Anterior Placenta

Mostly the placenta attaches to the back of the uterus. However, it can connect anywhere on the sides, top, bottom, and front (Anterior placenta) which shows up during an ultrasound.

What is an Anterior Placenta?

When the egg implants on the front wall of the uterus it is known as an Anterior Placenta. It can be diagnosed by carrying an ultrasound during the 20th week. The development does not impact the fetus instead fulfills the nourishment.

Symptoms

  • The movement of the fetus becomes challenging to feel any are stronger along the sides and lower down
  • A handheld Doppler will take more time to find the fetal heartbeat
  • Fewer movements in the second trimester

Note: Go for an ultrasound if a woman doesn’t feel any movement by the 23rd week

Typical Placenta Location

The placenta can attach anywhere in the uterus but usually positions at either top or the side. However, if it attaches to the front of the stomach, it is known as the Anterior Placenta. The posterior placenta is a condition when it connects to the back of the uterus. The doctor needs an ultrasound in the mid-trimester between the 18-21 weeks.

How is it Different?

The anterior positioning of the placenta does not make any difference and continues to nourish the fetus regardless of the position. However, there are few differences due to the front area like extra space between the stomach and the fetus where one might not feel kicks and punches because of the spacing. Also, listening to the heart sounds may become difficult.

If one experiences trauma or falls due to a car accident, call the doctor immediately as such injuries can affect the health of the placenta and require a doctor’s examination.

What is Grading of the Placenta?

It is the placental ultrasound which lies on the maturity levels of the placenta reflecting the age starting from grade 1 to 3 as the trimesters increase. It starts with class zero at early trimester and matures as it advances.

Grade 0

  • Is the end of the first trimester to the starting of the second trimester (18 weeks or less)
  • Chorionic plate remains smooth, straight and has a dense unbroken line
  • The placenta lacks echogenic areas and has an uniform echotexture
  • Echogenicities basal layer is missing

Grade 1

  • Is the second trimester half to starting of the third trimester (18-29 weeks)
  • First stage of the maturity of the placenta
  • a clear unbroken line having a fine undulation can be found on the Chorionic plate.
  • A few dispersing Echogenic areas on the substance of the placenta

Grade 2

  • At the end of the third trimester (30 weeks or more)
  • Indentations found on Chorionic plate
  • The material of the placenta divides incompletely with the densities of the linear Echogenic
  • More extensive Calcifications can be seen on Basilar plate with a configuration of a ‘Dot-dash’

Grade 3

  • After the week 39
  • Complete indentations on Chorionic plate
  • Placental substance divides into compartments that demarcate the cotyledons
  • Basal layer remains denser

Will it Affect the Natural Birth Plan?

An Anterior Placenta does not affect the natural birth, however, it is correlated to Occipital Posterior (OP) positioning where the baby’s face remains towards the front of the mother called Occipital Anterior (OA).

According to a study, a fetus in an OP position during labor is more likely to have an Anterior Placenta. Some people believe that a woman with an anterior placenta feels more comfortable in an OP position.

An OP does not represent any risk but can cause back labor or more difficult labor. In some instances, it may require a c-section with Placenta Previa and sometimes no symptoms at all developing dangers.

Is an Anterior Placenta a problem?

All the positions along the uterine wall are reasonable, and the placental health or the development does not depend on it, therefore, having it is not a problem:

  • It can act as a cushion between the fetus and inside surface making it difficult to record the first movements.
  • Going for regular fetal health assessment even if the movement’s lack in the 23rd week reassures the mother
  • There are few strong movements felt in the second trimester compared to others where the placenta remains elsewhere
  • It does not pose any additional dangers to the fetal health because of the thick uterine wall, abdominal muscles, and the fat
  • Birth complications are few and develop only when a C-section is required
  • The placenta can move upwards towards the uterus causing no difficulties at the delivery
  • If the Anterior Placenta is lying low in the womb at the time of birth, it might partially or wholly block the cervix requiring a cesarean also known as Placenta Previa.

Complications

  • Cesarean resulting in bleeding while giving birth
  • While inserting a needle, it may induce risks of bleeding, seeding, and rupture in the membrane
  • Back labor and posterior presentation causing severe painful contractions and back pain during the delivery
  • Placenta Previa
  • Placenta Accreta (Anterior Placenta grows over the site of old cesarean scar through the wall of the uterus

Ultrasounds and MRI scans can diagnose these conditions well to have a safe delivery.

What About a C-Section?

On having an Anterior Placenta, a cesarean is not only the delivery option however if the opening of the vagina uncovers those having it can deliver usually.

Anterior Placenta & Baby Movement

An Anterior Placenta is like a cushion between the skin and the fetus where the doctor can detect the movements and the heartbeat in the later trimester through a handheld Doppler or a Fetometer. Ultrasounds are done to check the fetal health after 23 weeks.

At grade 3, the placenta remains calcified which is a regular part of the trimesters rather a matter of concern.

Extra care is needed in premature calcification with pre-existing conditions like diabetes, Placenta Previa, high BP and severe Anemia. This is because according to some researches if it occurs before the 32nd week, the fetus may have a low birth weight. Complications resulting from the placental calcification are uncommon and does not affect the fetus development.

Factors Causing Complications

It is not a reason for complications however if it combines with conditions like anterior low-lying placenta, placenta previa or a placental abruption, it can produce difficulties. It would eventually require a C-section if the placenta detaches from the uterine wall.

Prevention

  • Eat a well-balanced diet
  • Drink plenty of fluids
  • Practice safe exercises and include them in the daily routine
  • Stop taking the stress, overwork, drugs over and after eating
  • Opt for a handheld Doppler instead of a Fetoscope to hear the heartbeat.
  • Try belly mapping to figure out the position
  • According to a study, sleeping on the back is the best way to get a posterior placenta
  • Follow a positive mindset

When to Call the Doctor?

  • Abdominal pain
  • Vaginal bleeding
  • Constant urine contractions
  • Severe back pains

ICD-9 & ICD-10 Codes

ICD-9 code is 641.0

ICD-10 code is O44.10

References

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