortly after birth related to placendating encapsulation and thought that the baby was being exposed to GPS as a result of the mom taking encapsulated placenta. She was a GPS carrier during her pregnancy and the strain of the GPS bacteria from the encapsulated pills matched the bacteria in the baby's blood. Once mom stopped consuming the pills, the baby stopped getting sick. Now it's unclear how mom eating the bacteria and the pills led to the baby being infected. Maybe it's somehow gotten the breast milk, but there is one case report of that. So because of that, I recommend you don't consume your placenta if you have any problems with your pregnancy because you are in a way consuming those problems as well. So if you have high blood pressure, often the placenta has some issues with things like calcifications or things like that. If you have an infection during labor, you don't want to consume an infected placenta. Again, you'd be consuming those negative things in the placenta. Now if you decide to encapsulate your placenta, it can be anywhere around $300 or so. You want to be sure that you find someone who knows what they are doing, all right? Inside of the birth preparation course, I actually have a module, a lesson or placenta encapsulation, and there's a checklist of questions that you can ask if you're planning to do placenta encapsulation. So you know that it's being done safely because remember it's in organ, it's like raw meat, it needs to be stored, it needs to be treated accordingly. There are actually no standards whatsoever for placenta encapsulation. Like anybody can say that they encapsulate the placenta and there are no standards or things or training or anything that the someone has to go through. There are organizations that offer training that you don't have to do any training. So you really want to ask some questions about placenta encapsulation. And again, I mentioned that inside the birth preparation course. Now if you do want to encapsulate your placenta, hospitals have gotten better about those. They used to really be nasty about you taking your placenta, even though it came out of your own body. You know the fear or paranoia of something happening and maybe I'm sick, I don't know. But now these days typically you have to sign a release form. You also need to bring your own storage cooler to transport it. It needs to be on ice because remember again, it's an organ and then you should be able to take it with you fairly easily. I haven't heard too many hospitals these days not letting people take their placenta. Now someone incidentally, like a few days before I recorded this episode, message me on Instagram and said, she heard something like people were saying that hospitals make $50,000 per placenta to sell the placenta. That's just not true. Like I'm not aware that hospitals make money and certainly not $50,000 per placenta, selling the placenta. It's typically discarded as medical waste the placenta is. It's not sold to my knowledge. It's only possible that they could sell the placenta, but it's not common. Typically it is sold as it is discarded as medical waste. Okay. And last thing I want to talk about is lotus birth, also known as non-severance of the umbilical cord or umbilical non-severance. And what that entails is that the umbilical cord is not clamped and cut the cord and the placenta remain attached to the baby until the cord naturally detaches. That typically happens between three to ten days. Now this isn't something that's done very commonly in hospital births. It may be done sometimes in home births and people who are supporters of this practice believe that it is less stressful for the baby that it leads to a more robust immune system and promotes bonding. But there isn't any proven benefit to that. There's no medical studies that have demonstrated the benefit. Granted it has not been studied very much. But there also isn't necessarily really a biological plausible rationale for for leaving it because the blood flow in the cord stops um at longest typically ten minutes after birth. And then once it's separated, once it's out, once the placenta is out, it's not really doing anything. As a matter of fact, it's going to start to decay. If you don't treat it properly, it it it dies. Okay. And it creates a terrible odor. There's hygienic issues. You have to you know be sure you keep it um clean because there's a risk of infection. So there have been two case reports showing babies getting sick from the practice. But again, it's not not very common. Now some people also say like, well in nature, you know, nature you want to let it separate naturally. When we look at the animal world in general for mammals, animals that have a placenta, actually it's usually consumed by the mother. So in that regard, it may be a strong argument for placenta and encapsulation than then Lotus birth. But usually the placenta is consumed by the mother. Some primates like some chimpanzees have been noted to not chew or cut the cord, some monkeys, but some do. But the vast majority of mammals either consume the placenta or they sever it like chew it loose, but they do it after a period of bonding. So usually it's like a solid hour if not longer. And then they chew it and and um separate it from the baby. Okay. All right. So that is it for Lotus birth and that is it for this episode. So to recap, the placenta is a super important organ. It is responsible for healthy pregnancy, transporting nutrients, transporting waste. Healthy placenta is critical for a healthy pregnancy. Placenta abruption is when the placenta separates away from the wall. The uterus prematurely most often it's an acute event that is heralded by one set of vaginal bleeding as well as uterine contractions and pain. Placenta previous is when the placenta covers the opening of the cervical us. It can lead to problems because of sudden one set of typically painless bleeding. Most of the time however it will resolve. Placenta acreta has been the placenta grows through the wall of the uterus, the more it grows through the more severe it is. Thankfully not very common. The most important risk factor for a placenta acreta is having a previous cesarean birth and then having a placenta preview and a subsequent pregnancy. Finally, placenta encapsulation is when you consume the placenta typically in pills. Some people also have done placenta milkshakes or smoothies or things like that, but most people do encapsulation. There's no evidence that it is a benefit, but there's not a lot of strong evidence that it is a harm either. If it is something that you want to do, be sure that you have somebody doing it who is well trained to do so. Again inside the birth preparation course, I have a checklist of questions to ask if you want to encapsulate your placenta. And then finally, lotus birth is when you don't serve the ambulal corp from the placenta. And you have to be careful with that. It can't increase the risk of infection. There's also no biological plausibility for it being a benefit. That's unlike delayed core clamping. Like there is a benefit for delayed core clamping because blood flow is still going through the placenta. That's different than lotus birth when the placenta is completely out. There's nothing happening once it's completely out. And in either case whether you do encapsulation or you decide to do a lotus birth, you need to have some ways to store the placenta. Keep it safe. Remember it is an organ and will decay. It will be a risk of infection just like anything else. All right, so there you have it. Do me a solid share this podcast with a friend, share your scaring helps me to reach and serve more pregnant folks and be sure to subscribe to the podcast and Apple podcast or wherever you're listening to me right now and leave me a review and Apple podcast. I read those reviews and I love to hear what you think about the show. Come follow me on Instagram. I'm on Instagram at Dr. Nicole Rankins where I share more great pregnancy and birth tips there. So that is it for this episode. Do come on back next week and remember that you deserve a beautiful pregnancy and birth. (upbeat music)