The placenta is a highly specialized organ that develops during pregnancy. Anterior placenta is usually a harmless condition where this organ attaches to the front of the uterus (womb) instead of the posterior area. The placenta helps supply oxygen and nutrients to the developing fetus and carries away waste materials. In addition, it protects the baby from infections and produces hormones for the smooth progress of pregnancy and childbirth (1). Read on to know more about anterior placenta, including whether it affects the baby’s growth or your labor and delivery. Also, learn about some signs that indicate you should consult your doctor and some home care measures to follow.
What Is Anterior Placenta?
An anterior placenta is when the placenta attaches itself to the front of the uterus, close to the abdominal wall. While the placenta can attach itself anywhere in the uterus, it usually develops in the posterior (back) side, close to the spine. In the anterior placental position, most of the baby’s movements are masked by the placenta and may not be detected. An anterior placenta is a rare phenomenon and is more likely to happen if you had a cesarean earlier (2).
When Will You Know If You Have An Anterior Placenta?
The doctor checks the placental position in the 20th-week scan, which is also referred to as the ‘anomaly scan’ (3). The placental location can be described as:
Anterior: Implants on the front of the uterine wall
Posterior: Implants on the back of the uterine wall
Fundal: Attaches to the top of the uterine wall
Right or left lateral: Implants on the right or left side of the uterus (4)
Placenta previa: The placenta is positioned over the cervix (the opening of the uterus).
Does Anterior Placenta Affect Your Pregnancy?
An anterior placenta is not a cause for concern, but it might make certain things difficult. This prevents you from learning about the baby’s development as easily as the other mothers could. And that is annoying!
Does Anterior Placenta Affect Your Baby’s Growth And Development?
The anterior placenta may not affect the baby’s development or health. It may not make any difference to the fetus as long as it is cushioned in the placenta.
Does Anterior Placenta Affect Your Labor and Delivery?
There is a chance of normal delivery even with an anterior placenta, as long as the vaginal opening is not closed. Even in this case, the placenta gets separated from the uterine wall and is removed and sent for analysis, if necessary. However, research states that the anterior placenta might increase the need for labor inducement and a cesarean section. It might also delay the start of labor. There is also a slightly higher risk of postpartum hemorrhage (PPH) during vaginal deliveries (6).
What Are The Complications Of Having An Anterior Placenta?
An anterior placenta might not cause any complications during pregnancy. However, it could create complications during labor and delivery, when it grows towards the cervix instead of growing up towards the uterus.
It might pose risks during a c-section. The placental position could make the incision more difficult, thereby resulting in heavy bleeding during delivery. The anterior placenta may, therefore, increase the risk of excess bleeding during vaginal delivery too (6).
Needle positioning may become challenging in the case of amniocentesis, resulting in bleeding and tears in the membrane.
Women with an anterior placental position are likely to experience low back pain (7). You may develop back labor, which is a severe pain in the back that occurs with the contractions during labor.
A low-lying anterior placenta might increase the chance of placenta previa, which might partly or completely block the cervix, increasing the need for a c-section (8).
Anterior placenta over an old C-section scar might lead to placenta accreta (9), which causes the placenta to grow deep into the scar and also the uterine wall.
When the baby is in the breech position, your doctor performs a cephalic presentation for a smooth vaginal birth. But with an anterior placenta, it might not be possible to turn the baby from a breech position to head-down position, especially if it is low-lying anterior placenta (10).
An ultrasound and MRI scan might help detect the above conditions so that the doctor can plan for a cesarean delivery accordingly. The anterior placenta is also known to increase the risk of (8).
Pregnancy-induced hypertension Gestational diabetes mellitus Placental abruption Intrauterine growth retardation Intrauterine fetal death
These risks to the mother and the child could be rare. Regardless, it is best to consult a doctor to stay safe.
When To See A Doctor?
Check for the following signs and symptoms that might indicate placental issue:
Strong uterine contractions Abdominal pain Vaginal bleeding Severe back pain
If you have suffered an impact to your belly during a fall or trauma, get the injuries checked by a doctor. These injuries might affect placental health and may warrant a medical examination. Besides the doctor’s recommendations, a few homecare tips could also help to maintain placental health.
Home Care In The Case Of An Anterior Placenta
The following measures will keep up the placental health irrespective of any position. They will also make labor easy, thus keeping both the mother and the baby healthy.
Eat well for nourishing the placenta. Include more leafy green vegetables, whole grains, nuts, and healthy fats. Minimize the consumption of processed and salty foods.
Hydrate yourself by drinking more water and juices. Placenta requires fluids to drain the fetal waste.
If you are allowed to exercise, brisk walking, prenatal yoga, and pelvic floor exercises can be helpful. Take precautions, and do not overdo them (12).
Avoid sudden jerks to the body – don’t plop on to the sofa or drop yourself into a forward-leaning inversion suddenly. Minimize sudden movements such as forward bends or twists. Wear a seat belt while traveling.
Avoid smoking and narcotics that may harm your placenta and fetus (13).
Studies About Anterior Placenta
In a retrospective Turkish study of 500 healthy pregnant women, it was found that the birth weight of fetuses with anterior placenta was higher compared to normal placental pregnancies. Also, the incidence of an anterior placenta was found to be higher in the case of female births (14).
Another study conducted in Abha General hospital of Saudi Arabia showed that the majority of women with an O-positive blood group had an anterior placenta (8).
Sleep position during conception also influences the placental implantation site, found another study carried on singleton pregnancies of gestational weeks between 15 and 20 (15).
The maturation of the placenta, according to the gestational age, is explained through a detailed classification system, which we talk about next.
Placental Grading (Grannum classification)
Placental grading is the classification of the ultrasonographic morphology of the placenta, based on its maturity. It reflects the extent of calcification with the gestational age. The placenta is grouped into four grades, from grade zero to three (11).
Grade 0:
Gestational age: between late first trimester and early second trimester, i.e., less than 18 weeks.
The chorionic plate is straight, smooth, and a well-defined, unbroken dense line.
The placental substance is a uniform echotexture with no echogenic areas.
No basal layer echogenicities
Grade 1:
Gestational age: mid-second trimester to early third trimester, i.e., 18 to 29 weeks.
It is the early stage of placental maturation.
The chorionic plate is a well-defined unbroken line which may have fine undulations.
The placental substance contains a few echogenic areas that are randomly scattered.
Grade 2:
Gestational age: Late third trimester, i.e., beyond 30 weeks.
The chorionic plate has more marked indentations.
The placental substance is incompletely divided with linear echogenic densities.
Larger calcifications are present in the basilar plate with a ‘dot-dash’ configuration.
Grade 3:
Gestational age: Beyond 39 weeks, i.e., when the placenta is mature.
The chorionic plate has complete indentations.
The placental substance is divided into compartments that demarcate the cotyledons.
The basal layer is denser and bigger.
Calcification, as above, is considered normal and healthy. However, there is a chance of premature calcification in case of pre-existing conditions such as placenta previa, high blood pressure, diabetes, or anemia. Calcification will not affect fetal development in any way. Next, we answer some frequently asked questions about the anterior placenta.
