Ages & Stages: Pregnancy: Your First Connection to Baby

Julianna Rhodes is a nurse. Her husband is a pediatric cardiologist. These two circumstances are very likely the reason her infant daughter, Harper, is alive today. Despite thorough screening, including a detailed “level 2” ultrasound, Rhodes had an undiagnosed condition called vasa previa that endangered Harper’s life just as she was being born. This condition had nothing to do with baby or mother — both were healthy. It had everything to do with the connection between them.

“It is just as important to assess the placenta/cord location as it is to assess the health of the baby [during ultrasound]. Many, including myself with my three pregnancies, focus on the baby’s health and findings,” Rhodes says. “Little did I know that not putting enough emphasis on questioning about my placenta/umbilical cord status could jeopardize the life of my normal, healthy baby.”

Rhodes’ situation shows that moms can play an active role in providing information and asking questions about their ultrasounds beyond the baby’s health and gender. The following are some of the conditions relating to the placenta that may be assessed and diagnosed during ultrasounds.

Vasa Previa
Although relatively uncommon, it seems that as technology has improved, vasa previa is more frequently diagnosed. Dr. Linda Fetko, an obstetrician with Durham Obstetrics and Gynecology, explains that the condition “is when the blood vessels that go between the baby’s umbilical cord and the placenta cross over the cervix so when the cervix dilates the blood vessels can tear.”

According to Fetko, the placenta can be thought of as little fingers that go into the umbilical cord and interlace the mom’s blood supply and the baby’s blood supply. “The mom’s blood and the baby’s blood don’t mix, but because they are so close together, nutrients and oxygen cross,” she explains. And when a mom with a vasa previa has a vaginal birth, the baby is denied that much-needed oxygen. The only safe delivery for these infants is a Caesarean section.

Although vasa previa is considered fairly rare — occurring in an estimated 1 in 3,000 births — it has a high fetal mortality rate, and moms with risk factors should inform their providers when getting prenatal care.

Risk factors for vasa previa include any previous uterine surgeries, including fibroid removal or prior Caesarean section, as well as a low-lying placenta. Moms with these conditions should be direct with their care providers and ask about the position of their placenta during ultrasound.

Diagnosing a vasa previa before it has tragic consequences is a challenge. “Even with very, very good ultrasounds, the vessels are very small so they can’t always be seen. The best way to see a vasa previa is to do a trans-vaginal ultrasound and use Doppler flow to look at the blood vessels going across the cervix,” Fetko says. And this sort of testing is not routinely performed.

Placenta Previa
While vasa previa is considered uncommon, placenta previa occurs in about 1 in 500 births. “Placenta previa is when the placenta itself lies over the cervix, so when the cervix dilates it can tear or bleed. Since the placenta is large . . . placenta previa is easy to screen for. It’s easier to see,” says Fetko.

This condition often is spotted during ultrasound. However, many of the same risk factors for vasa previa occur with placenta previa, and both sets of moms should ask about the location of the placenta during an ultrasound.

Placental Abruption
Placental abruption occurs when the placenta itself separates from the uterine wall. In this case, the bleeding is coming from the mother, and the risk to the mother is as problematic as the risk to the baby. Moms who experience a placental abruption have a totally different set of risk factors.

According to Fetko, “This is a condition of poor placenta insertion or poor vascular connection. Women with clotting disorders, hypertension, tobacco and drug use — particularly cocaine because it causes an increase in the mom’s blood pressure — are all at greater risk. And this cannot be assessed until it happens.”

However, this is another case where good communication with your care provider can change the outcome of your pregnancy. “I would be more worried about a woman with chronic high blood pressure who is smoking cigarettes,” says Fetko. So, honesty with your care provider is the only way for her to know you are at risk.

It’s normal for expectant mothers to ask about their babies during pregnancy, but they should also ask about the connection between their body and their baby’s. The health of the placenta and its location can ensure that a healthy baby inside gets the right start outside.

Myths and Facts about the Placenta

Myth: Exercise and weight lifting can cause placental tears. Fact: “Exercise in moderation is very good. The problem we have is people who don’t do anything,” says Dr. Linda Fetko, an obstetrician with Durham Obstetrics and Gynecology.

Myth:Raising your arms over your head will loop the umbilical cord around the baby’s neck.
Fact: The umbilical cord location has nothing to do with the movements of the mother. Also, “you frequently cannot see on the ultrasound when the umbilical cord is looped around the baby’s neck. When the baby doesn’t do well with contractions or descent, we can determine this condition,” Fetko explains.

Myth: If I tell my doctor about my drug use or smoking, she will refuse to deliver my baby.
Fact: Good prenatal care depends on an honest relationship. “The way to get the best care you can is to do your part, make the appointments and, ideally, discuss risk factors before pregnancy. It’s nice to have these discussions before anything unusual is seen,” Fetko says.

Myth: If I transfer my records from my gynecologist or primary care physician to my obstetrician, I don’t need to talk about my past.
Fact: “If you have been seeing a primary care physician and go to an OB for your pregnancy, it’s nice to have a sit-down, clothes-on discussion of your medical past,” Fetko says. And some risk factors, like prior uterine surgeries, are critical to disclose.