Placenta Previa - Accreta - Hysterectomy? - Mothering Forums

Forum Jump: 
 
Thread Tools
#1 of 12 Old 10-13-2006, 03:59 PM - Thread Starter
 
MindfulBirth's Avatar
 
Join Date: Mar 2005
Location: IBCLC
Posts: 1,342
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
My SIL is 27 weeks pg and has had multiple ultrasounds that show the placenta lying directly over the cervix. Her OB at this time has pretty much decided that she is going to have a C-Birth (I've been talking to her about how she still has a 51% chance that the placenta will move, as well as ways she can plan to have a beautiful C-Birth).

Now the OB is also scaring her with the possibility of placenta accreta and is saying there is a one in ten chance she will end up with a hysterectomy.

Can anyone shed some light on this? The odds her OB is quoting sound very high to me. He is willing to let her go to 38 weeks (provided no bleeding) rather than scheduling the C at 36 weeks like the hospital is suggesting.
MindfulBirth is offline  
#2 of 12 Old 10-14-2006, 04:13 AM
 
wifeandmom's Avatar
 
Join Date: Jun 2005
Posts: 1,539
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
Her statistical chance of accreta with previa present at delivery depends a lot upon her history. Has she ever had a c-section? D&C? Abortion? Any other uterine surgery? For every 'yes' to those questions, her odds go up.

I've had two sections, nothing else on the risk factor list like D&C or abortion, and if my PP had persisted til delivery (thankfully it did not), the chances of accreta were between 40-50% depending on which study you read.

There are also u/s findings that can indicate possible accreta, so I'd ask the doc if any of these signs are present. Depending on the answer, I'd ask to be referred to someone capable of doing a color doppler u/s, as this seems to be the best according to research in detecting accreta prior to delivery.

IF she DOES have this condition, it is VERY VERY SERIOUS. Truly, it is. There is a 7% overall maternal death rate. Hysterectomy is often the ONLY way to save mom's life...literally. And if u/s findings indicate accreta prior to delivery, most research I read indicated leaving the placenta intact within the uterus and going straight to hysterectomy was the safest option.

Now, going straight to hysterectomy is easy for me to suggest cause we are SO done with my uterus. I don't give a hoot one way or the other if I come out of this pg with a uterus or not. Obviously I'd prefer to have nothing go wrong at all, textbook surgery and recovery, blah blah blah. But there are to be NO heroic measures to save my uterus if I am bleeding out. None whatsoever.

If she is not finished having kids, she will likely want them to at least TRY to save her uterus. But the bottom line is, blood loss with accreta is MASSIVE, as in your entire blood volume plus some in the average case, meaning you are getting your entire blood volume plus replaced. DIC is very common with accreta, another life threatening complication.

Actually, from what I read, accreta now leads the pack for cause of maternal death during c-section. So if her doc truly suspects she has this condition, I'd be gathering as much information as possible, asking for a referral for better u/s, etc. It's not something to play around with at all.
wifeandmom is offline  
#3 of 12 Old 10-14-2006, 08:25 AM - Thread Starter
 
MindfulBirth's Avatar
 
Join Date: Mar 2005
Location: IBCLC
Posts: 1,342
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
Thanks for your reply. This is her first child and it took them a year and a half to conceive. I don't know that her doc is saying that yes, she has it..I think he was just saying it is a possibility given the location of the placenta. As far as I know she has never had an abortion or other uterine surgery (but then, my DH's family is so secretive about health issues.)

Thanks again. I'll let her know to ask for a doppler u/s.
MindfulBirth is offline  
#4 of 12 Old 10-14-2006, 02:49 PM
 
wifeandmom's Avatar
 
Join Date: Jun 2005
Posts: 1,539
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
Quote:
Originally Posted by MindfulBirth View Post
Thanks for your reply. This is her first child and it took them a year and a half to conceive. I don't know that her doc is saying that yes, she has it..I think he was just saying it is a possibility given the location of the placenta. As far as I know she has never had an abortion or other uterine surgery (but then, my DH's family is so secretive about health issues.)

Thanks again. I'll let her know to ask for a doppler u/s.
Unless her particular OB has experience diagnosing acretta with u/s, I'd insist on a referral to a perinatologist for that. It's something that isn't a for sure thing like diagnosing previa, and it's largely dependant upon the experience of the person doing the u/s (and of course they have to have a really up-to-date u/s machine). Even then, diagnosing it isn't fool proof prior to delivery.
wifeandmom is offline  
#5 of 12 Old 10-15-2006, 05:08 PM
 
MAMom's Avatar
 
Join Date: Mar 2005
Posts: 1,472
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
This is a UK-based site run by a woman who had an unwanted hysterectomy from the c/s support list I participate on.

There are several books she recommends:
http://www.a-little-wish.co.uk/Pages/Books.aspx

There are also several personal accounts on her website.

I would definitely tell your SIL to get a 2nd (and 3rd, and 4th opinion). Losing your uterus is a big deal. This doc seems like he is determined to rid her of her uterus no matter what.

Tell her to do her own research. She can read the medical studies surrounding this issue and make a better-informed choice, and then find a doctor who's not so butcher-happy.

Just my 2 cents.
MAMom is offline  
#6 of 12 Old 10-26-2006, 02:57 AM
 
kindergirl77's Avatar
 
Join Date: Jun 2005
Location: California
Posts: 181
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
I know this is an old post, but I just wanted to say that I had placenta accreta with dd2- I was having a homebirth, but my placenta didn't deliver, so we went to the hospital- turns out I had placenta accreta and i had a DnC to remove it- I was tired, but didn't lose a lot of blood and had no complications. My uterus in intact and I didn't have any trouble healing, although I had a post partum flow for about 12 weeks.

My doctor also said that I had partial previa during both babies, but both times, my placenta moved out of the way just fine. 90% of the time, the uterus does move.

I think that this may be nothing but an over-caffinated doctor on your hands. Hopefully the placenta will move fine. And even if she does have accreta- there is a good chance that they will save her uterus for the next baby- 1 in 10 chance in historectomy also means 90% chance of saving her uterus.

I plan to have more children, even though my chances of accreta go up with subsequent pregnancies. For me, it didn't seem more dangerous than having a c-section.

Definetely tell her to get another opinion.
kindergirl77 is offline  
#7 of 12 Old 10-26-2006, 03:22 AM
 
Jane's Avatar
 
Join Date: May 2002
Location: Kenmore, Washington
Posts: 7,110
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
I don't think any doctor wants to do an emergency hysterectomy at term - it's a very scary operation to take out a uterus at the end of pregnancy, even if it's planned. The blood flow is so great at that time that there is always a serious risk of complications.

Is she having bleeding? In the absence of bleeding or other problems, it's always nice to wait until 34 weeks to follow up on a low lying placenta found on a 20 week ultrasound. So many are still low at 28 weeks, but move nicely by 34.

Homebirth Midwife biggrinbounce.gif

After 4 m/c, our stillheart.gif is here!

Jane is offline  
#8 of 12 Old 10-26-2006, 05:06 AM
 
ldsapmom's Avatar
 
Join Date: Apr 2002
Location: Chico, CA
Posts: 1,531
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
My best friend had two accretas -- the first with her first baby, the last with her fourth baby. The first was a totaly surprise. Had she had a younger doctor, she would have lost her uterus. Luckily she had an old-school doctor who stayed and scraped out every last bit of hamburger-like tissue.

She went on to have babies #2 and 3 via cesarean with no problems.

During her last pregnancy she started bleeding at around 22 weeks. A number of problems were found, including major fetal abnormalities, plus a previa and a suspected accreta. She was sent for further testing, and the perinatologist gave them all a grim diagnosis. An immediate cesarean was recommended. After a day to pray about their decision, they agreed.

Baby Claire was born alive, but she soon passed (she had a curvature of the spine, gastroschisis, a heart defect, and other health issues -- visually it could not be determined what her sex was -- a prior amnio revealed her sex a few days after her birth). I wish they would have taken my best friend's uterus out, because 7 weeks later -- to the day -- she hemmorhaged in her kitchen, home alone with her three children. She had to be taken to the hospital by ambulance, and they did an immediate hysterectomy. A vein had fused to an artery, ballooned up, and popped. They knew, at Claire's birth, that she would never be able to have another baby -- the doctor should have taken her uterus then.

This has to be just about the worst-case scenario, but I thought I would share -- it is someone's story.
ldsapmom is offline  
#9 of 12 Old 10-26-2006, 01:26 PM - Thread Starter
 
MindfulBirth's Avatar
 
Join Date: Mar 2005
Location: IBCLC
Posts: 1,342
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
Quote:
Originally Posted by ldsapmom View Post
This has to be just about the worst-case scenario, but I thought I would share -- it is someone's story.

I don't think I'll share that story with my SIL, lol! She needs lots of positive vibes right now.

So far, no bleeding. I don't think her doc is all that butcher-happy..he just wants her to be aware of the possibility. I wasn't sure what the validity of his statistics were, though.

I'm still holding out hope that the placenta will move, although she has already put it into her mind that she is getting a C and is doing absolutely nothing to prepare for a possible vaginal birth..so she may end up with a C anyway!
MindfulBirth is offline  
#10 of 12 Old 10-26-2006, 02:57 PM
 
ldsapmom's Avatar
 
Join Date: Apr 2002
Location: Chico, CA
Posts: 1,531
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
I only shared that here knowing this area is frequented by more professionals, less regular mamas. Had this been a general birth area, I would not have shared. I did not expect you would share this with a regular mama facing an accreta or a previa.

I have known other moms with previas who were able to deliver vaginally with no problems (as the uterus moved up, and the placenta did as well).
ldsapmom is offline  
#11 of 12 Old 10-26-2006, 03:17 PM
 
crazy_eights's Avatar
 
Join Date: Nov 2001
Location: Nisht ahir un nish aher
Posts: 6,837
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
The way the placenta 'moves' is that the lower uterine segment has poor blood flow, so the placenta 'dies out' there and grows upward, in addition to it 'moving' as the uterus stretches upward. A placenta that lies directly over the cervix is probably not going to move with stretching and the 'die out' of the placenta over the cervix puts a woman at risk for vasa previa. If they did tell her that her placenta has moved, they should do blood flow studies to check to see that she hasn't been left with a vasa previa.
crazy_eights is offline  
#12 of 12 Old 10-27-2006, 12:31 AM
 
savithny's Avatar
 
Join Date: Oct 2005
Posts: 1,820
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
Here's a link to the blog of a woman who had accreta and increta after multiple uterine surgeries. SHe did a LOT of research on it, which she discusses, and she writes really well about it:

http://uncommonmisconception.typepad.../12/index.html

I'm linking to December 2004 archives because that is when she found out. Click through to January to read more, as well as the birth of her healthy daughter and the fact that she did not have to have a hysterectomy, though it was close.

savithny, 42 year old moderate mom to DS Primo (age 12) and DD Secunda (age 9).

savithny is offline  
Reply

Quick Reply
Message:
Drag and Drop File Upload
Drag files here to attach!
Upload Progress: 0
Options

Register Now

In order to be able to post messages on the Mothering Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
If you do not want to register, fill this field only and the name will be used as user name for your post.
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



User Tag List

Thread Tools
Show Printable Version Show Printable Version
Email this Page Email this Page


Forum Jump: 

Posting Rules  
You may post new threads
You may post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off
Trackbacks are On
Pingbacks are On
Refbacks are Off