Friend with placenta previa at 20 weeks...

[courtenay_e]

Hello! This is a full previa, centered exactly square over the cervix. First she's wondering what the chances are that it'll move enough to have a vaginal birth, and second, she is very serious about doing whatever she can, if anything, to help it move upward. I said I didn't know that there was anything she could do, haven't had a chance to look it up, but thought that perhaps one of you knew off of the top of your head. Help!? Thanks!

[wifeandmom]

Statistically speaking, the chance that it'll 'move' enough to allow vaginal birth is very high. I've seen numbers as high as 95% that 'move' prior to delivery.

I have not, however, seen anything that indicates one can *help* it resolve.
It either happens, or it does not.

Things that decrease the chance it will resolve before birth: prior c-section or other uterine surgery of any kind, the fact that it is a complete previa sitting directly on the cervix is worse than one that is off to the side some, and the longer it stays over her cervix, the less likely it is to resolve.

She needs to be educated on signs and symptoms of potential complications associated with previa so she could get medical help promptly if she had any complications. She needs to be re-scanned at about 28 weeks or so, or sooner if symptoms warrant, to see where the placenta is at that point.

The good news is most previa cases resolve before delivery. The bad news is there's nothing she can do but wait and see.

[amyro]

I agree with PP but would add that she could insist on repeating ultrsounds until it moves out of the way or labor starts. We had a client in my previous practice who had persistent previa, scheduled her CS when the previa was still present at the 37 week ultrasound, went for a final repeat US 3 days before the CS (39 weeks) and it had moved. Had an absolutely lovely vaginal birth in the birth center, as originally planned.

(Side note - completely ridiculous, the doctor actually recommended that she keep her CS appt after the previa had moved because she had had a traumatic birth (read: overmanaged ending in forceps vaginal delivery and a very bad tear) with her first baby. I couldn't believe a doctor would recommend completely unnecessary surgery, and the woman in the end had no laceration and an enormous sense of empowerment and healing!)

[SublimeBirthGirl]

If it were me I wouldn't bother with multiple ultrasounds. I'd believe it's going to move, and wait. Probably get another u/s around 35/36 weeks, since a full previa usually is going to necessitate a pre-labor cesarean.

[amyro]

I certainly am not advocating lots of ultrasounds. My point was that if the follow-up ultrasound says the previa is still present, insist on another ultrasound several weeks later. And if it still hasn't moved, ask for yet another. Etc. until the placenta moves or labor begins or the previa becomes symptomatic.

Most women with previa want to do the follow-up ultrasound sooner rather than later because they are on pelvic rest (i.e. no sex or anything in the vagina) as long as previa is present. So, while I am no fan of ultrasounds (have only had one between my two pregnancies, myself), in this case I think a balance can be struck between over-imaging and maximizing the chance of vaginal birth.

[courtenay_e]

Thank you. Funny thing is, she was there for her 20 week ultrasound and the tech AND the CNM missed the previa, until, when she peed halfway through the ultrasound there was blood in her urine. Then they REscanned and found a full previa.

Also, question: The CNM is suggesting that she wean her 14 month old. There hasn't been any issue YET with their nursing while pregnant...no contractions, etc. Is there TRUELY a risk with nursing with a previa with no history of preterm labor and no current contractions? Thanks so much for all of your help. I'll link her to this thread.

[onlyboys]

Personally, I'd feel comfortable nursing through a pregnancy that had a previa. I also would encourage her to watch things very closely. A good friend had a previa (that she nursed through) at 20 weeks, it moved slightly, but still covering the os by 33 weeks, when she started dialating and effacing. She avoided the c/s for as long as was safe (about 34.5 weeks) when she hemorrhaged and had the c/s. Strangely enough, they still did vaginal exams on her (wth??) and were SHOCKED that she hemorrhaged after one. :

[courtenay_e]

Thanks for that, onlyboys!

[ZoeyZoo]

From what I have read on the subject, if it was complete previa it is less likely to move high enough before labor than partial previa. Not that it can't, but it isn't as likely. The good news is at 20 weeks, from what I understand, some state of previa is relatively common. As PP said, I would get an addition US as your friend gets closer to see if the placenta has moved.

[Mindi22]

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I'm subbing to this thread, as I just found out today I'm in the same situation as the friend of the initial poster. The MD that looked at the scan pics told me I should follow up with an US in about 4 weeks to see what was happening. I'm not so concerned about the issue of moving or not, since it's not something that I can really change regardless, but now I'm concerned after doing internet research and hearing about risks to the baby d/t the placental placement and decreased blood supply there.
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