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placenta previa statistics, anyone?

post #1 of 25
Thread Starter 
a loved one was just diagnosed with placenta previa at ~19wk ultrasound, but i don't have any of the specifics (i.e. marginal, complete, posterior, anterior, etc.). we've all been reading up online, but i'm not finding the information i really want, and i was hoping some of you wise mamas could help. here are some of my questions:

1) i've heard that around 80-90% of PP diagnosed at this stage in a pregnancy resolve. are there more detailed statistics if you have more info about the PP? iow, if i know it's complete or if i know it's anterior, are there more specific rates of resolution available?

2) if you follow all of the doctor's recommendations as far as bedrest, going to hospital at any sign of bleeding, c/s as soon as is indicated, etc etc, what are the rates of "adverse outcome" in terms of loss of baby or loss of mama or emergency hysterectomy?

thanks for any information. my loved one is very scared and sort of in the dark about what the real risks are. she's also taking an anti-clotting drug due to previous pulmonary embolism, and is scared about what implications that will have now that she's been diagnosed with PP.
post #2 of 25
I had marginal PP when I was pg with my DS. My OB advised of no sex, no heavy lifting, plenty of rest, etc., When I returned to my next visit, it had moved and all was okay.

I was scared to death. Up until that point, I had a smooth sailing pregnancy and then ran in to a little bump. It is common and from the statistics that you've found, it's true...it resolves for a majority of women.....

Wishing your loved one the best!!
post #3 of 25
The degree of previa is important. I don't have any stats but it's my understanding that a partial will usually resolve but a complete won't.

I had a partial at 12 weeks and was put on "pelvic rest." I didn't necessarily listen to that, just listened to what my body needed. Of course, since I had HG it pretty much amounted to the same thing. Come 20 weeks the tech hemmed and hawed and even had to use the vaginal probe to finally decide that I had a previa. Considering how unsure she was I wasn't concerned. I was also told that my placenta is posterior. By 26 weeks my baby was punching me in the rectum, which wouldn't have been possible if I still had my placenta that low.
post #4 of 25
Are you by any chance a relative of mine? The u/s tech identified placenta previa at my 18 week scan on Tuesday. (My placenta is anterior too. Fun times.) It's been a frustrating diagnosis to have, because at this stage, the correct action is "wait and see", and with all the terrible things the condition is linked to, it's impossible not to want to DO something.

Thinking about this logically (which is about all that's available to a nervous pregnant lady): The thing that moves the placenta is uterine growth. So posterior or anterior shouldn't matter so much. Presuming that uterine growth functions like a balloon inflating, with all the parts expanding at about the same rate. Which I don't know that it does. I hope it does.

I haven't been able to find specific rates of resolution on-line, and it's a question I plan to tackle with my midwife when next I see her. I assume that the more completely the placenta is centered on the cervix, the lower the rates of resolution, but I am not a medical professional, and I don't know if there is some other factor at work. (Also - "complete" vs. "partial" or "marginal" previa is a somewhat misleading set of terms. My previa is complete - the placenta completely overlies the cervix - but "marginal" - it's the edge of the placenta that overlies the cervix. The medical professionals I have spoken to have occasionally been confused. Illustrations of "complete" previas on the internet always seem to show the placenta centered on the cervix.)

I have had to give up internet research on this topic, on the basis that all it does is terrify me. However, I did find this site: http://emedicine.medscape.com/article/796182-overview

The article looks to me like information intended for the use of EMTs and emergency room personnel on the handling of placenta previa when it presents to the emergency department. The maternal mortality rate associated with this condition in the United States .03% for the years studied. Because of the seriousness of placenta previa, I can only assume that this rate is supported by a high level of ability to medically handle the situation. I haven't been able to find rates of infant mortality or for maternal or infant morbidity related to placenta previa. I have stopped looking.

The care providers I have spoken with this week have been very - *very* - clear with me that they do not feel that placental positioning is an issue at this time. They want to do another ultrasound in ten weeks, they want me to call *immediately* if I experience vaginal bleeding, but they do not feel that it's appropriate to limit my activity or begin to plan a surgical delivery at this juncture. Rates of resolution of placenta previa diagnosed at this stage are very high.

s I hope everything works out for your loved one, and she gets to have a nice, calm, uncomplicated delivery in November.
post #5 of 25
Thread Starter 
thanks for sharing your experiences, ladies. i really appreciate it. and thanks for the link to that article, MeepyCat (and no, not your relative, but i'm sure there are lots of folks in the same boat!).

again, if anyone has found an article with lots of numbers in it, i'd love a link.
post #6 of 25
I have a complete previa myself. Just looking for some answers.
post #7 of 25
As you'll find a lot of marginal previas found early in a pregnancy resolve themselves without any trouble for a vaginal delivery.

If it is a complete previa and covers the cervical opening it might not have as good a chance of growing away from the OS.

You need to know how are they measuring the distance? The best way to measure it is through vaginal ultrasound. I had a marginal previa that moved to low lying and finally at 37 weeks through vaginal ultrasound it had moved enough for a vaginal delivery.

If it moves and they clear you for a vaginal delivery I would encourage you to have the sonographer visualize the cord and where it inserts into the placenta. I had a velamentous cord insertion (the cord inserted into the amniotic sac, ran along the sac a distance and then inserted into the side of the placenta). Those exposed vessels also ran very close if not over my cervix (vasa previa). My sonographer did not catch this and minutes before my son was delivered the sac and the cord tore and he lost most of his blood. He died 12 hours later. I should never have been allowed to have a vaginal delivery.

The placenta doesn't "move" with the uterus as it expands but it usually will grow upward to the more blood vessel rich areas of the uterus as the uterus expands. Wherever the cord inserts into the placenta does not move with it - the insertion of the cord into the placenta is set. As the top of the placenta grows upward the lower part of the placenta can atrophy away from the OS. If the cord inserts near the lower part of the placenta it can leave the cord in a precarious position. The cord insertion is very easy to look for and it should be done as part of your regular care - especially with any type of previa. Previa is a risk factor for velamentous insertion and vasa previa.

I do not say this to scare you. It is very rare and it is very easy to diagnose if it is looked for. I just wish someone here had mentioned the small possibility with a low lying placenta last year when I was posting about mine. I would have loved to have been given the chance to ask about it at all of the ultrasounds I had. A vaginal ultrasound with color doppler makes it very easy to visualize where the cord is and how it inserts. It is worth bugging your doctor and sonographer about.

Best wishes.
post #8 of 25
A close friend has had complete placenta previa with her DD and partial with her DS. She was put on bed rest for the last 4 weeks of her pregnancy for her DD and had a c/s with her at approx 37 weeks, her daughter and her came through just perfectly. With her son they chose to do a scheduled c/s and in her case it was a very good choice because she developed a secondary issue because of her c/s scar, that required surgery. She had no bed rest though and he came at 39 weeks. Her son is also fantastic and came out with no issues.

Overall you can have good results with complete placenta previa, it just needs to be watched.
post #9 of 25
Quote:
Originally Posted by Cheshire View Post
As you'll find a lot of marginal previas found early in a pregnancy resolve themselves without any trouble for a vaginal delivery.

If it is a complete previa and covers the cervical opening it might not have as good a chance of growing away from the OS.

You need to know how are they measuring the distance? The best way to measure it is through vaginal ultrasound. I had a marginal previa that moved to low lying and finally at 37 weeks through vaginal ultrasound it had moved enough for a vaginal delivery.

If it moves and they clear you for a vaginal delivery I would encourage you to have the sonographer visualize the cord and where it inserts into the placenta. I had a velamentous cord insertion (the cord inserted into the amniotic sac, ran along the sac a distance and then inserted into the side of the placenta). Those exposed vessels also ran very close if not over my cervix (vasa previa). My sonographer did not catch this and minutes before my son was delivered the sac and the cord tore and he lost most of his blood. He died 12 hours later. I should never have been allowed to have a vaginal delivery.

The placenta doesn't "move" with the uterus as it expands but it usually will grow upward to the more blood vessel rich areas of the uterus as the uterus expands. Wherever the cord inserts into the placenta does not move with it - the insertion of the cord into the placenta is set. As the top of the placenta grows upward the lower part of the placenta can atrophy away from the OS. If the cord inserts near the lower part of the placenta it can leave the cord in a precarious position. The cord insertion is very easy to look for and it should be done as part of your regular care - especially with any type of previa. Previa is a risk factor for velamentous insertion and vasa previa.

I do not say this to scare you. It is very rare and it is very easy to diagnose if it is looked for. I just wish someone here had mentioned the small possibility with a low lying placenta last year when I was posting about mine. I would have loved to have been given the chance to ask about it at all of the ultrasounds I had. A vaginal ultrasound with color doppler makes it very easy to visualize where the cord is and how it inserts. It is worth bugging your doctor and sonographer about.

Best wishes.
Cheshire, I am so sorry.

I had the same exact thing except I kept bleeding throughout my pregnancy and had the color flow doppler done at 31 weeks. I was sectioned at 35 and my little guy was just fine.

I agree - if it is a complete previa, have your relative push for a color flow doppler - even if it looks like the placenta is moving out of the way. I was told at my 30 week ultrasound that the placenta had moved but less than a week later I started bleeding like crazy again. But, on a good note, every pregnancy is different and I had a marginal previa with this one and it has moved and there is no cord presentation so I can have my home birth! Yeah! Good luck to you and your family
post #10 of 25
to you Cheshire, I am so sorry and thanks for the warning. I know they did something with the cord when I had my 20 wk u/s and there was color (red/blue) but she said it just showed the direction.
post #11 of 25
Pookietooth - yes, they'll check the blood flow in the cord and they often check where it inserts into the baby but there are some that do not check the placental insertion site. Be sure to ask them to check it - it would only take a minute for them to see if there are any problems or not.

Best wishes!!!
post #12 of 25
Just want to note that a full or even partially full bladder at this stage of pregancy can make a low lying placenta appear to be a partial previa. My 19+ week U/S showed a decent partial previa yet today, at 21+ weeks, we saw the perinatologist who did an external and internal ultrasound on an empty bladder and saw that it is nearly an inche from my cervix. He specifically said that it's not uncommon for less skilled techs and radiologists to make this mistake.

I have read in many, many places that 90% of partials resolve themselves when noted at 20 weeks.
post #13 of 25

Update?

Thank you for all the information. I was diagnosed at 19 weeks with Complete PP, and based on symmetry doc doesn't think it will resolve. I see it has been a couple months since this thread was started, do any of you mind posting an update on your condition? Did yours resolve, or persist? Did you experience any bleeding episodes, and if so, in what week and can I ask if there was anything in particular that started it? Thanks in advance, I know everyone's case is different but the information out there is extremely inconsistent at best, so I am interested in anecdotal evidence to get the *real deal* as far as what can possibly be expected in weeks to come. Thank you in advance.

gbphoenix, 20 weeks along with my first, a little boy.
post #14 of 25
gbpheonix, I'm sorry you're dealing with this.

Updates: I had small bleeds at 26 and 29 weeks. After the first bleed, they kept me in L&D for four hours, the second earned me a week in the ante-partum unit. I began hemorrhaging at 32w, 4d and delivered my daughter by c-section - my birth story is up in the Birth Stories forum here. I cannot trace any of my bleeds to any particular event or exertion. The first and the last both started while I was lying in bed. I suspect that the last bleed was related to pre-term labor (I was 2-3 cm dilated when I got to the hospital, and I think if I hadn't been, I wouldn't have bled).
post #15 of 25
I had a friend (somewhere here on mdc) who had a complete previa at 20w. By her 32w u/s, it had completely resolved. I think the standard to wait and see is a good one. So much of the anatomy changes in a few short weeks.
post #16 of 25
Thank you, MeepyCat. I read your birthstory and sincerely appreciate you sharing, I am sorry you had to go through all that. It makes me feel better when I read about this stuff because I tend to do worse when I don't understand what is going on. I think now after researching I'll have less of a tendency to panic if something like that happens to me.

Looking back, any tips for me or others in this situation? Doc just has me on standard pelvic rest and limited activity, no exercise, not bed rest yet. But I have to admit that I've thought about putting myself on bed rest when I'm at home just to be on the safe side. In general it seems the less we do the less chance we have of aggravating anything (unless preterm labor, not much you can do about that). Is there anything you wish you would have looked into beforehand, perhaps pertaining to csection or NICU? Any specific questions we should ask our doctors? Thanks again and best wishes to you and your baby girl.
post #17 of 25
Advice on previa generally:
Stop wearing your red panties now. Ditto any dark pink ones you happen to have. Put them away or throw them out. Buy new ones in pale colors. Damp red panties are indistinguishable from bloody red panties, and you're pregnant, so you're probably damper down there than you've ever been. It's not worth the heart attacks.

If you bleed, medical personnel will ask you to describe your previa. The easiest, fastest way to do this is to use a fist to represent your cervix and the other hand to represent the placenta.

If they ask you how much you bled, don't even try to guess at volume, tell them the size of the splotch. Holding up your hands for this works fine. If there is too much bleeding to describe in this way, just show them your pants.

One of the reasons that previas make OBs nervous is that they can't perform cervical exams. No checking for effacement. No fetal fibronectin tests. They can do a visual exam for dilation, but that's it. It makes them twitchy. You can expect a lot of non-stress tests. Always pee first - you'll get better results.

Hospital/NICU/C-Section Advice:
I feel like one of the things to know about hospitals, NICUs, etcetera is that when you get into an ambulance, the ambulance will take you to the closest appropriate facility. The only way that you have a choice at that point is if two appropriate facilities are equidistant from your current location. So find out what you can about the closest obstetrical unit and Level III NICU to your house.

It's best if you can get yourself to the hospital - that way you do get to choose where you want to go. There are, however, situations in which an ambulance really is what you need.

I feel like I lucked out with my section - I was really comfortable with the surgeon, and I think he and his team did a really good job by me. If your doctor is telling you that you need to plan for surgical delivery, ask him who would likely perform that surgery, and try to meet that person. However, I would also demand a Level II ultrasound at 30 weeks to check for placental movement, and possibly follow-ups as well.

Ask where your doctor thinks you should deliver if the baby is early, and if that's any different from where you should deliver if you carry to term.

If I had it all to do over, and I knew how things were going to go (and, presuming I knew, wasn't panicked to the point of complete idiocy), I would really want to be in a hospital with a breastfeeding friendly NICU. So I'd want a pediatrician that had admitting privileges at that hospital and was willing to help me transfer the babe there if I didn't give birth there in the first place.

Bedrest advice:
There's a high-risk pregnancy forum that will probably recap a bunch of this stuff, but I'll say it anyway.

I would go ahead and do things early, because time may be limited. Find a ped. Buy a carseat. Cook freezer meals. Hire a cleaning service (now, if you want to put yourself on bed rest at home). If you don't give birth early, doing all this early will let you do it at a more leisurely pace. It won't be wasted.

I say "hire a cleaning service" rather than "get someone to clean" because long stretches of bedrest made me really tired of asking for help and having to be grateful to the people who did things for me. If you can afford to pay someone, it's worth it to not feel bad every time you think something is put away wrong, or not clean enough.
post #18 of 25
Wow MeepyCat, that was extremely generous of you to take the time to put all that together for me. Thank you so much. It really helps now having some focus, some things to actually do (as opposed to just sit and wait), I will break out my old freezer meal books thand start researching carseats. Thanks again really for getting so specific, there wasn't a thing on there that was generic advice or that I'd heard already somewhere else. Extremely informative, and I am very grateful that I found you and this thread. Have a good night and many blessings to you and your DD!
post #19 of 25
Just a quick update to say that my complete previa dx'd at 20 weeks totally moved out of the way by the 36 week ultrasound, leaving me cleared for a vaginal birth! So I'm doing a home birth after all! Just goes to show there is hope. I did weekly acupuncture, a Chinese Herb combination called "arouse vigor" and also homeopathic sabina, 30C, three times a day (but I was not consistent about it). I also did some moxabustion on a couple of points -- one on top of my head and the other at the top of my uterus, although again I wasn't consistent with that either (especially the head one, as I singed my hair a couple of times doing it).
post #20 of 25
Thanks Pookietooth, also very helpful. I'm trying to prepare myself for any scenario, my OB didn't sound encouraged, but obviously I would love to have a similar outcome. The waiting game is awful though! Three more weeks for an ultrasound, ugh. In the meantime my friend and I have coined ourselves the Finger-Crossing Club (FCC) :-) Congrats on being able to realize your home birth plan, hope everything goes perfectly!
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