Placenta previa is the abnormal implantation of the placenta in the lower uterine segment. It occurs in .5% to 1% of pregnancies in the United States. So the placenta wholly or partially covers the opening of the mother’s cervix, where the uterus connects the vagina. What happens is as the cervix dilates, the underlying muscular tissue disappears. The result is that the attachment of the placenta to the wall of the uterus is lost. The placenta provides nutrition, oxygen and a waste disposal system the fetus needs.
Placenta previa is, like placental abruption, a hemorrhagic disorder. Approximately 25% of pregnancy-related deaths are the result of a hemorrhage. Preterm delivery can result from these conditions, which can lead to oxygen deprivation birth injuries like hypoxic ischemic encephalopathy or cerebral palsy.
So while placenta previa is often not an impediment to a healthy pregnancy, proper management of the condition is critical to a good outcome.
- What is the settlement value of placenta previa cases?
- Example placenta previa lawsuit filed in Maryland
Types of Placenta Previa
There are three variations of placenta previa: complete, partial and marginal. With complete placenta previa, the lower intravaginal portion of the cervix (or cervical oz) is completely covered by the placenta. This is the most dangerous variation for both mother and child Marginal placenta previa is where the placenta is embedded very near to the cervical os. Partial placenta rests in the middle of those extremes.
Proper staging of this condition can be a challenge. The extent of the occlusion of the cervical oz may vary with the magnitude of the cervical dilation. So what may appear to be partial or marginal on an ultrasound before labor begins may be more serious than anticipated. Prudent doctors keep this in mind when making treatment decisions.
Signs and Symptoms of Placenta Previa
The biggest sign of placenta previa is painless bleeding. Some women do, however, experience contractions or cramps that may seem associated with bleeding. This bleed can be at 15 weeks but most classically present in the latter part of the second trimester or the third trimester of pregnancy.
The biggest indication of placental abruption, another hemorrhagic disorder, is painful bleeding. The pain typically feels stronger than you would expect with contractions. Other risk factors include a history of multiple pregnancies, prior history of placenta previa or a previous c-section, advanced maternal age, and cocaine or smoking.
Causes of Placenta Previa
There are a number of well-known risk factors that can cause or contribute to cause the occurrence of placenta previa. These risk factors include:
- Previous Cesarean Sections: A history of cesarean deliveries increases the risk of placenta previa. Scar tissue from previous surgeries can interfere with normal placental attachment.
- Advanced Maternal Age: Women over 35 are more likely to develop placenta previa.
- Uterine Surgery: Past surgeries on the uterus, such as removal of fibroids or dilation and curettage (D&C), can leave scar tissue, increasing the chances of placenta previa.
- Multiple Gestations: Carrying twins or more puts additional pressure on the uterus, which can lead to abnormal positioning of the placenta.
- Smoking and Substance Use: Smoking, drug use, and poor lifestyle choices can contribute to placental problems, including placenta previa.
- Previous Placenta Previa: Having had placenta previa in a previous pregnancy significantly raises the risk of recurrence in subsequent pregnancies.
Managing Placenta Previa
Placenta previais a significant concern during pregnancy. The degree of concern varies depending on the timing of diagnosis. Ironically, the earlier it is diagnosed, the less worrisome it may be. For instance, when placenta previa is identified early, such as at 15 to 20 weeks of gestation, it often resolves on its own. In over 80 percent of cases, the placenta “migrates” as the uterus expands, moving away from the cervix by the third trimester. This movement alleviates the risk of complications, allowing many pregnancies to proceed without the need for additional interventions related to previa.
But if placenta previa is diagnosed later in pregnancy, particularly in the third trimester, the scenario changes dramatically. At this stage, it is far less likely that the placenta will move away from the cervix. When the placenta remains over or near the cervix as the pregnancy progresses, it poses a more significant risk to both the mother and the baby. The risks include preterm labor, excessive bleeding (hemorrhage), and complications during delivery. So the mother needs careful monitoring and potentially early intervention.
Most placenta previa cases are typically managed by general obstetricians and gynecologists without immediate referral to maternal-fetal medicine specialists, also known as perinatologists if the pregnancy is otherwise not high risk. These subspecialists focus on high-risk pregnancies, but routine OB/GYNs are usually well-equipped to handle uncomplicated cases of placenta previa. So it is not necessarily a breach of the standard of care not to refer the patient to a MFM. That said, effective management requires a clear understanding of the condition, diligent monitoring, and timely decision-making to ensure the safety of both the mother and baby, and the OB/GYN has to get it right. Proper prenatal care, with regular ultrasound evaluations, is critical to track the placenta’s position and assess any potential risks. If an OB/GYN does not adequately monitor or manage the condition, the consequences can be dire, leading to preventable complications such as severe hemorrhaging during labor or the need for emergency surgical interventions.
Ironically, the earlier the placenta previa is diagnosed, the less of a concern that may be. If a placenta previa is diagnosed at 15 weeks, more that 80 percent of the time the placenta will move out of the way or migrate by the third trimester. Conversely, if a placenta previa is diagnosed in the third trimester, it is probably there to stay.
Most placenta previas are managed by general OB/GYNs and not sent to maternal-fetal subspecialists. There is nothing wrong with this. But the obstetrician needs to know how to properly manage this condition. Otherwise, the consequences can be disastrous.
Vaginal Birth Can Be Medical Malpractice
A vaginal birth in the face of placenta previa is generally understood to be a breach of the standard of care if the pregnancy has reached 37 weeks or more at the time of initial bleeding. If there is a complete placenta previa, that also necessitates a c-section.
Among other things, an attempted vaginal birth when a placenta previa is present can cause or exacerbate the separation which can lead to a stroke and other injuries. The correct medical path is delivery by c-section before term because the placenta may impede the baby coming through the birth canal, and also, with contractions, there will likely be significant bleeding as the placenta is separated from the lower uterine segment, which can be fatal or significantly injurious to mother and baby.
Placenta Previa Medical Malpractice and Birth Injury Claims
We see four types of placenta previa malpractice claims:
- The failure to diagnose the condition. Normally, this is the mother going to her OB/GYN complaining of painless bleed, and the doctor does not follow up with the necessary follow-up testing, most notably an ultrasound, to better diagnose the condition.
- The failure to properly treat the condition after diagnosis
- Performing a digital exam of the patient which is contraindicated
- Failure to perform a c-section
Settlement Value of Placenta Previa Malpractice Cases
If the mismanagement of placenta previa has led to a birth injury to your child, you are likely to be angry and confused. But there is one thing on which there is no confusion. You want to figure out what you need to do from here to give your child the best possible life. The reality is that involves millions of dollars for adequate care in far too many cases. So should you be trying to get find a path to getting those millions of dollars to get the best possible care for your child? Absolutely.
This leads to the question of what is the average settlement value of placenta previa birth injury cases in Maryland? Good question. But while you can average the placenta previa settlements and verdicts below and get a number, that is not a meaningful answer. You can drive a truck through the range of values in these cases because there is a great variance in the severity of the injuries.
The formula to calculate the maximum value of the damages in these cases is simple. The formula is all of the expected medical bills, future lost wages as an adult, and ongoing care costs over a lifetime plus the child’s noneconomic pain and suffering damages. Getting these numbers requires medical experts to offer their opinion on what expenses and needs your child will have. To make economic sense for these numbers, our malpractice lawyers engage life care planner and an economist who can calculate the costs of this care. In birth injury cases, the cost of medical treatment and additional care can sometimes approach or exceed $50 million.
Settlements and Verdicts in Placenta Previa Malpractice Cases
What is the settlement value of placenta previa birth injuries? The average settlement is in the millions. But the answer to this question depends on a lot of variables of differing weights. This means that looking at the summaries of verdict and settlements in placenta previa lawsuits cannot give you a precise answer to this question. No two cases, even seemingly similar, are the same. Still, these verdicts for children and their families should give you some idea of the range of verdict and settlement values in your case.
- $4,000,000 Settlement (California 2023): The infant suffered placenta previa and a lack of oxygen to his brain, causing neurological injuries, while under the care and treatment of the medical staff at defendant Loma Linda University Children’s Hospital. The lawsuit contended the defendant was medically negligent for failing to select and monitor a competent medical staff and failing to ensure he was delivered in a timely manner.
- $24,500,000 Verdict (Florida 2021): The mother had been diagnosed with placenta previa and was sent to the hospital for a C-section delivery. The C-section was supposed to be done that morning, but it did not happen until a full 24 hours later and during the mother suffered massive internal bleeding. The mother eventually died from blood loss. The wrongful death lawsuit alleged that the defendants were negligent in a number of ways, including failure to follow up on a transvaginal ultrasound which identified a possible diagnosis of placenta accrete, failure to obtain a transvaginal ultrasound and an MRI, failure to timely perform a hysterectomy, failure to consult a gynecological oncologist, and failure to manage a suspected placenta accreta.
- $2,590,909 Settlement (New York 2019): The lawsuit alleged that the defendant negligently mismanaged the mother’s placenta previa during a prenatal emergency room visit. The plaintiff claimed that the defendant damaged the mother’s placenta during a pelvic exam, resulting in retroperitoneal hemorrhage that contributed to the infant plaintiff’s premature delivery, which left him with neurologic injuries.
- $2,124,000 Verdict (Texas 2017): The mother went to the hospital for a Cesaerian section delivery of a stillborn at approximately six months gestation. It was known during the pregnancy she had placenta previa. After delivery, and upon attempted removal of her placenta, the mother began to bleed profusely. It was determined that her placenta had grown through the wall of the uterus and into her bladder. Despite attempts to control the bleeding surgically, she continued to bleed, suffered a cardiopulmonary arrest and could not be resuscitated.
FAQs
How is Placenta Previa Diagnosed?
Placenta previa is diagnosed based on ultrasound imaging showing abnormal positioning of the placenta. In some cases, the condition is diagnosed during routine prenatal exams, before any symptoms occur. In other cases, placenta previa is diagnosed after vaginal bleeding or other symptoms occur. The diagnosis is usually
made during the second trimester.
What Are the Signs and Symptoms of Placenta Previa?
Placenta previa presents with a distinct set of symptoms, the most common and significant being vaginal bleeding after the 20th week of pregnancy. This bleeding is often the first sign that something may be wrong. In fact, around 80% of women with placenta previa experience this symptom. What sets the bleeding from placenta previa apart from other types of vaginal bleeding during pregnancy is that it is usually painless, though the amount of blood can vary widely—from light spotting to heavy bleeding that may require immediate medical attention.
The bleeding typically occurs as the lower part of the uterus thins and stretches in preparation for labor, which can disrupt the attachment of the placenta to the uterine wall. As the pregnancy progresses and the uterus expands, the placenta, especially if it is covering or near the cervix, can be disturbed, leading to this characteristic bleeding.
In addition to vaginal bleeding, other signs of placenta previa may include premature contractions or a sense of pressure in the lower abdomen, particularly if the placenta is putting extra weight on the cervix. Although it is not very common, some women may experience discomfort or cramping in the pelvic area, which can sometimes be confused with normal pregnancy pains or even the early onset of labor. But one of the things that make diagnosis tricky is that pain is not a hallmark symptom of placenta previa. (If there is pain as well, that is even more of a concern.)
It is also important to note that some women with placenta previa may not experience any symptoms at all, especially if the condition is discovered early during routine prenatal ultrasounds. In these cases, the diagnosis may come as a surprise since no outward signs are evident.
If bleeding occurs, it is critical for women with placenta previa to seek immediate medical attention, even if the bleeding is light and painless. This is because the bleeding can escalate quickly, leading to potential complications for both mother and baby, such as preterm birth or hemorrhage.
What Are Complications of Placenta Previa?
Placenta previa is known to be associated with an increased risk of other complications involving the placenta and umbilical cord. Other risks associated with this condition include premature rupture of the membranes and breech or abnormal positioning of the baby.
Getting an Experienced Malpractice Lawyer on Your Team
If you have been harmed or your child has suffered a birth injury because a doctor improperly managed placenta previa, the Law Firm of Miller & Zois has the experience and resources to help you both get the cash compensation you deserve for the harm you both have endured. We are based in Maryland but handle birth injury cases throughout the country. Call Miller & Zois today and speak to a newborn injury medical malpractice attorney at 800-553-8082 or get an online case evaluation.
More Malpractice Claim Information
- Oxygen deprivation is catastrophic for baby during the birthing process. This is called a hypoxic-ischemic injury.
- Uterine rupture malpractice claims
- Caput succedaneum malpractice cases