During pregnancy the placenta develops with the baby and attaches to the wall of the uterus. It provides a connection between mother and baby where nutrients and oxygen are passed from the mother's blood and into the baby's blood via the placenta. The placenta is delivered shortly after a baby is born, also known as the “afterbirth”.

Placenta Praevia is a condition where the placenta attaches to the womb, and sometimes covers the cervix completely. This can cause difficulties in delivering a baby naturally and women who have placenta praevia usually require their baby to be delivered by caesarean section. One out of every 200 women have this condition at the end of their pregnancy.

Placenta accreta is a serious condition when the placenta attaches to the tissues near to the womb such as the bladder, or to the muscle of the womb. If placenta accreta is diagnosed before the baby is born, the doctor should discuss with the patient the options and the extra care that will need at birth. Sometimes early delivery is required and often in a hospital with specialist facilities and experienced teams available.

Both of these rare conditions can lead to heavy bleeding, especially at the end of the pregnancy, because the placenta is lower in the uterus. Heavy bleeding can put the lives of mother and baby at risk. A mother may require blood transfusions and the conditions can lead to the loss of the womb.

The Royal College of Obstetricians and Gynaecologists (RCOG) guidelines have made clear that it is vital that the diagnosis of conditions placenta praevia and placenta accreta is made as early as possible. The highest rates of complication for both mother and baby occur when these placenta complications are only diagnosed at delivery. The RCOG has suggested that more scans and specialised care can help reduce the risks associated with these conditions.

Vasa praevia is a very rare placental complication where blood vessels which travel between the baby and the placenta are unprotected by the umbilical cord or the placenta, and pass close to the cervix. Those blood vessels are very delicate and can tear when a woman goes into labour, this can lead to dangerous blood loss from the baby and so caesarean section deliveries are required. This complication affects between one in 1,200 and one in 5,000 pregnancies.

The RCOG have confirmed that the risk of a woman having placental complications increases for smokers, if they have had a previous caesarean section, or if they have had fertility treatment. This is due to an increased likelihood of scars in the uterus, which subsequent pregnancies are more likely to implant into, causing later problems with the placenta.

The RCOG has now has an online page explaining these conditions and the risks, for those who are at increased risk of developing, or who have these conditions: https://www.rcog.org.uk/en/patients/patient-leaflets/placenta-praevia/

Prof Eric Jauniaux, is Professor of Obstetric and Foetal Medicine at University College London. He was also lead author of these guidelines. He recommends that it is important for doctors to discuss with their patients the safest way for women to give birth. He added "We hope this updated guidance will support healthcare professionals during discussions with women and their partners who may be considering assisted reproduction, particularly IVF, or an elective caesarean birth.”

Dr Geeta Kumar, chair of the RCOG patient information committee, added: "It is important for women to be aware of these complications of the placenta, but they should be reassured that these are very rare and specialist care is available.”

This guidance for patients from the RCOG has made clear the importance of shared decision making between a patient and their doctor. Those women who are at risk of developing or who have these complications, should be fully informed by doctors about the safest way to give birth. They suggest that patients ask three questions about their care:

  1. What are my options?
  2. What are the pros and cons of each option for me?
  3. How do I get the support to help me make a decision that is right for me?

Karen Reynolds, Partner of our Derby and Stoke on Trent offices represented the claimant in the case of Webster v Burton Hospitals NHS Foundation Trust [2017] EWCA Civ 62. The Claimant won at the Court of Appeal where the court confirmed that the claimant’s mother’s wishes to be induced should have overridden the views of the Consultant Obstetrician who was advising her. This decision has been referred to as a “landmark case” and emphasised the importance of patient choice in respect of the treatment they receive. This decision confirmed that the role of the medical practitioner is to advise, that they must ensure that they discuss all material risks with their patients, and that a patient has the ultimate choice as to which treatment they receive.

Freeths’ Clinical Negligence Solicitors have a national reputation for providing the highest quality advice following failures to provide appropriate care during labour and delivery. See our website for further information:http://www.freeths.co.uk/legal-services/individuals/clinical-negligence/

If you are concerned about any treatment or which you or a loved one have received during labour or pregnancy, please contact our specialist medical negligence lawyers in our national team:-

Siobhan Genever, Director (Nottingham) on 0845 271 6793 or siobhan.genever@freeths.co.uk

Carolyn Lowe, Partner (Oxford/Milton Keynes) on 0186 578 1019 or carolyn.lowe@freeths.co.uk

Karen Reynolds, Partner (Derby/Stoke) on 0845 272 5677 or karen.reynolds@freeths.co.uk

Jane Williams, Partner (Leicester) on 0845 272 5724 or jane.williams@freeths.co.uk

For more information about this BBC news report please see the following link: https://www.bbc.co.uk/news/health-45664489