28 Weeks and a Vasa Previa Diagnosis - Mothering Forums
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#1 of 25 Old 03-29-2004, 11:18 PM - Thread Starter
 
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I had a follow-up ultrasound this morning and have discovered that our hoped-for homebirth won't be happening. I am bummed about that but I'm way more concerned about the diagnosis--Vasa Previa.

From what I've read, this is a rare condition that, undetected, is most often fatal for the baby. Barring speaking with an OB (our midwife accompanied us to the appointment and did tell us what SHE knows) all we know is that we'll need to schedule a c-section for around the 36th week. I may also end up on bedrest...worst case scenario, bedrest IN the hospital.

Anyone experienced this? Know anything about it?? I've done some research and read some frightening things...and also some things that give me hope.
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#2 of 25 Old 03-30-2004, 12:06 AM
 
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I think there is still some hope that the placenta will move up, isn't there?

Are you on total pelvic rest (meaning no lifting, no sex, etc.)?

Hang in there, the good thing is that it was detected and you will be monitored closely to prevent anything tragic from happening. I know you are disappointed about not having a homebirth but you sound like you have come to terms with the possibility of a c-section. The most important outcome is a safe mom and baby.

I love your picture on the front of the current issue! What a great keepsake for you to show your baby one day!
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#3 of 25 Old 03-30-2004, 12:33 AM
 
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No, this is not placenta previa - it's vasa previa, where veins from the umbilical cord run across the cervix. I have to say it is AMAZING that it was caught - they usually aren't. I've only experenced one as an L&D nurse. I was on duty with another nurse who thought she felt a cord pulsing near the cervix. The doctor came to assess, said there was no cord but the mom was having occassional deep decels, so they decided to c/sec. Vasa previa dx at c/sec and baby did fine. The OB was so greatful to the nurse for alerting him to it b/c the only other case he had did not have a good outcome despite "crash" emergency c/sec.

I think you have the best case scenario in that you have a prenatal diagnosis and your baby should do fine.
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#4 of 25 Old 03-30-2004, 12:42 AM
 
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PS - after the above incident I found a site on vasa previa. Not sure I'd recommend it until after the baby is born, but one thing it did mention is that vasa previa is often caused by a resolved placenta previa. The part of the placenta that covers the cervix dies away due to poor blood flow leaving just the vessels that lead to the umbilical cord. Thought you might find this interesting as to the "why" of it happening. The site also emphasised that with prenatal diagnosis and c/sec the outcomes are almost always good.
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#5 of 25 Old 03-30-2004, 12:46 AM - Thread Starter
 
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Thank you both. Mama2six, I hadn't heard it that way before--it makes sense. I did have a complete previa at 20 weeks and this u/s was a followup on that. It appears that the placenta is still on each side of the cervix and that there is a membrane running across the cervix with the vasa previa.

And yeah, I hear that of those that aren't caught, mortality rate is shockingly high.

Am I right in thinking that I will have a scheduled section at about 36 weeks and that if I have any bleeding between now and then it will be an emergency section? I also didn't mention that I have a velamentous insertion....

Whoa. I feel like I've suddenly landed myself in the ultra high risk category. Some of the sites I read say that docs recommend hospital admittance at 28-30 weeks until delivery. Good Lord.

I guess I just want to know what to expect from here on out--after three wonderful homebirths this is TOTALLY out of my league of understanding.
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#6 of 25 Old 03-30-2004, 12:57 AM - Thread Starter
 
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Quote:
Originally posted by Mamax3
I love your picture on the front of the current issue! What a great keepsake for you to show your baby one day!
Thank you! It's is a little bit weird to see ME there. And it doesn't look like how I *think* I look. But it was certainly exciting.
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#7 of 25 Old 03-30-2004, 01:04 AM
 
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I am sorry to hear you have to change your plans. It's something one dreads during the pregnancy and then the reality of it- well, again, I am sorry you have to change gears.

The good thing (aside, of course, from the obvious early detection and treatment!) is you have time to think on how you want a cesarean birth to be for you, time to accept and plan and advocate so that you still feel the autonomy and participation that you wanted from birth in the first place. An emergency cesarean can be so hard for a lady to deal with, during and after.

I am curious if you don't mind. How did you get the diagnosis of placenta previa in the first place? Was it routine ultrasound? I ask because you have had homebirths before and I wondered if there were any indicators to suspect placenta previa before your ultrasound at 20 weeks, such as the mw hearing the placenta low down, etc.
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#8 of 25 Old 03-30-2004, 01:19 AM - Thread Starter
 
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Yes, I am glad that we can prepare for this. It would be SO much more difficult if this turned into an emergency situation!

As for the whys...I had some false labor at 20 weeks and my midwife was out of town. Her backup suggested I go in because she was feeling some effacement (and with no baseline to judge it was the most cautious approach. Turned out, my midwife came back, examined me, and said that my cervix HADN'T changed from the contx that sent me to the er...but I digress). I went to the er and had an u/s at which point they diagnosed the complete previa.

We decided to proceed as planned cause the er ob was confident it would resolve in time. We were going to wait until about 38 weeks to do a follow-up but I had this intuition that told me I wanted to know much sooner than that. I wanted to be able to prepare for a section well in advance, if necessary. I figured it wouldn't hurt to at least be prepared for that and then have it all turn out fine and birth at home...rather than the other way around!

So that's the short version....
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#9 of 25 Old 03-30-2004, 01:39 AM
 
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Quote:
Originally posted by AnaNicole
Am I right in thinking that I will have a scheduled section at about 36 weeks and that if I have any bleeding between now and then it will be an emergency section? I also didn't mention that I have a velamentous insertion....
That would be my guess. Are you seeing an reg. OB or perinatologist? You might want to think about a perinatologist. But either way, I'd go over all scenarios with him/her.

As a mama who has had 3 homebirths I can't IMAGINE what you are going through. Something like this is just so far from your mind when you've had uncomplicated and healthy homebirths.
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#10 of 25 Old 03-30-2004, 03:23 PM
 
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You are getting such great advice....

Mom2six- thank you for clarifying the diagnosis....I was thinking of placenta previa, I too am a L&D nurse (i currently only work per diem).

AnaNicole- I wish you the best, and would say that "yes, if you have any bleeding at all between now and your scheduled c-section that, it would probably be cause for emergency c-section".

What a great mama you are, you knew something wasn't quite right and you followed your instincts.....good job!!!
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#11 of 25 Old 03-30-2004, 04:32 PM
 
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I attended a local midwifery conference last November and one of the featured guest speakers was a homebirth midwife who is now focusing on teaching and research. The topic she spoke about that day was placental abnormalities, and one of them was velamentous insertion. She had numerous photos forwarded to her by fellow midwives who had attended homebirths where the placenta was found to have velamentous insertion. I recall one that she described where the mom had a very quick second stage followed very soon by a rapid third stage. The midwife later attributed this to the velamentous insertion. The term vasa previa is new to me, so I am not sure if this mama's placenta displayed this characteristic as well.

So although you found out about your earlier partial placenta previa and your current vasa previa, I wonder if it truly does preclude your option of having a homebirth should you continue through your pregnancy without further issues...

warmly,
claudia
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#12 of 25 Old 03-30-2004, 04:54 PM
 
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I'm so thankful they caught this. From what I understand that is unusual.

During my last pregnancy I made a cyber friend on another board. She was due two weeks ahead of me, diagnosed with placenta previa at the same time I was and our PP was found to be resolved at about the same time (LATE at 35 weeks). I went on to have a normal vaginal birth and a healthy baby (although I did hemmorhage post-partum and I always wonder if my placenta issues had anything to do with that). Unfortunately, her precious baby died during the birth and she nearly bled out as well. Vasa previa was the post-mortem diagnosis.

Since my PP resolved so late I was preparing for a c-section as a possibility. My doctor said that unless I was bleeding she would not deliver the baby before 39 weeks in case my dates were off. If I had any symptoms that made her think I might need an earlier c-section she would try to do an amniocentesis to assure lung maturity.

Hang in there! I know this must be such a blow for you. Do you have an OB that you are comfortable with?
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#13 of 25 Old 03-30-2004, 05:30 PM
 
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Quote:
Originally posted by TurboClaudia
So although you found out about your earlier partial placenta previa and your current vasa previa, I wonder if it truly does preclude your option of having a homebirth should you continue through your pregnancy without further issues...

warmly,
claudia

Yeah, in this case it would. When the vessels cross the cervix, there is a risk. The baby cannot descend without stress on those vessels - and if the water were to break, it could break those vessels as well, comprimising the baby.

Ana, do you remember that you had a velamentous insertion with Chiara? Still, the placenta previa and the vasa previa totally compunds things and makes them pretty high risk.

I'm so sad for you at the loss of your homebirth, but I'm SO RELIEVED that you found this out! I think that preparing for an EMPOWERING cesarean birth can be done!
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#14 of 25 Old 03-30-2004, 05:33 PM
 
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Quote:
Originally posted by TurboClaudia
IThe term vasa previa is new to me, so I am not sure if this mama's placenta displayed this characteristic as well.

So although you found out about your earlier partial placenta previa and your current vasa previa, I wonder if it truly does preclude your option of having a homebirth should you continue through your pregnancy without further issues...
Velementous insertion often goes undiagnosed and is fine. Vasa previa is often undiagnosed and *is not* fine. It is an absolute indication for a c/sec. There are blood vessels that lead to the umbilical cord that lie over the cervix, so when rupture of membranes occurs and with the decending head, the vessels rupture and cause baby to bleed out (and mom can as well). Trying to avoid being scary, but this is truely one of those scenarios where we say thank G-d for c/sec.
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#15 of 25 Old 03-30-2004, 05:51 PM
 
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I had (almost) the same thing. Was watched carefully for placenta previa and at about 26 weeks (I think, it's pathetic how quickly I forgot all this) was told the placenta hadn't moved. So, did the annoying "cut out exercise and sex and don't life anything over 10 pounds" for a couple of weeks. Then I had an incident of very light spotting, which landed me in the hospital for three days. While I was there, they did multiple ultrasounds and were concered about a vasa previa (from what I leared, it is almost impossible to confidently predict a vasa previa).

I was, of course, scared to death. But I have a couple words of wisdom (because now I have a beautiful and totally healthy 5 month old son!).
1. Find the best care you can (if you don't have it already). Although I had been working with a midwife, I was referred to a high risk clinic at Massachusetts General Hospital. Even though I wasn't so keen on the medical model, I _did_ like the fact that the doctor who worked with me had been through this before and was an expert in his field.
2. Take it easy. I know that there are a lot of studies out there showing that bedrest may not really do much (and it is REALLY hard to be on bedrest!). But the reality is that the less jostling, etc. you do the better chance you have to avoid the spotting/hospitalizing/emergency scenario, which is no fun!
3. Be an active member of your C/S team. I was very verbal with my docs about how I wanted things to go - I wanted to see the baby right away and have him on my chest as soon as possible. They were really open to my input.
4. Remember that a C/S isn't the end of the world - although it does require that you alter your expectations a bit. I was really bummed that I wasn't going to get to have a vaginal delivery - but dh was very helpful in reminding me that our goal was healthy baby/healthy momma, and that's what we got!

Also, just a little funny for you - don't think you have life all wrapped up just because they schedule your c-section! I was scheduled to have mine at 37 1/2 weeks but ds decided that he would make sure we knew exactly who was boss- my water broke 2 days before I was scheduled and he came when HE dediced to!

I know you will do fine. GLTY!
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#16 of 25 Old 03-30-2004, 06:42 PM
 
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AnaNicole:

If you are anything like me then you will have to research this condition as a way of dealing with the stress. I really hope, though, that you stay away from the "memorial" type websites. My placenta is high up, and I'm still a sobbing nervous wreck after reading some of those.

I am so, so glad that this condition was DXed. I go to a perinatology practice for my ultrasounds, and this is WHY. They know about all the weird, rare, scary stuff and I feel they're more likely to catch things like this. I would really encourage you to see if you can establish care with a perinatologist. Even if they're not fuzzy and pro-midwife like mine are, they will have training and experience that a regular OB just won't. They're also most likely to have admitting privs at a hospital with a level-III (or is it IV?) NICU, which is what you want.
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#17 of 25 Old 03-30-2004, 08:02 PM - Thread Starter
 
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Thank you so much for all the wisdom and support. I am very touched. This helps me find the strength I need to face this and create a very empowering birth experience!

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#18 of 25 Old 03-30-2004, 08:30 PM
 
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I am so glad they caught this!

Is there any way to diagnose this without an ultrasound?
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#19 of 25 Old 03-31-2004, 12:52 AM
 
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AnaNicole, you don't "know" me but I learned from the boards that you're this month's cover girl on Mothering, and I saw you today at the pediatrician's office - having read this thread this morning, I thought "Wow! That is one strong mama, and this is going to be one lucky baby!"

There are a lot of mamas here who have a lot of information and wisdom about how to have a good c-birth, including OnTheFence and others. Check out the Birth and Beyond forum (I'm pretty sure) for the c-birth support threads and/or PM OnTheFence directly.

Sending you lots of vibes for a peaceful pregnancy and a safe and empowering birth.

Come visit the NEW QuirkyBaby website -- earn QB Bucks rewards points for purchases, reviews, referrals, and more! Free US shipping on great brands of baby slings and carriers and FREE BabyLegs or babywearing mirror on orders of $100+. Take the QB Quiz for personalized advice!

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#20 of 25 Old 03-31-2004, 12:58 AM
 
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Hi AnnaNicole. I'm sorry to hear about your vasa previa diagnosis. I've been dealing with placenta previa with this pg myself.

I was wondering if you could answer a question for me and I'm sorry if I'm guilty of hijacking your thread.

I had never even heard of vasa previa until I came across your thread here, so I did some reading on it. From what I can tell, every woman with a low placenta should be checked, via color doppler u/s, for vasa previa.

I will have my 34 week u/s on Monday to check the previa (which at 30 weeks was just a marginal, btw) and I'm wondering if I should bring this up. I have not been via color doppler at all and of course now I'm freaking out.

Did your doctor or midwife suggest this, did you ask for it? Is it the standard of care?

Again, I'm sorry for your news, but from what I can tell, the catastrophic results occur when the diagnosis is unknown and the mama just goes into labor. Sounds to me like you are in good hands and have excellent odds of having a healthy little bundle.

I can understand the grief involved in not having the birth you desire, though.

(((hugs)))

lisa

~lisa~mama to 3 boys (1/02, 5/04, 12/06)
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#21 of 25 Old 03-31-2004, 01:12 AM
 
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Wow, Ana.

I'm not one for medical management of birth (to put it lightly) but this is one case where I would be glad to have it!

Here is an article about humanizing cesarean birth:

http://www.eheart.com/cesarean/oliver.html

(scroll down to "Intrapartum: Non-Labor Cesarean Birth")
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#22 of 25 Old 03-31-2004, 01:18 AM
 
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Lisa wrote: "From what I can tell, every woman with a low placenta should be checked, via color doppler u/s, for vasa previa."

I've read that, too. I think that is called for if there is no other way of determining the location of the placenta, or if placenta previa is suspected. (My midwife was able to locate the placenta with the use of a doppler.)

If a regular ultrasound is done (the low-frequency black & white one, probably like what you had) they will be able to see the location of the placenta. From what I understand, vasa previa only becomes a concern when, there was a placenta previa and later it appears to have moved upward, then there's a chance that what actually happened was that part of the placenta died and left the exposed veins over the cervix. Uh, I think. Anyone else? Pam?
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#23 of 25 Old 03-31-2004, 02:03 AM
 
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AnaNicole -

No words of wisdome from me, I just wanted to suggest that you attend a local ICAN meeting if there is one in your area. They can be wonderful for women in helping to deal with emotions surrounding cesarean birthing. They've helped me deal with my c-birth a lot!!!
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#24 of 25 Old 03-31-2004, 02:50 AM
 
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AnaNicole,

Nothing intellectual to add, but I just wanted to send out my love and warm wishes to you and your family. It must be overwhelming to sort the emotions out, but you have a huge group of mamas supporting you!

All the best,

I have retired from administration work, so if you have a question about anything MDC-related, please contact Cynthia Mosher. Thanks!
 
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#25 of 25 Old 03-31-2004, 01:39 PM - Thread Starter
 
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Quote:
Originally posted by The Lucky One
Hi AnnaNicole. I'm sorry to hear about your vasa previa diagnosis. I've been dealing with placenta previa with this pg myself.

I was wondering if you could answer a question for me and I'm sorry if I'm guilty of hijacking your thread.

I had never even heard of vasa previa until I came across your thread here, so I did some reading on it. From what I can tell, every woman with a low placenta should be checked, via color doppler u/s, for vasa previa.

I will have my 34 week u/s on Monday to check the previa (which at 30 weeks was just a marginal, btw) and I'm wondering if I should bring this up. I have not been via color doppler at all and of course now I'm freaking out.

Did your doctor or midwife suggest this, did you ask for it? Is it the standard of care?

lisa
Hi Lisa, no worries about hijacking! I am so glad you asked (not that I'm any expert!). As far as I know, the tech used a color u/s and caught the vasa previa right away. She was really skilled, particularly with high risk OB cases, and I would guess she did what she did as a matter of course. I didn't ask for it because I had no idea about this stuff before, and I don't think my midwife asked specifically for it either. But it never hurts to ask your doc for an extra measure of care. Tell him/her that you heard about vasa previa and want to make certain that the u/s tech will check for it. Better to catch it before labor starts, as I am learning.

I'd tell you to take a deep breath and not to worry but...I can't cause I'm completely freaked myself. I went from feeling really positive and empowered to being on the verge of tears. I just don't know what's going to happen yet, and I don't see my OB until the 13th. It's going to be a long wait.

That said, I did speak with my midwife last night and she said we need to try to get my dates straight. Both ultrasounds dated me ahead of my dates and my EDD according to this latest u/s is the 17th of June, as opposed to the 29th. This means we could schedule the section for mid May! I imagine everything will start moving very quickly.... I feel like I'm on a rollercoaster...or more precisely, about to board one. It's daunting.

Thank you again--I can't thank you all enough for all your wisdom and support!!!! I sent the link to this thread to my mother cause she wasn't understanding all of this either and she was touched too. Now, of course, she's also more worried. But, day by day.... I guess we'll just take it day by day.
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