Placenta Previa - Is this for real? (long)

[Xiaohua]

I was diagnosed with complete placenta previa a few days ago at 21 weeks at my diagnostic scan. I'm told the placenta is completely covering and centered on the cervix and not much chance of moving. I have spend hours since then researching this, and I think I understand the risks, treatments and issues involved. Till now, this has been completely asymptomatic, with no bleeding issues at all.

So I saw my dr today for the first time since the diagnostic scan (three days ago) and I cannot understand what the heck is going on! Basically, he told me that he is not going to call it a previa now, just a "low lying placenta". A bit of semantics for sure, but if he documents this as a "previa" now, then for liability reasons he must admit me and keep me inpatient until I deliver.

So here is the plan. No restrictions of any type, no pelvic rest. No more scans until 34 weeks. At 34 weeks they will see what has happened to the "low lying placenta". If it has moved, great, no need to worry about anything. If not, it will be documented in my records as a true previa and I will be admitted immediately at 34 weeks to await delivery. Even in the absence of any bleeding or other factors, they cannot allow a documented previa out of the hospital. Cesarean delivery would be scheduled for 39 weeks, which is not really a huge risk as I'd be in the hospital the whole time.

And if I should have a bleeding episode before 34 weeks? Then they will do another scan, and if a previa they would call it that. I would then be inpatient until I deliver.

I asked if they might do another scan at say, 28 or 30 weeks, or even 32 weeks to see if the placenta is moving at all, just to give me some idea what is going on. However, if they do at any point and it shows a previa they cannot allow me out of the hospital.

So what the heck - why would the hospital be so blasé about restrictions and risks, but once it is documented in my records as a previa then I am inpatient for weeks and weeks regardless of my actual condition? If I requested another scan before 34 weeks and it still showed a low lying placenta, then I'd be stuck inpatient for the duration, even if no bleeding or other problems.

Do you think that is irresponsible, to "pretend" nothing is wrong? Or do you think my doctor really believes no restrictions are needed at this point? I could haved a bleed next week and be stuck inpatient for the next 17 weeks. I cannot wrap my brain around this.

On the one hand, I could totally tell that my doctor thinks I am pretty uneducated and ignorant, and does not want to WORRY me with things that could "possibly" go wrong. His whole tone today was to put this in the back of my mind, and not to even think of it unless I start bleeding; we'll deal with it all at 34 weeks. It is true that there is nothing anyone can do at this point to influence the outcome. On the other hand, where on earth do they keep someone in patient for weeks and weeeks based mostly on liability? Surely they would claim high risk (and I understand there IS risk) but how can they do that? Is my insurance really going to pay for all that? Surely they're not fools...

Now you are all probably wondering where I am that I'm stuck in such an unusual situation. I am in Beijing, China, seeking care at a very high level international hospital with a very experienced and highly respected Australian OB. There are other practices locally where I could get a second opinion, but nowhere else that has inpatient capabilities in case of an actual bleed, or need for emergent c- section. That is because I am also rh-, and in the event of a bleed or surgery I might need blood, and this type (rh-) is not stocked in China. Only this one hospital stocks rh- blood in case it is need by the rare foreigner (like myself) who happens to have this blood type.

Guess I'll end that this is my 6th baby, and the first time to have any complications at all. My last two were unassisted home births, so this previa thing has been really hard for me to accept. I am scared to death and my visit today has left me shocked, overwhelmed and scratching my head.

Would love to hear from others who have experience with a previa, especially if your doctor did NOT place you on pelvic rest or other restrictions. I've just never heard of that!

Thanks!

Serena

[MsBlack]

What comes to mind is that if they are so very 'liability shy', then this doc would not have given you the advice/direction he did. In other words, that he is not being irresponsible, but realistic with you--placenta placement does shift quite a bit as uterus expands, this is well known. As conservative as OBs tend to be about something as risky to mom and baby both as placenta previa, I think I'd be inclined to trust his assessment and advice to a great degree. I'd trust that what he is seeing of your placenta makes him feel sufficiently reassured that you could well avoid the issues associated with previa.

Of course, you also have to trust yourself, your own intuition--for instance, he did not put you on pelvic rest but if *you* feel that pelvic rest is called for, then follow your own dictates on this.

I know this is so scary for you! Naturally you are worried, and want to be sure to make the best possible decisions. But let me say this: we are all, at every minute of our lives, basically 'on notice' that things can change very rapidly indeed; illness, disruption, loss and even death are ever-present realities for us all. However, most of us just don't think about it--we create our routines and our securities, trusting all of that for the most part. In this situation, you simply have been given an opportunity to be aware....painfully, shockingly aware....of life's fragility and uncertainty. This gives you the opportunity for at least 2 things that most of us rarely have (but many of wish we'd had, after unexpected problems do arise): to be consciously, willingly grateful for every moment of life, love, creativity, all that makes life good and powerful for us. Only in the presence of 'impending doom' can we so sharply be aware of all the reasons for gratitude, joy, cups that runneth over with love and spirits aware of Divine Presence.

And the other thing you have now is time to prepare--not often given to us. As another pp put it--take the reins now. Make your birth as conscious and healthy an experience as possible, do what you can to make informed choices and even more important, prepare to face the gravest possibilities with an open, courageous and peaceful heart/mind.

As the Chinese traditionally say, "crisis" is both danger and opportunity.

And I will say one thing as a person who has survived some pretty hairy crisis situations in my own life--many difficult things can occur in life. But once a 'crisis' has been ongoing for awhile, it stops being a crisis and becomes 'just the way things are right now'. The surprise wears off, we find ways to cope, to integrate the feelings and the life-conditions both. Right now you are still in crisis, it's still so new and unsettling. So, have those feelings, ride those waves....and know that over the days and weeks, you WILL begin to cope, to make choices, to get accustomed to this situation. It will lose that power of surprise; you will find your feet and your faith. Not saying it will get easy! Only that by taking one step after another, you will find the way--and while you will not truly let go of the insecurity until this pregnancy is done, you will have the opportunity to grow past the fear as days pass.

You *can* rise to this, and I will be praying that you get every help to do so

[MeepyCat]

My doctors didn't place me on pelvic rest or any other restrictions when my previa was first identified. I wound up on pelvic rest for minor bleeding at 26 weeks, inpatient bed rest for a week at 29 weeks, home bed rest after that, and delivered at 32w4d.

I'd think that mandatory inpatient rest for any identified previa is pretty draconian, but looking at your situation, it seems like your doctor is trying to manage your needs and his requirements as best he can. Ignoring the stuff about the hospital rules, what he's doing is telling you that right now, it's his judgment that you can carry on as usual and warning you that you should prepare to spend a lot of time in the hospital.

Placenta previa is pretty much the 800 pound gorilla of obstetrical complications. It gets what it wants. Even stateside, they discussed keeping me inpatient until delivery at 29 weeks. If I hadn't been able to convince them that I had enough help at home, they'd have kept me and yes, my insurance would have paid.

[MaerynPearl]

I agree 100% with MsBlack

Its hard to accept that something might go wrong, but you have more warning of it than most do.

Ive been in a somewhat similar situation. I had a placental abruption at 17 weeks due to nearly getting in a car accident and was put on bedrest (at home) with a large list of warnings and things that could happen (loss, brain damage, etc. of my child)

I lived 23 weeks in fear that I would lose my baby. He came 4 days past his due date and healthy as can be. But I had to live with that fear and restriction for so long after about a month and half of it, it just became life.

I lived in books for most of that bedrest though... to get away from the fear.

[lunarlady]

If it is a true previa, you really, really do not want to go into labor outside the hospital. This is one of those situations where a c-section can and will save both your life and the life of the baby. Since the chance of that happening before 34 weeks are very slight, your doc has said okay for you to live a normal life until then. But after that I think it is reasonable for you to be hospitalized until delivery, as an uncontrolled hemorrage outside the hospital could be fatal, esp. considering the lack of Rh- blood available for transfusion in the community. At this point, you can hope for the placenta to move, but your doctor is basically telling you that they see it as a bomb that will go off when labor starts, and they really want to avoid that at all costs. So I would start planning now for an extended hospital stay. I'm certian your insurance will cover it. Look into the options, get all your ducks in a row, and make plans for your family. If the placenta moves, great! But if not, at least you will be prepared.

[LaughingHyena]

I seem to remember something about not calling it placenta previa till a certain number of weeks, till then it was a low lying placenta which might well move.

I was admitted to hospital several times with bleeding, but as long as it stopped quickly I was allowed home and even back to work (I had a desk job so nothing strenuous). It was only when the bleeds where close together and not stopping as quickly that I had to stay in.

It was only after the first bleed that the doctors recommended pelvic rest. I was never on full bed rest, though while actively bleeding I was encouraged not to do much.

With my second DH and I felt we wanted to do pelvic rest as soon as we found that it was a low lying placenta again.