Complete Placenta Previa at 20 weeks?

[Xiaohua]

I had my 20 week (I am actually 21 weeks now) diagnostic scan today, and the US tech said it looks like a complete placenta previa. I asked her if she thought it might move but she was doubtful. I haven't seen my dr yet, as that appointment is not until next week.

I just feel crushed and numb. This will be my 6th baby, and my last two were absolutely wonderful homebirths. I was planning homebirth for this one too... but now I am looking at the reality of a scheduled section before labor even starts.

I know that many previas do move up. Previas that are not complete, and those diagnosed before 20 weeks are very likely to move (over 90%, from what I have researched). But after 20 weeks the chances are lower, and complete previas are less likely to move. I know anything is possible, but I feel pretty hopeless now.

There were a few things that caught my eye as I was searching on the web... contractions can push the placenta lower and make it look like a previa when it isn't, and I had a lot of them during my scan. Also, some studies show a 25% misdiagnosis rate with abdominal scans, and a much lower rate of misdiagnosis with a vaginal scan (my scan today was a transabdominal scan). Having a full bladder can affect the apparent position of the placenta as well, and I felt like I had to go during the first scan, but then she had me drink a ton of water and did a second scan to have a better look at the previa again and so my bladder would have been really full. But then she said the placenta was definitely posterior, so I don't know how bladder fullness would affect it back there.

I want to think there is a chance that this will all work out, but I don't want to fool myself either. The thought of having a scheduled section just about ruins my year, and completely dampens any joy I might have had about a new baby. I'd just like to start over with a new baby and new placenta - I feel angry at this baby like it's all her fault. It just seems like a nightmare. I guess I do have 4 more months to get used to the idea, if the placenta doesn't move. But right now I could just cry.

Any thoughts or experiences on complete previa when you were planning a homebirth?

Serena

[MittensKittens]

No advice really, though my understanding is that complete previa is unlikely to move out of the way. I couldn't read your post and not reply though,

[LaughingHyena]

I had complete previas at my 20 week scan with both children. With DS it had moved enough by 38 weeks for me to go for a normal delivery. DDs caused more complications, I was taken to hospital several times with pretty heavy bleeding and at 33 weeks it did not stop so she was born by C/S

In both cases I had been planning a homebirth, in both cases I ended up with a C/S. However I was able to go home quite quickly in both cases (though DD had to stay in a lot longer)

My advice would be to wait a while and take it all in then look around here at some C/S birth plans, there are a lot more options than I thought there would be when I first started looking.

I found a lot of very scary stories when googling so be prepared if you do that.

[MsBlack]

Oh, mama, what a thing to have to think about!

But...all I think you know for sure is that you most likely have a very low lying, posterior placenta. It may or may not be a complete previa at all. And as LaughingHyena experienced, even a 'complete previa' at this stage can shift enough for normal birth (apparently LH had a csec for other reasons???).

So have your time of feeling mad, sad, frantic--and let the wave pass on through you. You have lots of time still! Time for placenta to move, and it certainly will move some. No need quite yet to give up to a csec! On the other hand, with a later scan if it's still very low or complete, and it does seem that you may have to have a surgical birth....well, there will be time to prepare for that, and even to find peace and gratitude for a healthy baby (and healthy you) due to the surgical option.

Not what any of us *wants* to be prepared and grateful for! And still....if this is the way it is, then you really can make the best of it if you so choose.

Meantime--it's too early to tell. Have your moment, your worry and anger and grief, and then let that wave pass. And keep visualizing, praying for, calling to, a beautiful birth, a placenta that moves away from it's present position--and seeing yourself calm, and prepared for the birth that must be.

[mntnmom]

That's a lot to deal with when you should be focusing on growing your baby!
Look into having a vaginal ultrasound, and keep an eye on it to see if it moves. But since it is a real possibility, take the opportunity to be as prepared as possible for a c-section. Find the hospital with the best nic-u. Talk to OBs about their stances on vaccinations or whatever is important to you. You CAN have an informed an empowered experience, even with a section.
And if it does move up, it'll just be a lot of good information you can pass on to another mama!

[MeepyCat]

I did a ton of work finding the midwifery practice that gave me the best possible chances of a peaceful, natural delivery and then wound up with an emergency section due to previa.

While I was pregnant, I felt like I wanted to bury my head in the sand so very badly. I wanted a natural birth, I was terrified of surgery, I knew I was probably not only going to have to go to the hospital, I was likely to wind up at a different hospital than the one I'd carefully researched and selected, at an institution I'd rejected for having insufficient regard for natural birth. And in the end I did end up at that rejected hospital, and their level of regard for natural birth was totally irrelevant. They have a great NICU, which we needed badly (DD was born at 32w 4d).

Couple things:
1. Not all complete previas are created equal. There are complete previas as illustrated on the internet, with the cervix centered on or near the cervical os, and then there are complete previas where the cervical os is completely covered by one end or edge of the placenta, and the placenta is actually centered higher up. This last kind is far more likely to politely go away.
2. If they've identified a suspected previa at this stage, they should be scheduling you for a follow-up level 2 ultrasound sometime between 28 and 30 weeks. If they haven't said anything about this, push for it.
3. It is possible to have an informed and empowered experience of even an emergency c-section - start taking those reins now. If the previa resolves, you can drop them.

At my six week follow-up appointment, I made the OB who did my surgery tell me what had happened to me, and why I had hemorrhaged. She told me some things I wished I had known earlier - when the placenta is implanted over the cervix, it tends to irritate the cervix, causing dilation. Dilation, in turn, irritates the placenta, and can cause rupture of the lacunae of blood in the placenta and damage to the oxygen-transfer membrane between mother and baby. This can cause really dramatic bleeding and some serious health problems for both of you.

Practitioners vary in their recommendations regarding how much and what kind of rest is appropriate for patients with placenta previa, and every woman and every pregnancy is different. No one who hasn't met you can possibly tell you with any certainty what you should and shouldn't do. What I can say, what my experience leads me to strongly suggest, is first that you get help now (who would you call to come be with your kids or to take you to the hospital if you started bleeding? what can be put in place in case you need to be on bed rest, or have an extended hospital stay?), and second that you respect your body's limits. If you feel tired, rest (I totally sucked at this part). Be more than usually vigilant about your hydration and about contractions.

The longer you can stay pregnant, the better it is for you and the baby, and the higher the odds that the previa will resolve.

[Xiaohua]

Thank you so much for all the responses. I did have a follow-up visit with the doctor today, and the rather shocking result of that is posted here:
http://www.mothering.com/discussions...4#post15104164

Think I need a second opinion?

Serena

[LaughingHyena]

And as LaughingHyena experienced, even a 'complete previa' at this stage can shift enough for normal birth (apparently LH had a csec for other reasons???).

Yes I also have a large fibroid right next to my cervix so it was always touch and go whether there was room for DS to get out. The scans showed the placenta was clear but the fibroid still had some room to move. 48 hours after my waters broke I opted for the section.