Placenta Previa and C-section timing

[triony]

My husband was talking to a coworker about the co-worker's wife's birth. (I love that DH is so interested in this stuff!!) Apparently the Co-worker's wife had placenta previa, and a c-section at 38 weeks.

My husband's question was about the timing. Why did they need to do the c-section "2 weeks early"? Could they have waited? I don't know if she was bleeding, etc., but the impression I got was that she wasn't.

Does anyone know at what point they need to do a section for Previa?

Thanks!

[GoBecGo]

I have no idea in her case. My mother had placenta praevia with my brother which abrupted at 30weeks and he was c-sectioned out immediately (they both almost died, mum lost 80% of her blood volume). Was it her first baby?

I always wonder with praevia - do they just cut right through the back of the placenta to get the baby out? Presumably it's down there where the LT incision is made...? Doesn't that pose risks? Or do they cut higher? Or what?

[jeliphish]

because with full placenta previa you cannot risk the mother going into natural labor. Like the PP said, it is a great risk of maternal and fetal death

[triony]

But why 38 weeks? Why not 37? or 39? or 40? or 36?

Thanks for your replies so far!

[jeliphish]

I guess because 38 is considered "term". I am sure they did complete a statistical analysis of when most women went into natural labor....mean, median, mode, all that stuff.... and decided on the "safest" time to do a necessary C-section in the case of full placental previa.

[GoBecGo]

Perhaps she'd begin dilating or effacing? Perhaps the last praevia baby her ob lost was born at 39 weeks? Perhaps her ob was going on holiday and she didn't want an otherwise-unknown to deliver the baby? Could be anything but probably isn't related directly to the praevia.

[MeepyCat]

I was sectioned for previa at 32 weeks due to hemorrhagic bleeding, had that not happened, we'd have scheduled the section for probably 38 weeks. My understanding is that 38 weeks is the compromise between giving the baby as much time as safely possible to mature in utero and avoiding cervical dilation (which can irritate and rupture reservoirs of blood in the placenta). Because placental placement in previas often results in cervical irritation (which, in turn, results in irritation of the placenta), it is not unusual for complete previas not to make it to term.

They absolutely do *not* cut through the placenta when sectioning for previa. The risk of death or disability from previa is the result of the risk of damage to those blood vessels during labor, they'd just about kill you if they sliced through them during surgery. They'll locate the placenta by ultrasound and then do what they have to do to get around it. My c-section turned out to be the standard-issue lateral incision, but I was lucky. They do sometimes have to do classical incisions, or, in drastic cases, hysteroscopy.

[MeepyCat]

Originally Posted by GoBecGo

Perhaps she'd begin dilating or effacing? Perhaps the last praevia baby her ob lost was born at 39 weeks? Perhaps her ob was going on holiday and she didn't want an otherwise-unknown to deliver the baby? Could be anything but probably isn't related directly to the praevia.

I pretty strongly disagree with this. If she had a section at 38 weeks for previa, I'd guess that previa was the reason for the timing. If she'd been dilating, she probably would have bled like crazy (that's what happened to me). They actually can't check for effacement except by transvaginal ultrasound with previa (and they're pretty cautious even with that, because they do not want anything to touch the cervix). This is one reason why they do sections so early - because the tools they would ordinarily rely on to see whether it might be safe to wait aren't available. Previa is some scary stuff - before doctors got so good at surgical delivery, it was a death sentence.

[GoBecGo]

But 38 weeks isn't "early" - my brothers abrupted at 30+4. Why 38weeks specifically in this case when we all know abruption can occur at any time and can be fatal for both mum and baby (perhaps you missed my earlier post about my mothers experience?)? If a baby can die at 30, 33 +4, 37+1 from abruption due to previa why wait until 38? Equally some babies will go to 40 without abruption or dilation starting off bleeding. My mother was in hospital from 16 weeks with my brother, when bleeding made them aware that she had placenta praevia. She spotted on and off from there, and he was considered a miracle at the time (1977) because he made it long enough to survive his birth and then survived his relative prematurity and the illnesses that it caused.

In this specific case where we do not know the ob or have access to the notes we have no way of knowing. My point was NOT that c-sections don't save lives in the case of praevia, only that the exact timing of that c-section might well be unrelated to the actual woman and baby in question. Clearly she had to have the section, but did she HAVE to have it at 38 weeks? Could 37 or 39 have been overall "better" or safer? Maybe, we've no way of knowing. Why could it NOT have been unrelated to the praevia?

[MeepyCat]

Originally Posted by GoBecGo

But 38 weeks isn't "early" - my brothers abrupted at 30+4. Why 38weeks specifically in this case when we all know abruption can occur at any time and can be fatal for both mum and baby (perhaps you missed my earlier post about my mothers experience?)? If a baby can die at 30, 33 +4, 37+1 from abruption due to previa why wait until 38?

Per my previous post - they'll do an earlier section if they have to (that's what happened to me), but 38 weeks is the standard compromise between giving the baby as much time as possible in utero and trying to make sure that the mother doesn't go into labor before the planned surgery.

[claddaghmom]

Because 38 weeks is the soonest they will do it without other presentation.

I actually think she must have a good doctor...I would say many other doctors would push for an earlier surgery.

[GoBecGo]

Originally Posted by claddaghmom

Because 38 weeks is the soonest they will do it without other presentation.

I actually think she must have a good doctor...I would say many other doctors would push for an earlier surgery.

Hmmm, i'm in the UK, 36 or 37 weeks is more common here when there is something like praevia, 39 if it's a repeat due to previous issues without pressing dangers before labour. Here 37 is "term" so when there is something like praevia going on, especially if it's a second or subsequent babe (where dilation might begin to occur much sooner than right before labour) that is the longest they advise. I did not state or imply her doctor wasn't good.

[MeepyCat]

37 weeks is term here too, but I think 38 is a better time for section than earlier (presuming there isn't a problem or crisis requiring the surgery be done sooner). Also, up to a point, more time in utero = more opportunity for previa to resolve on its own. Which, in the VBAC unfriendly climate in the US, is a very good thing.

When people say things like "maybe the surgery was done then because the doctor was going on holiday", the vibe I get is definitely "bad doctor."

[GoBecGo]

I actually said maybe he was going on holiday and she preferred to have him rather than an unknown alternative. If i was facing praevia i would want MY ob who was familiar with me and my pregnancy to be doing the surgery, and i would take an earlier c section to ensure that providing it wasn't weeks and weeks earlier. Even my independent midwife goes on holiday sometimes, birth care professionals are people too!

[lulu2011]

Hello

I also have been diagnosed with complete placenta previa but it's posterior. My doctor has me scheduled for a C-section at 39 weeks. I have been reading many many posts that say it's better to have c-section at 38 weeks like you're all discussing. I asked my doctor about this and she said because you're not bleeding and you're cervix is completely closed, we can try to go for 39 weeks. I guess deep inside my heart I'm worried and I'm not sure if it's good to wait that long. There are several factors that I'm considering. First, I live 40 minutes away from hospital so if I bleed, I will have to go to the nearest hospital which is 7 minutes away to an unknown facility with unknown doctors. Second, I heard that having posterior previa was at least better than anterior previa. Please let me know what you think on this. Third factor, is that I have made it to 37 weeks with no bleeding and my doctor checked me 3 days ago and found that I'm still completely closed. 

I asked her if I can be admitted to the hospital and stay there under supervision until my scheduled c section and ofcourse the answer was no. The only way I can be admitted is if I'm going to go ahead with the c-section. 

I'd love to hear your thoughts and comments on this. Should I push for c section at 38 weeks?

Thanks

lulu

[lawmama1984]

Originally Posted by jeliphish 

because with full placenta previa you cannot risk the mother going into natural labor. Like the PP said, it is a great risk of maternal and fetal death

This. My chiro was planning a HB with her baby due last October. She had a complete placenta previa (which was only dx with u/s...there was no indication otherwise, which is so rare!) and had to be sectioned right at 37 weeks because she could not risk going into labor at all.