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Discussion Starter · #1 ·
For purposes of locating the placenta & making sure it doesn't attach to the c/s scar that is. So what do you think? I'm leaning towards having one again, but I'd hate to find out it was unneccesary.

Is there any truth to the placenta placement hype?
 

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Women who have had C-sections AND have placenta previa are far more likely to also have placenta accreta. The more cesareans, the more likely the accreta. A previa may have other signs associated with it (like bleeding), but not always.

The concern with attaching to the scar area is also with placenta accreta, but I have never read any stats on that.

ETA: Here's a link with a table with risks vs # of prior cesareans:
http://mediwire.sma.org/main/Default...ticleID=139429
 

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My first pregnancy, I ended up with 3 ultrasounds because I had marginal placenta previa. I had no signs such as bleeding. Thankfully by the last ultrasound, the placenta had shifted enough that I was no longer considered to have placenta previa, which allowed me my vaginal birth.

From the evidence I have seen, I do believe that there is truth to the risk factors and placental placement. Since my second pg ended in a c-section and the marginal previa in my first pg, I am planning on having an ultrasound for this third pg just because of my previous risk factors. However, I am not having it until I am nearly 21 weeks because I don't want a false positive. I would rather have the ultrasound and find out that the placenta is fine than to risk skipping it.
 

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I had one done because the midwife felt that there is a higher chance of hemmorage if the placenta is embedded in your scar tissue (anterior). This was a piece of the puzzle for me, but I don't know that it would change my mind as to whether to VBAC or not. In my case, I would probably opt for a hospital birth for an anterior placenta rather than the homebirth I'm hoping for. For me, knowing that my placenta is posterior and away from the scar tissue is reassuring.

I wish you well as you decide what is best for you!
 

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How far along are you? I asked my OB at one of my last appt's if I should have one to determine if my placenta was on or near my scar since my placenta is anterior this pregnancy. She said that it would have been noted at my 18 week u/s if it was and another u/s wouldn't be necessary.
 

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Do you think you're more likely for the placenta to implant in the front of your uterus? Has that happened before?

I didn't have any u/s for DS. In fact, was turned down my an OB because I refused an U/S. Which greater fueled my fire to homebirth.

Mandy
 

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Ok, I dont mean to hijack the thread. But I have a silly question:

My placenta was anterior with my first pregnancy (ended in c-sec, not for that reason) So, is it most likely going to be anterior again? Will this affect my vbac? Now Im worried
 

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Quote:

Originally Posted by EAGA
Ok, I dont mean to hijack the thread. But I have a silly question:

My placenta was anterior with my first pregnancy (ended in c-sec, not for that reason) So, is it most likely going to be anterior again? Will this affect my vbac? Now Im worried

I'm not sure if having one anterior placenta indicates that you will have another one. My understanding is that it's luck of the draw, where it lands it attaches, but it wouldn't be a bad idea to research this further IMO.

To put your mind at ease a little bit, the midwife told me that an anterior placenta does not necessarily mean one can't VBAC, she just stated that if the placenta is embedded in the scar tissue that there is more of a chance of hemmorage after the birth.

HTH
 

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Discussion Starter · #9 ·
Thanks for all the info., ladies. I'm thinking I'll go ahead and have an ultrasound around/after 20 weeks. Someone in my due date club said that the placenta can still shift after 20 weeks? Thoughts?

I'm really glad to read the info. re: anterior placenta only increasing chance of hemmorage (not being a vbac deal-breaker).
 

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This is a great question.

The midwives I've spoken to and my reading suggests that not only placenta accreta and previa are more common with VBACs (because if the placenta is deeply implanted into the scar tissue the placenta CAN'T migrate away from the cervix), but also placental retention, which is related to the hemmoraging.

That said, I think I've decided that I'll wait and see. If I can determine for myself (by the way the baby's kicking feels, etc) that the placenta is not anterior, or anterior but very high, I will not have an ultrasound. If it feels low and in front, I will have an u/s at 22 weeks or so, and if there is a possiblity of previa/accreta I will have another u/s very late (34-36 wks) to check again before I commit to a change of birth plans. I do believe as long as the uterus is growing the placenta can migrate.

It's important to remember, though, that u/s are not fool-proof. One midwife I spoke to said that one VBAC mom she attended was assured at two u/s scans that her placenta was not near her scar, but then she ended up having to transfer after her hb for retained placenta and bleeding because she did have placenta accreta. It turned out to be a scary thing, but she recovered quickly--apparently she went to church three days later!
 

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Quote:

Originally Posted by cinnamonamon
Someone in my due date club said that the placenta can still shift after 20 weeks?

...

I'm really glad to read the info. re: anterior placenta only increasing chance of hemmorage (not being a vbac deal-breaker).
Well, thats not exactly accurate. The placenta doesn't move once it is implanted. What happens is that as your uterus expands with the pregnancy, the placenta may move up and out of the way of the cervix. A complete placenta previa is less likely to move out of the way than a partial previa.

Accreta can be a very serious, life threatening complication. I would talk very seriously with your provider about the safety of VBAC with a known accreta. But an anterior placenta is only a "risk" in the sense that it may be more likely to be over the scar and is considered more serious if you should happen to be one of the small numbers that have an accreta. I have an anterior placenta this time, but my high risk peri is not concerned at all because it is high and out of the way, and two ultrasounds have not shown any signs of accreta.
 

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On the topic of Acreata, is there an increase/decrease in the risk of it developing dependant on the length of time between the c-section and the next pregnancy?
This something I am curious about because I am planning a UC. Its been 2 years nearly exactly between my daughters pregnancy and this one...
 

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I also have an anterior placenta with this pregnancy (and planning a HBAC), but I thought that it wasn't an issue so long as the placenta is higher than the scar? Is this incorrect? I had an u/s, and no one mentioned any concerns about the location of the placenta. I can feel the baby (and SEE him) kicking all over the front of my belly, so I don't know how to tell where exactly the placenta is (though I'm guessing the midwives could tell with doppler?).

Is anterior placenta is general a risk, or only if it's very low?

Lex
 

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I don't want to change the subject, but since there's so many knowlegable mamas on this thread....We are having a hba2c in March, and midwife wants a placenta placement u/s. For those who've had an u/s for this, at what week did you have it?
 

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I second egoldber:
Anterior placenta isn't usually a problem in and of itself. It's just an indication that the placenta may be growing nearer to the scar than a posterior placenta. If the ultrasound shows that the placenta is growing clear of the scar, you're probably not at increased risk for accreta.

Lexbeach--it sounds like you're fine! I don't think the doppler won't tell you where the placenta is, unless it happens to interfere with finding the baby's heartbeat, and even then its a general thing, and you wouldn't have any idea where the margins are. If the u/s tech saw any indication of that on your scan I'm sure they would have said something.

mackenziesmama--Of the two lay midwives I interviewed, one required the u/s just for VBACs to assess placenta placement, and the one we hired did not (though that wasn't a deciding factor). The former midwife suggested that 22 weeks was a good time, as the uterus is large enough to allow for an early low-lying placenta to migrate away from the cervix, but still early enough for you and the tech to see most of the baby all at once.
 

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Quote:

Originally Posted by lexbeach
I also have an anterior placenta with this pregnancy (and planning a HBAC), but I thought that it wasn't an issue so long as the placenta is higher than the scar? Is this incorrect? I had an u/s, and no one mentioned any concerns about the location of the placenta. I can feel the baby (and SEE him) kicking all over the front of my belly, so I don't know how to tell where exactly the placenta is (though I'm guessing the midwives could tell with doppler?).

Is anterior placenta is general a risk, or only if it's very low?

Lex
Lex, my understanding is that an anterior placenta is just fine if it's not implanted into the scar. I would do a little more research to make sure, but that's my .02.
 

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Quote:

Originally Posted by mackenziesmama
I don't want to change the subject, but since there's so many knowlegable mamas on this thread....We are having a hba2c in March, and midwife wants a placenta placement u/s. For those who've had an u/s for this, at what week did you have it?
I'm not sure when the protocol for checking placement is, but in my case I ended up with an u/s at 12 weeks because the midwife couldn't find a heartbeat. (Baby's fine) They were able to tell me placement at that time.

I had another at 20 weeks (the standard 20 week u/s) and I asked about location again. They were easily able to tell me where the placenta was at that point.

I wish I knew the "ideal" timing, but my experience was that they could tell at both 12 and 20 weeks, so I'd guess that it can be done pretty much any time.

HTH--what does your midwife suggest?
 

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Thanks for posting this, I have really been struggling with this myself (choosing u/s or not).

I still don't know what to do. Hoping for an epiphany of some sort.
 

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Discussion Starter · #19 ·
From what I've read here, I think I'll go ahead and get one -- sometime after 20 weeks -- 22 maybe? Hopefully at that point it will be obvious whether or not the placenta is close enough to the scar to be a problem (or on it.).
 

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There's a study from Helsinki that shows outcomes are not improved by early dx of PP. PP has other signs anyway such as bleeding which occur before labour so time enough to have that checked out if you choose. I just freebirthed #2 after a c-sec with #1 and chose to not have any u/s. I too debated about it but the evidence didn't seem compellingly in favour of it - to me
 
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