Dr. Rebecca Dekker:
Hey everyone, on today’s podcast, I’m going to do a mini Q&A about radiation exposure during air travel in pregnancy, low platelet counts and induction, and the location of the placenta.
Welcome to the Evidence Based Birth® Podcast. My name is Rebecca Dekker, and I’m a nurse with my PhD and the founder of Evidence Based Birth®. Join me each week as we work together to get evidence-based information into the hands of families and professionals around the world. As a reminder, this information is not medical advice. See ebbirth.com/disclaimer for more details.
Hey everyone, and welcome to today’s episode of the EBB Podcast. My name is Dr. Rebecca Dekker, pronouns she/her, and I will be your teacher for today’s episode. Today, I’m so excited to answer some questions that we’ve been receiving this year inside the Ask the Research Team question area for EBB Pro members. So if you’ve ever wanted to personally ask me or the other researchers at EBB a question? You can do so inside the EBB Pro membership. You can learn more about this opportunity at ebbirth.com/membership. If you ever want to access the full range of resources here at Evidence Based Birth®, I highly recommend getting involved with our Pro Membership because not only do you get our full library of PDFs and continuing education courses and certificates, but we also have a mentorship program for new doulas, a midwifery brunch and learn program, and of course, as I mentioned earlier, direct access to Ask Our Research Team questions about the evidence.
So today I’ve chosen three questions and answers to share with you here on the podcast. They have to do with, first, radiation in air travel during pregnancy, particularly for airline crew. Second, whether low platelet counts mean you should have an induction. And third, new research on the location of the placenta in terms of whether it’s anterior or posterior. And with that, let’s get to our Q&A.
Okay, so today’s first question comes from a pro member who asked us, Is there any evidence on radiation from airplanes affecting pregnancy? For example, do flight attendants experience a higher rate of miscarriage than the general population? Thank you to the research team for all your help in helping our families get evidence-based information. So here is the answer I gave to our pro member. I’m going to make it a little bit longer for all of you. So most of the time when people are thinking about traveling on an airplane in pregnancy, you’re thinking about how you’re supposed to avoid getting on an airplane towards the end of pregnancy because you don’t want to go into labor and have a baby on a plane. So I’m really thankful to our pro member for asking me to look into radiation during air travel and pregnancy. This is not something that was on my radar beforehand. So occasional air travel during pregnancy is considered safe, but air crew or frequent flyers, any of those who might be pregnant, might experience adverse effects from frequent air travel. So this pregnant population that I’m thinking of includes pilots, flight attendants, frequent flyers, and military air crew members. But air travel can also include preconception risks for frequent flyers, regardless of your sex, which I’ll talk about later. So let’s talk about cosmic radiation. Cosmic ionizing radiation is made up of solar radiation and galactic radiation. The Earth is constantly being hit by high energy radiation from the sun, this is called solar radiation, and from the outer space, which is called galactic radiation. This question actually came at the perfect time because I have been reading this book, “A City on Mars: Can We Settle Space, Should We Settle Space, and Have We Really Thought This Through?” by Kelly and Zach Weinersmith. And there’s actually a whole lot of info in here about solar and galactic radiation.
And in fact, radiation in space is one of the big evidence reasons why it would be really difficult, if not impossible, to settle space. And they go into depth in their book about this. So solar radiation can vary depending on the position of the sun and the cycle of the sun and its solar flares. We just had a solar flare event earlier in 2024 where everybody was looking at the sky in the evening and how beautiful it was. Well, this was a temporary, somewhat unpredictable event, although they do tend to happen in a cycle, as they kind of know that it might be coming, where there’s increased eruptions of radiation from the sun. Now, a lot of the overarching category of cosmic ionizing radiation is absorbed by the Earth’s atmosphere. And the thicker the atmosphere, the greater your protection. The Earth’s magnetic field can also deflect radiation. And this protection is greatest at the equator and least at the poles. This means that the risks from cosmic radiation are greater at higher altitudes. So as you go higher in the Earth’s atmosphere, you have less protection from the atmosphere because it’s thinner above you. And the cosmic radiation exposure increases with the highest rates of exposure at 35,000 feet and above. You also can have higher exposure at higher latitudes, meaning that you’re near the North Pole or the South Pole. Directly measuring cosmic radiation is cumbersome, and so it’s rarely done on airplanes. Instead, they tend to use duration of flight, where you’re flying, etc., to kind of estimate your risk. The highest risk of cosmic radiation is for astronauts who get zero protection from the atmosphere and less from the Earth’s magnetic field.
Now the risks of cosmic radiation are for anyone, not just pregnant people, because excessive exposure to cosmic ionizing radiation can increase your risk of cancer and other health problems. However, there are also other risk factors for aircrew, including chemical exposures in the aircraft, such as jet fuel and engine oil combustion products, as well as cleaning products. And there are also circadian rhythm disruptions if you are changing time zones or flying when you are normally sleeping. And then there’s also a lot of physical and psychological stress on air crew type positions. Now, cosmic radiation is measured in something called millisieverts. And sometimes this is estimated by how much time you’re spending on flights. I found a recommendation from Australia where they recommend that a member of the general public not be exposed to more than one millisievert, abbreviated MSV, per year. This one MSV per year is also considered a limit by many other national organizations as well as international organizations for a 40-week pregnancy. In the United States, the recommended limit during pregnancy of millisieverts is one MSV with no more than 0.5 MSV exposure in any single month of your pregnancy. Now, how long it takes to reach that threshold would depend on how many hours you’re flying at a specific altitude or latitude. For example, it would take 510 hours of flight time at 27,000 feet to reach this one MSV if you’re flying higher latitudes. It would only take 140 hours of flight time if you’re flying at 48,000 feet at a high latitude. For example, you would have to fly from Australia to Singapore 107 times in one year to exceed this amount. But if you flew from Buenos Aires to Sydney, you’d exceed this threshold in just 13 flights.
So why is cosmic radiation a specific concern during pregnancy? Well, the risks actually start preconception. And the FAA in the United States has a document with a table showing the increased risk of severe genetic abnormalities in your offspring due to ionizing radiation that took place prior to conception during occupational exposure of either biological parent. So if either biological parent has a total preconception exposure of 10 MSVs, then the risk of the offspring having a severe genetic abnormality is 1 in 25,000. If the parent’s preconception exposure was 50 MSVs, then the risk of the offspring eventually having a severe genetic abnormality is about 1 in 5,000. During pregnancy, the bigger concern is the risk of miscarriage. In a study published in 2015 by Grajewski et al. Called Miscarriage Among Flight Attendants, they interviewed 2,654 women flight attendants from the U.S. and examined data from 840 of their pregnancies. So although this study was published in 2015, the data were collected back in the 1990s.
They also selected 380 women teachers who agreed to participate as a comparison group, and they chose teachers because there was minimal air travel among this group. The researchers calculated radiation exposures and circadian rhythm disruption using company records as well as questionnaires. As a group, back when this study was conducted, the flight attendants were more likely to be white, have a higher family income, and be exposed to higher physical jobs demands and workplace stress. Flight attendants were not more likely than teachers to experience a miscarriage. But they did find in the study that flight attendants who reported more circadian rhythm disruptions had a higher rate of miscarriage during the first trimester, and this was defined as working 15 hours or more per week during their home-based sleeping hours. There was also what they called a modest association between cosmic radiation and miscarriage. The higher risk of miscarriage with radiation exposure was consistent with studies that had looked at nurses and veterinarians who’ve been exposed to more x-rays during their occupational hours. And the flight attendants that were more likely to have high exposure were more likely to be on flights that happened during solar particle events, such as the ones we saw earlier this year in 2024. Reporting that they had high physical job demands also increased the risk of miscarriage, including standing and walking for more than eight hours per day and bending at the waist more than 25 times per day.
I found quite a few guidelines on flights and pregnancy, the American College of Obstetricians and Gynecologists says that occasional air travel is safe in pregnancy in terms of radiation, but that pilots, military air crew and flight attendants who are pregnant are at higher risk. Other risks of air travel include trauma to the abdomen, stress, blood clots, and disruption to circadian rhythms. In the show notes, I’ll link to an article from the Centers for Disease Control, about air crew safety in pregnancy. And they have detailed info about the risks of radiation exposure, especially during solar events. I also found the most recent guidelines from the FAA about radiation exposure in pregnancy from flights, and I will link to that in the show notes. They note that the greatest risk to the embryo or fetus would be a large exposure on the first day or two of development. They also state that exposure to radiation during pregnancy can result in the child having a higher lifetime risk of cancer, although that overall risk is extremely low. They state that exposure of one MSV during prenatal development would mean that the offspring would have an increased lifetime risk of fatal cancer of 0.01%. They recommend that a pregnant crew member work together with their management to ensure that exposure during pregnancy does not exceed the recommended limits.
I’ll also link to an interesting document, from the Office of Aerospace Medicine that gives example scenarios, it calculates the radiation impact of different flight paths and talks more about pregnancy and flight-related occupations. I hope this info helps and I’m really thankful to our pro member for asking such an interesting question.
Okay, the second question has to do with low platelets in pregnancy and induction. This person asks, quote “From what I understand, low platelets are common in pregnancy. I am a newer doula. I would love to learn about any research supporting whether induction for low platelets is evidence-based or is this just a doctor-based decision to induce? I have a client with thrombocytopenia who is not interested in being induced, but the doctor is putting pressure on her. She is otherwise healthy.” End quote. So this is a really great question, and I’m thankful to Morgan Cayama Richardson, one of our EBB Research Fellows, for doing a lit review to help me find more information on this topic. And we actually get this question messaged to us a lot on Instagram as well, so I thought it would be a great one to pull the answer for those of you who are listening to the podcast or watching the video on YouTube. So first of all, I want to be clear that we do not comment on individual medical scenarios, but what I can do is share some general information about low platelets in pregnancy.
So as the doula mentioned, the medical term for this is thrombocytopenia. And if you’re doing any kind of online search to get more information, that term is the best way to find medical information about low platelets and pregnancy. So I’m going to define thrombocytopenia, talk about the possible causes of this condition, and we’ll also talk about induction, epidurals and delayed cord clamping when you have thrombocytopenia. So platelets, also known as thrombocytes, are small fragments of cells in your blood. They form clots to stop or prevent bleeding. Platelets, like red blood cells, are made inside your bone marrow. The normal range of platelets is 150,000 to 450,000 per microliter. And you might hear these numbers abbreviated by dropping the last 100,000. So they might say your platelets are 150, but they mean 150,000. So in general, the platelet count decreases by about 10% in most healthy pregnancies compared to when you’re not pregnant. This normal decrease is due to several factors, including the fact that you have a much larger volume of blood while you’re pregnant that dilutes your platelet count. And you also have an enlarged spleen in pregnancy that is, grown to take care of the extra blood volume, and it then may destroy platelets at a higher rate. But these are just theories as to why platelets drop about 10%, and scientists still don’t know exactly why we see this normal decrease. When platelets drop to a little more than we would expect, to platelet counts between 100,000 to 150,000, then this is called gestational thrombocytopenia, or GT. GT is the second most common blood abnormality in pregnancy after anemia, and it affects about 7 to 11% of all pregnancies. GT is more common in the mid-second through the third trimester, and it typically resolves on its own within one to two months after giving birth.
The international definition of immune thrombocytopenia, or ITP as it’s called, is when you have a drop of platelets during pregnancy below 100,000. When platelets get less than 100,000, this is considered more serious, but it’s more rare. It happens in less than 1% of all pregnancies. Most of the time, if you have ITP, this was a problem that was present before pregnancy, although sometimes it can begin during pregnancy. So it’s more commonly diagnosed in the first trimester when you’re having routine blood work. If you have ITP, you should be cared for by a hematologist or blood doctor in addition to your regular maternity care provider. If your platelets drop to below 80,000, you might not be a candidate for an epidural during labor because of higher risks associated with epidurals and very low platelets. And every hospital and care provider seems to have a different cutoff for when an epidural can be given with immune thrombocytopenia. I’ll talk more about that in a little bit. Another condition that can affect the platelets is thrombotic microangiopathy. This is a syndrome or a collection of signs and symptoms that includes low platelets. This can be caused by severe health problems such as preeclampsia, HELLP syndrome, and acute liver problems of pregnancy. These thrombotic microangiopathies, or TMA as they are called, can also cause damage to your blood vessels. Other rare conditions that can contribute to low platelets include a severe life-threatening disorder known as disseminated intravascular coagulation. This is something that’s usually happening in combination with a very severe third trimester complication such as HELLP syndrome or Amniotic Fluid Embolism. There also may be hereditary conditions and other autoimmune conditions that can contribute to low platelets.
Another thing that can be helpful to remember is that although it’s rare, it’s possible you can have a false positive test that indicates thrombocytopenia. This is because some people’s platelets will clump together after a prolonged time sitting in a test tube, leading the machine to count a smaller number of platelets because maybe 10 platelets have clumped into what looks like, you know, one clump. So it’s important if you’re diagnosed with low platelets that your provider follow evidence-based ways of measuring platelets, including not waiting too long to get your blood sample to the lab and confirming any concerning low platelet counts with a direct microscope count. Getting inaccurate results for platelets might be more common if your clinic is a long ways away from the blood laboratory. Say you live in your clinic is in the countryside and they got to get the blood a couple hours away to the city. Or maybe you just missed the lab pickup for the day. And so your platelets, your sample has to wait in a tube sitting at your doctor’s office for another 24 hours before it’s taken to the laboratory. There is also a condition you can inherit that leads your platelets to clump in a specific kind of blood tube. So getting a second verification with a direct microscope count, if you’re told you have extremely low platelets, can be helpful when you’re confirming your diagnosis.
In terms of induction in thrombocytopenia, I’m just going to focus on gestational thrombocytopenia or GT because this is the most common type of low platelets in pregnancy. GT becomes more common as pregnancy progresses, and it happens in up to 1 in 10 pregnancies by the time of birth. GT does not require any special treatment or care. And as I said earlier, most cases go away on their own after you give birth. Regarding management of delivery or birth for people with this condition, I looked it UpToDate. UpToDate is a subscription service where you can get in-depth literature reviews on different medical topics. And they don’t mention any recommendation of induction for GT. And the ACOG guidelines also do not mention induction. So if your client is having GT and there’s no other problems or concerns, if this is just that mild condition that we talked about earlier, and the doctor’s recommending induction, that might just be a clinical, that doctor’s clinical opinion or preference. But there’s no guidelines recommending it in that specific situation. There’s also very little research on thrombocytopenia and labor induction. The only promising article I could find was an article from 2006 when researchers looked at pregnancy and birth complications associated with thrombocytopenia. They found that pregnant people with this condition had higher rates of labor induction. They had four times the odds of being induced compared to those with low platelets. This does not mean that these inductions were medically necessary, just that they were being recommended more often with low platelets.
I do want to talk a little bit more about epidurals and thrombocytopenia. So we’ve covered epidurals and spinals in depth this year already at EBB. And I want to point out that some anesthesiologists will not provide an epidural to someone with very low platelets. That’s because a severe case of low platelets could raise the risk of something called an epidural hematoma or a spinal hematoma. I’ll link in the show notes to what I think is a really helpful article from the Society for Obstetric Anesthesiology and Perinatology. And they suggest that a platelet count of 70,000 and above should be safe to have an epidural or spinal, that this would be considered very low risk for complications. In my experience of just getting correspondence with people from all over the world, I’ve heard that every OB department has slightly different policies. And how they deal with thrombocytopenia and offering or permitting an epidural for labor. Some hospitals might permit an epidural with a platelet count of 50,000, depending on the patient’s circumstances. Another hospital might not allow that. So you really have to talk with your anesthesia team or your OB in advance if you have very low platelets to find out what their cutoff is for an epidural. And I’ll link to those guidelines from the SOAP. They’re from 2021. They go into a lot of detail about the different cutoffs and the different risks. I think it is also worth noting that with a labor induction, if it did result in a longer labor or more painful labor, and if you’re not allowed to have an epidural because of your very low platelet levels, that could end up being a problem. If an induction or a spontaneous labor ends in the need for a Cesarean, then sometimes patients with very low platelet levels may be told that they need general anesthesia because their platelets are too low for an epidural. UpToDate in their article does mention that there are no data comparing vaginal and Cesarean births for gestational thrombocytopenia and that both forceps and vacuum-assisted delivery are not recommended if you have severe thrombocytopenia. Since platelets are there to help you with bleeding, some people might worry about the risk of bleeding or postpartum hemorrhage if they have low platelets.
There was a study that came out in 2023 published by Kazma et al. and they found that gestational thrombocytopenia is associated with a slightly increased risk of postpartum hemorrhage, but only if you are also anemic. So having a high hemoglobin and hematocrit is protective if you have low platelets. Someone also asked me in the past if delayed cord clamping is permitted with thrombocytopenia. In most cases with GT, the baby should not have any problems with their own platelets. And delayed cord clamping does not increase the risk of postpartum hemorrhage in the birthing person. It does not increase the risk of bleeding in the baby. So you can still do delayed cord clamping if you have thrombocytopenia. And you can read more about the evidence on delayed cord clamping at ebbirth.com/thirdstage. One final note before I move on for this topic related to thrombocytopenia. After gestational thrombocytopenia, which is the mild condition that resolves on its own, the next most common cause after that of low platelets is preeclampsia. Preeclampsia would most likely require an induction, so that’s a totally different scenario than GT. Platelet counts of less than 50,000 happen to about 5% of people with preeclampsia. And by definition, HELLP syndrome, the LP stands for low platelets. HELLP syndrome is a variety of preeclampsia that also can be life-threatening. And we’re going to be talking with the survivor of HELLP syndrome in detail in episode 325 coming out in two weeks. And I’ll make sure to link in the show notes to some helpful resources I found about low platelets in pregnancy.
Okay, so we’ve talked about radiation and air travel in pregnancy and low platelets and induction. Our third and final question for today comes from a pro member who wrote in to our research team and said, hi there, in birth class a couple nights ago, an expectant parent asked if an anterior placenta leads to any increased risks, particularly in the third stage of labor. The student later sent me the study, which I’ve attached. And I was just wondering if you have any thoughts on this study and/or if you know any other research on this topic to point out. And the pro member attached to me the study by Torricelli et al. called Anterior Placental Location Influences Onset and Progression of Labor and Postpartum Outcome, published in the journal Placenta in 2015. So Sara Ailshire, our second year EBB research fellow, helped with a literature review to answer this question. And I also dug up some additional info to kind of expand on this for today’s podcast. So this is a great question. I’ve never gotten this one before. The placenta, for those of you who are not aware, is the body’s only temporary organ and it plays a key role during pregnancy. The placenta is how nutrients, oxygen, and fluids are exchanged between you and your baby. As pregnancy progresses, the placenta grows. It is anchored in the wall of your uterus. An anterior placenta is when the placenta is implanted in the front wall of your uterus. You might hear people talk about how their anterior placenta makes it harder for them to feel their baby’s kicks in front or maybe they start feeling the kicks later in pregnancy. So the placenta is the body’s only temporary organ, and it plays a key role during pregnancy.
Here is a more realistic looking placenta, and it exchanges oxygen, nutrients, and fluids between you and your baby. As your pregnancy progresses, this placenta, the other side of it, is anchored in the uterine wall. An anterior placenta is when the placenta is implanted in the front wall of your uterus. You might hear people talk about how an anterior placenta makes it harder for them to feel their baby’s kicks in front. Or maybe they started feeling the kicks later in pregnancy. It took longer until they could start feeling it. If you’re watching the YouTube video, I have my plush placenta, and now I have my plush uterus from iHeartGuts. And if you look at the uterus, we have the fundus on top, the cervix on the bottom. This would be the anterior, the front. We have the posterior, and then we have lateral, which are the two sides. So when the placenta is implanting on the front, on the inside of this uterus, that’s anterior, that’s considered totally normal. It’s also normal for the placenta to be implanted in the back, posterior, the top, known as the fundus, the right or the left, known as the lateral sides of the uterus. An abnormal place for the uterus to implant would be lower, partially covering or covering the cervix, because the baby could not come out that way then when it’s time for the birth. Another abnormal finding is that the uterus, has a placental implantation that’s too deep into the uterine tissue. This is also known as placenta accreta.
So in recent years, some researchers have been looking into the potential impact of the location of the placenta. So this is that, you know, one of those studies was the Torricelli article that the student sent to the childbirth educator. There has been a lot of new interest in the placental location because there are some proposed, you know, associations with pregnancy complications. Although in the past, researchers have been mainly just looking at complications from placenta previa when it’s covering the cervix. So I do want to let you know, though, that this research has been limited by a lack of detailed documentation of the placental location and a lack of consensus on the terminology used to describe where the placenta is located inside the uterus. Now, why the placenta implants in different parts of the uterus is not totally clear. The Cleveland Clinic, they found an article there that cited two studies suggesting that having O positive blood type or being a stomach sleeper during conception might be more associated with anterior placenta implantation, but these are not definitive findings. I’ve also seen a couple of articles about IVF affecting implantation. Now, before I share the current research, I do want to make sure we go over the language of risk in research for anyone who needs a refresher on that. So you got to understand there’s a difference between relative risk and absolute risk. Relative risk is the risk in comparison to something else. Absolute are the actual levels of risk that you have. And the findings in some of the studies might find a potential relative risk, but sometimes it doesn’t really mean a whole lot clinically. There might be a mathematical association, but in the big picture, it’s not really making a difference, or even at the individual level, it’s not making a difference. So just giving you a heads up that they might say there’s an increased risk, but the risk of something is so small or the increased risk is so small that it doesn’t really make a difference.
So the study that these students sent to the childbirth educator by Torricelli et al., it’s a good example of, you know, really looking at the details of a study to find out, you know, does this study really have meaning or significance? So it was carried out in 2011 and 2013 on everybody admitted to a hospital in Siena, Italia for a planned vaginal birth. They only included low-risk women in the study. They excluded anyone with placenta previa or low-lying placenta or any other abnormal placental findings such as placenta accreta. The sample of about 2,300 pregnant women at term included roughly 1,100 with an anterior placenta, about 1,100 with a posterior placenta, and 103 with a fundal placenta where the placenta was on the top of the uterus. They found that participants with an anterior placenta were more likely to be induced, 31% versus 23%, partially because there were higher rates of induction for post-dates pregnancy and prolonged rupture of membranes. They were also more likely to have a Cesarean for failure to progress during labor, 5.8% versus 3.3%. However, the rate of premature rupture of membranes was higher with posterior placenta, and they had an extremely high rate of PROM of 59%. The rate of postpartum hemorrhage was slightly higher with the anterior placenta, 9.8% versus 6.2%. The length of the third stage where you’re birthing the placenta was slightly longer, and 2% of the anterior group needed a physician to go in and manually remove the placenta from the uterus, compared to 0.8% of the posterior group. The authors theorize, that the location of the placenta might impact uterine contractions.
I don’t think the results from this study can be applied universally. There are very high rates of interventions in Italian hospitals. I’ve never seen such a high rate of PROM before, of 59%. This leads me to guess that there might be something going on with prenatal care that impacted labor and delivery results. Perhaps they were doing really aggressive membrane sweeping prenatally. Also, everyone had an ultrasound when they were admitted to the hospital. The providers were then told the results. So if the providers had bias either way towards anterior placentas or against it, that could have influenced some of their diagnoses and treatments. So to dig a little bit deeper to see if there really is anything bad associated with an anterior placenta or a posterior placenta, we pulled a couple other studies. I’ll link to them in the show notes. I’m going to share a few of them with you. There was a large study of 74,000 first-time mothers from Sweden. This was published by Grand Forest et al. in 2018. All of the women in the study were pregnant with a single baby, and they all had second trimester ultrasounds that they were able to link and then look at their birth outcomes. They found that anterior placenta occurred in 48% of pregnancies, 46% of pregnancies had a posterior placenta, 3.3% had a fundal placenta, and 2.5% had a lateral placenta. They found that fundal and lateral placental locations were associated with higher risks of preterm birth. Small for gestational age, and breech presentations at term. A lateral placental location was associated with a higher risk of preeclampsia. However, most of these increases in risk were very small. The largest increase in risk was a threefold increased risk of needing the placenta manually removed with a fundal or lateral placenta. And they suggest that because the posterior and anterior spots are flatter, that this is more advantageous for a healthy blood supply compared to the fundal and lateral spots where there are sharper corners and it’s not as healthy a blood supply for those placentas. But that is just a theory. And again, increases in risk in general were very small.
So I think because this study was a much, much larger study with a better quality, I would say that I would probably use these results over the Torricelli results. And the results from this Swedish study found no increase in risk with anterior or posterior placental locations. There was a small study from New York that looked at the medical records of 361 women who had ultrasounds in the second or third trimester, then they looked at the outcome of their pregnancy. About 43% had an anterior placenta. The rest had a posterior placenta. This study was too small. They did not identify any lateral or fundal placentas because those are rare. And they found that most of the outcomes were similar between the groups. They did find a slightly higher average five-minute APGAR score in babies with posterior placentas, but it was not clinically meaningful. This is another good example of something might be mathematically different, but not clinically different, because the APGAR scores were 8.9 in one group and 8.8 in the other, and both of those scores are perfectly fine. Retained placenta is a rare condition where part or all of the placenta does not come out of the uterus during the third stage, and so the patient requires surgery or a medical procedure to remove the remaining pieces. There was a study published by Meyer in the journal Placenta in 2020 that examined risk factors for this condition. They had more than 16,000 participants in the study, and 6.5% of the births were complicated by all or part of the Placenta being retained. Retention of the Placenta was more likely with lateral or fundal placement of the Placenta.
Again, no increased risk with anterior or posterior placements. I’m not going to go into detail about placenta previa today, where the placenta is covering part or all of the cervix. But I did want to note that if you have placenta previa, when the placenta is covering all or part of the cervix at term, a Cesarean is usually required. This is a life-saving surgery in this situation, and a vaginal birth is not possible. If the placenta previa is more anterior or it’s kind of covering the cervix but also the front part of the uterus, then that can complicate the Cesarean because it’s more difficult to do the surgery and do the incision and avoid cutting the placenta. And you don’t want to cut the placenta during the surgery because that could cause massive blood loss. So I’ll link to a few studies in the show notes, about problems associated with that combination of placenta previa that is oriented towards the anterior wall of the uterus. Maybe someday we’ll do low-lying placenta and placenta previa in a different Q&A, but I think I’ve covered as much as I can in today’s podcast.
These were really thought-provoking questions, so thanks to our pro members for always keeping us on our toes, asking such great questions, and thanks to our EBB research fellows for always helping me stay on top of those questions. Thanks, everyone. I hope you learned a lot. Again, stay tuned for our upcoming podcasts, including the one about HELLP syndrome. I’ll see you all next week. Bye!
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