Exercising Safely with Placenta Previa: Understanding Stages, Risks, and Recommendations

By Dr. Scott Pearce, Obstetrician and Gynaecologist and Kerryn Boyle, Founder of PregActive.

Pregnancy is a time of profound change, and for women diagnosed with placenta previa, maintaining physical activity requires careful consideration to ensure the safety of both mother and baby.

As a prenatal exercise specialist and an OB-GYN with expertise in high-risk pregnancies, we've collaborated to provide evidence-based guidance on this condition.

Placenta previa occurs when the placenta partially or fully covers the cervix, affecting about 1 in 200 pregnancies.

While exercise can support overall maternal health, it must be adapted, or in some cases, avoided, to minimise complications. In this article, we'll outline the stages of placenta previa, associated risks and practical recommendations for staying active.

Stages of Placenta Previa

Placenta previa is classified based on the placenta's position relative to the cervix, typically diagnosed via ultrasound in the second or third trimester.

The stages (or types) include:

1. Complete Placenta Previa

The placenta fully covers the cervical opening. This is the most severe form and often persists until delivery, necessitating a Caesarean section.

2. Partial Placenta Previa

The placenta covers part of the cervix but not entirely. It may resolve as the uterus expands.

3. Marginal Placenta Previa

The edge of the placenta reaches the cervix but doesn't cover it. It will usually shift upward with pregnancy progress, potentially allowing the option of a vaginal birth at full term.

4. Low-Lying Placenta

The placenta is positioned near (within 2 cm) but not touching the cervix. This is a milder variant, which frequently resolves by term.

Many cases of low-lying placenta (up to 90%) identified early in pregnancy improve as the lower uterus stretches, but persistent previa after 28 weeks requires heightened vigilance.

Risks Associated with Placenta Previa and Exercise

The primary concern with placenta previa is vaginal bleeding, which can occur suddenly and be life-threatening.

The placenta's low position means blood vessels connecting it to the uterus are vulnerable to tearing, especially during activities that strain the pelvic area or increase abdominal pressure.

Key risks include:

1. Bleeding and Haemorrhage

Strenuous exercise, heavy lifting or high-impact movements can trigger bleeding, particularly after 20 weeks. Severe cases may lead to maternal shock or require emergency intervention.

2. Preterm Birth

Bleeding episodes may prompt early delivery via Caesarean section to protect the baby, increasing risks of neonatal complications like respiratory distress.

3. Placenta Accreta

In rare cases, the placenta attaches too deeply into the uterine wall, exacerbating bleeding risks during or after delivery.

Risk factors for previa overall include prior Caesarean sections, multiple pregnancies, advanced maternal age (over 35), smoking or assisted reproductive technologies.

This can usually be diagnosed by a specialist ultrasound.

4. Exercise-Specific Risks

Activities involving jumping, deep squats or core-straining poses (e.g., in yoga) can elevate intra-abdominal pressure, potentially dislodging the placenta or causing contractions.

Women with placenta previa are often placed on ‘pelvic rest’, avoiding intercourse, tampons or anything that could irritate the cervix. Ignoring these risks can escalate to hospitalisation or bed rest.

Recommendations for Exercise with Placenta Previa

Always consult your healthcare provider before starting or continuing any exercise regimen, as recommendations vary based on the stage, trimester and individual symptoms like bleeding history.

The goal is to promote gentle movement for mental well-being, circulation and muscle tone without compromising safety. Here's our tailored advice:

General Guidelines:

Before 28 Weeks

If asymptomatic (no bleeding), light activities may be permissible. Focus on low-impact options like walking (2-5 km daily, broken into short sessions) or swimming in shallow water to reduce gravity's pull.

After 28 Weeks

Avoid moderate to vigorous physical activity (MVPA) due to increased risk of bleeding. Prioritise rest or gentle walking if complete or partial previa persists.

Pelvic Rest Integration

No heavy lifting (over 10 kg), straining or exercises that engage the lower abs intensely.

Avoid sexual intercourse or tampon usage. Monitor for warning signs like bright red bleeding, cramps or dizziness, stop immediately and seek medical help.

Safe Exercise Modifications:

1. Walking and Gentle Cardio

Stick to flat surfaces. Aim for 20-30 minutes daily if cleared by your doctor. This supports cardiovascular health without jarring movements.

2. Prenatal Yoga and Pilates

Modify Pilates and yoga poses to avoid deep twists, inversions or wide-legged stances.

Opt for seated or supported positions like tabletop or high bear holds to strengthen the core gently. Avoid anything that compresses the abdomen.

3. Strength Training

Use light resistance (bodyweight or bands) for upper body only. Focus on posture-improving exercises to alleviate back strain common in pregnancy.

4. Breathing and Relaxation

Incorporate diaphragmatic breathing and mindfulness to reduce stress, which can indirectly support placental health.

What to Avoid:

1. High-impact sports (running, jumping), cycling, weightlifting or contact activities.

2. Exercises involving Valsalva manoeuvres (holding breath while straining).

3. Any activity if you've experienced bleeding, be advised by your health professional.

Research

Research shows that appropriate prenatal exercise can reduce overall pregnancy complications, but with previa, personalisation is key.

At PregActive, we offer guided programs with modifications for conditions like this, including our dedicated ‘Bump and Breathe’ program that is free and focuses on meditations, positive affirmations and gentle stretches in bed.

If diagnosed, regular ultrasounds will track progress, and many women deliver healthy babies with proper management.

Summary

In summary, while placenta previa introduces challenges, informed choices can help you navigate exercise safely. Prioritise open communication with your OB-GYN and remember listening to your body is paramount.

For personalised plans consult a specialist like Dr. Scott Pearce.

Dr Scott Pearce is an Obstetrician, Gynaecologist, Laparoscopic Surgeon, IVF Specialist and Clinical Director of Create Fertility in Mount Waverley, Victoria.

Dr Scott Pearce has over 20 years’ experience providing advice, treatment and procedures on all aspects associated with women's reproductive health and providing expert care to you and your baby during pregnancy, labour and the postpartum period.

Who is Dr Scott Pearce?

Dr Scott Pearce is an Obstetrician, Gynaecologist, Laparoscopic Surgeon, IVF Specialist and Clinical Director of Create Fertility in Mount Waverley, Victoria.

This article is for informational purposes only and not a substitute for medical advice.