advice on marginal placenta previa

4797 Views 7 Replies 4 Participants Last post by TzippityDoulah, Apr 22, 2009

clintonhillmama

Discussion Starter · Apr 20, 2009

posting for a friend:
As of 33 weeks my placenta is 1.2 cm from my cervix (marginal previa). Most everything I have read indicates the safest course of action to avoid possible hemorrhage is a C Section near 37 weeks -- ideally the placenta should be 2 cm or more for vaginal delivery. I would love to know the following:

Is there a chance the placenta may move .8cm in the next 4 weeks?
If not, what is the risk of delivering vaginally or is a C Section really the safest option?
If C Section is the safest, can I postpone to 39 weeks? maybe even 40 weeks? - DS1 was 3 days late, but I was dilated about 2 cm several weeks prior (not sure that matters)

of course, she wants what's safest for her and her baby - but she's hoping waiting past 37 weeks is possible....and would like to avoid the c/s.

she's with an OB, so she wants to gather all the information she can. I thought this would be a perfect place to find some things out.

thanks!

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TzippityDoulah

· #2 · Apr 20, 2009

honestly I think it's not a set science. I would encourage your friend to use "dr. google" and look up everything about placetna previa and talk to her providor and make some decisions. I can only tell you what *I* would do. I can't tell you what would be the safest option for her b/c I don't know her background, desires or what have you and that could make a large difference.

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jengacnm

· #3 · Apr 20, 2009

I would recommend weekly TRANSVAGINAL ultrasounds to measure distance. It isn't likely it will move enough, but the chance is high enough that it's worth waiting & trying.

The true test-and here's where she could argue for more time-is if she starts bleeding. Her docs probably want to schedule it so it's not an emergency. Women with total previas will likely bleed before labor, or very early in labor, and that's what declares it's time for a section. A low lying placenta probably won't start bleeding until early or active labor.

If I were her, I'd ask the docs for a c section at 40 weeks, the onset of labor, or the onset of bleeding, whichever comes first.

HTH!!!

Jennifer

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MsBlack

· #4 · Apr 21, 2009

Has she had any bleeding episodes at all, yet?

I would want to wait and watch--I kind of agree with pp who said chances of further upward migration of placenta are high enough to warrant waiting--even though this late, she cannot *count on* sufficient migration for a vag birth. Of course, if bleeding starts, that is another matter. She should probably go to mainly bedrest at any point that spotting starts, and just take it easy for as long as taking it easy keeps bleeding at bay (adding that 'more than just spotting', but a steady drip or trickle or more, is cause for immediate transport to hosp). If taking it easy does not slow/stop spotting, then it's time to re-evaluate.

But OTOH--if there's no bleeding, then waiting is safe enough. If there's no bleeding, then csec at 37ish weeks is just too early, IMO. The doc of course, is thinking that med science can compensate for any lack of needed gestational time that the baby would lose by a forced early delivery. But if all else is equal--very small or no bleeding, baby growing well, mom doing fine--then I heartily disagree with that attitude.

While it's true that previa can be life-threatening, it still sounds like the OB is mainly practicing 'defensive medicine' with this plan. And does not apparently understand/believe that Real Gestation cannot be replaced by med science--that med science runs a poor second indeed. All very well for those babies who truly need what med science has to offer, but definitely not a good idea to forget that we simply cannot improve on--or even come equal to-- Nature.

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TzippityDoulah

· #5 · Apr 21, 2009

Quote:

Originally Posted by MsBlack

While it's true that previa can be life-threatening, it still sounds like the OB is mainly practicing 'defensive medicine' with this plan. And does not apparently understand/believe that Real Gestation cannot be replaced by med science--that med science runs a poor second indeed. All very well for those babies who truly need what med science has to offer, but definitely not a good idea to forget that we simply cannot improve on--or even come equal to-- Nature.

very well said!!!

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clintonhillmama

Discussion Starter · #6 · Apr 21, 2009

thanks for all the great info!
here's an update from my friend- surprising and wonderful news!
Just talked to my doc - great news! She is not at all concerned (oddly enough) with the 1.2cm. She told me we will take it through labor and if bleeding starts (either during labor or at any point over the next several weeks) then we will go into an emergency C-section, but otherwise no reason not to allow for labor to kick-off and assume/hope for a vaginal delivery.

i am shocked considering what i have read about 2cm being the preferred doctor cut-off, but also very relieved by her approach.

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MsBlack

· #7 · Apr 22, 2009

THat's great!

I just reread the original post, and realized (sorry) that the OB had not personally rec'ed the early csec--that came from the literature. So it's 'those guys' who made that rec who are seeming to practice defensively, not her doc. And I'm glad to hear it, very glad.

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TzippityDoulah

· #8 · Apr 22, 2009

oh good!!! it's such a shame to make rash judgements. I'm glad her doc isn't!

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