Vaginal Birth with Low Lying Placenta

[omshantihi]

Hi,

I had a question birth professionals with experience in this area or for those who are planning to deliver vaginally or have already delivered vaginally with a low lying placenta. In my case, I've gone from a partial previa at 21 weeks to a marginal at 34 weeks to a low lying (1.1 cm from cervix) at 36 weeks. My OB would like a 2 cm clearance to okay vaginal birth. I'm really hoping that happens by week 39. I haven't had a bleed all through my pregnancy. So these were my questions to those of you who have assisted in, gone through, or are in a similar situation.

1) Have any of you or your care providers (midwives/obs) okayed vaginal birth at less than 2 cm from OS?

2) For those who have been cleared for vaginal birth, are there any special precautions that your care provider is taking? (I'd still prefer an unmedicated birth but would take a controlled/medicated vaginal over c-section if that's possible.)

3) Those of you who had successful vaginal births or attempted vaginal births, what was your delivery like? Were there issues with bleeding/detachment of the placenta after baby was delivered?

4) Finally, those of you who had c-sections, when was your surgery scheduled for? 38 or 39 weeks? Were any of you allowed to start labor on your own?



Thanks!!!

[jengacnm]

Here are some articles-I think the results speak for themselves.

I'd recommend an IV lock (no IV bag hanging) for a vag birth.

Best wishes!

Jennifer

BJOG. 2003 Sep;110(9):860-4. Links
Placental edge to internal os distance in the late third trimester and
mode of delivery in placenta praevia.Bhide A, Prefumo F, Moore J, Hollis
B, Thilaganathan B.
Fetal Medicine Unit, Academic Department of Obstetrics and Gynaecology, St
George's Hospital Medical School, Cranmer Terrace, London SW17 0RE, UK.

OBJECTIVES: To correlate transvaginal ultrasound findings with mode of
delivery in cases of placenta praevia. DESIGN: Cohort study. SETTING: A
London Teaching Hospital. METHODS: Retrospective review of all cases of
placenta praevia diagnosed by transvaginal ultrasound between February
1997 and March 2002. MAIN OUTCOME MEASURES: Likelihood of vaginal delivery
and major obstetric haemorrhage. RESULTS: A total of 121 pregnancies were
studied with a mean scan-to-delivery interval of 10.5 days. In the 64
women who laboured, the likelihood of vaginal delivery rose significantly
as the placental edge to internal os distance increased. Caesarean section
rate was 90% when the placental edge-internal os distance was 0.1 to 2.0
cm, falling to 37% when this measurement was over 2.0 cm (P < 0.00045).
CONCLUSION: Trial of vaginal delivery is appropriate in cases with a
placental to internal os distance >2 cm. The term "praevia" should be
restricted to cases where the placental edge is < or =2 cm from the
internal os, as the likelihood of operative delivery and significant
postpartum haemorrhage is high. Cases where the placenta is more than 2 cm
from the internal os have a greater than 60% chance of vaginal delivery
and should be defined as "low lying" in order to reduce the clinician's
bias towards operative delivery.
Am J Obstet Gynecol. 1991 Oct;165(4 Pt 1):1036-8. Links
What is a low-lying placenta?Oppenheimer LW, Farine D, Ritchie JW,
Lewinsky RM, Telford J, Fairbanks LA.
Department of Obstetrics and Gynecology, Mount Sinai Hospital, University
of Toronto, Ontario, Canada.

Transvaginal ultrasonography was performed in 127 women thought to have
placenta previa. In all cases of complete previa, placental location was
confirmed at cesarean section. Where the placenta was situated in the
lower segment of the uterus but did not cover the cervical os the distance
from the placental edge to the internal cervical os was measured. This
distance was analyzed in relation to the route of delivery. No patient
with a placental edge greater than 2 cm from the internal cervical os
required cesarean section for the indication of placenta previa, whereas
seven of eight patients with a distance of less than or equal to 2 cm
underwent cesarean section because of bleeding characteristic of a
placenta previa. These preliminary results suggest that transvaginal
ultrasonography measurement may indicate the optimal delivery route and
make the traditional classification of placenta previa obsolete.

[MaryLang]

This is good info to have.
I had a marginal previa with #3, I don't remember the measurements.
I had a c/s with her because at 35wks I started having a pretty good bleed, we held on for a week and delivered at 36wks.

[lola731]

I had a complete previa until my 38 week pre-op appt. for a c/s. Never had any bleeding with it though. This was my 2nd baby. The dr. (wonderful guy) did "one last u/s" per my request because I so did not want a c/s. The previa had moved 1.9 cm off the cervix. So he said he felt good about me waiting and going for vag. birth. A week later he checked again and it was 2.1 cm off. Baby came at 40w4d after a short no meds labor The only thing he said was for me to come in as soon as I knew I was in labor, so they could check my cervix in the OR (so I was prepped for a c/s, but no meds; anesthesiologist was ready to put me under general if needed), and they did have to break my water to make sure there was no bleeding. I did have some bleeding as soon as I was in labor at my house, but baby and everything were just fine (scared me though). Good luck! Hope it moves more for you, every case is different.

C

[Defenestrator]

I think it is pretty likely that your placenta will move enough for a vaginal birth. The uterus grows a lot between 34 and 39 weeks and it is the growth of the uterus that helps the placenta move up.

Good luck!

[omshantihi]

Thanks for your advice, everyone. I'm 1.5 cm at 37 weeks. Praying for 2 cm :-)