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Discussion Starter · #1 ·
Ugh...ok background (bear with me)<br><br>
Pregnancy #1 I hemorrhaged at delivery and again 2 days later. A portion of my placenta had adhered to my cervix and had to be surgically removed. I had 6 units of blood transfused in over the course of about 30 hrs. between the 2 hemorrhages and the surgery. The birth was a drug-free water birth. Pregnancy complications included a low-lying placenta, significant edema, and mild PIH. I also apparently had a double-lobed placenta.<br><br>
Pregnancy #2 Was <i>supposed</i> to be another drug-free water birth but baby was transverse breech and wouldn't turn for anything. When I went into labor I had an emergency CS. A classical incision on my uterus was necessary to safely turn/deliver baby. No other pregnancy complications.<br><br>
Pregnancy #3 Knew that I'd be needing a repeat CS due to the classical incision on the uterus from #2. Subchorionic hemorrhages diagnosed at 8 weeks following a moderate bleed. Strict bed rest at 15 weeks following a major bleed. I've been on bed rest for 7 weeks, I'm 23 weeks tomorrow. The MW transferred my care to an OB due to the inevitable CS combined with the complications. I met with the OB for the first time today (she was the OB who delivered #2, but since it was an emergency CS, I'd never met her before #2 was born and we don't have much history. She's in the same practice with my MW). Anyway, she was talking with me about my placenta position. I said that I was told that it's in the front, but that's all I know. She expressed concern that it might be in a bad position relative to my CS scar (on my uterus) and added that the placenta may have adhered to the scar tissue from the earlier incision. She asked me to give some thought to how I'd feel if I hemorrhaged again at delivery because the placenta is adhered to uterine scar tissue, and she had to remove my uterus in the event of an emergency.....not really sure WHAT to think. Um, I'd like to keep my uterus. I don't want to bleed to death. Are there any other choices?<br><br>
So, if we are armed with information ahead of time, can't we be prepared to address a placenta that does not fall cleanly away from the uterus? Can't they be prepared to scrape away the placenta, transfuse blood, etc. if we know in advance? Am I being irrational? (I don't have any real future plans for my uterus, but I'd still really like to keep it around). I really really don't want to bleed to death though. I almost did that the first time and it was bad, but I've also never worked with OBs before and maybe she's just much more comfortable with the idea of cutting out a uterus as a surefire way to achieve a positive outcome than I am. Any ideas?
 

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Discussion Starter · #3 ·
Oh yes, I've been ultrasounded up the wazoo due to the SCHs, it's just that the perinatologists didn't mention anything in their notes about the placenta position (which she commented was somewhat unusual). I'll be specifically asking the peri about it at my next appointment/US with him in 2 weeks. I'm just wondering IF it's determined that the placenta may be in a position that suggests that it might have adhered to the scar tissue thereby increasing the risk of hemorrhage at delivery, is there some other course of action to plan on other than removing my uterus.
 

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From what i've read they are talking about a potential placenta acreta? That is where the placenta grows through the uterine wall or scar tissue. It happens more often if you have had a c-section obviously because of the scar tissue. (Link below is information about it)<br><br><a href="http://www.marchofdimes.com/pnhec/188_1128.asp" target="_blank">http://www.marchofdimes.com/pnhec/188_1128.asp</a><br><br>
From what I know about this in many of the cases the placenta cannot detatch from the uterus fully. They can try but in the event of them trying you could potentially loose a lot of blood while they are trying to remove it and eventually doing the hysterectomy. So if you choose to try and save your uterus know that you may need more transfusions in the event they are unable to get it to detatch.<br><br>
I hope you find answers you are looking for and I hope you can make an informed decision you are ok with.<br><br>
Me personally... I wouldn't risk it IF I knew 100% I had an acreta (which they can tell when they open you up since your placenta will be anterior they will be able to see it). I wouldn't want to risk the complications from the hemmorage especially if I have no plans for kids in the future.<br><br>
But it would definately be a discussion between the peri and your OBGYN. If they do find a placenta accreta I'd personally also want the peri to be delivering me not the OBGYN since they specialize in high risk pregnancies.<br><br>
Good luck!
 

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You know, I'm not so sure about that. I know a lot of MFMs only do consults, not deliveries, or do relatively few deliveries. In that scenario, I would want the best surgeon, and that may or may not be the MFM depending on how things are structured.
 

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<div>Originally Posted by <strong>AlexisT</strong> <a href="/community/forum/post/14744726"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">You know, I'm not so sure about that. I know a lot of MFMs only do consults, not deliveries, or do relatively few deliveries. In that scenario, I would want the best surgeon, and that may or may not be the MFM depending on how things are structured.</div>
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Oh really? Here the MFM do the surgeries... so yes I guess it would depend on who is more specialized. I guess what is the point of a MFM if they don't deliver? Isn't that the whole idea?<br><br>
If they do find a placenta accreta I would definately be grilling your OB and MFM and decide who to do delivery and plan of action for the delivery. If either of them have any experience in accreta and how many and what the outcomes were. I would get as much information as possible and if you still feel at ease get another opinion there are many many OB's and MFM out there who may have more experience and better outcomes.
 

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I'm interpreting your description of what she said as her flagging up that she thinks you are at higher risk of placental attachment problems and she wants to know your preferences. Sounds like you are in the camp of do everything she can to save your uterus, when other people on having there 3rd child might be thinking they are done having kids, they had troublesome periods, if it comes to the crunch just go straight for the hysterectomy and possibly reduce complications that might come from fighting harder to avoid it. So you need to make clear to her what you want. I've never heard of anyway to change your risk, other than by what actually happens in the OR, the more skilled and experienced a doctor is the better they are going to be at judging when it's the point of no return.
 

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You might find <a href="http://www.alittlewish.co.uk" target="_blank">www.alittlewish.co.uk</a> helpful. It's a community of women who have been through post-pregnancy hysterectomy.
 

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not trying to scare you but IF you have a true placenta accreta it is a very dangerous condition. 6 wks ago at our university hospital there were 2 patients with this condition who both delivered the same day. one spent 2 days in the ICU after receiving "only" 15 units of blood and had a hysterectomy to save her life.<br>
the other one also had a hysterectomy but it was too late. she was given over 100 units of blood.<br>
so i think you need to definitely get the MFMs (who will be the best at looking for accreta on u/s etc) to give you a firm idea if you have one or not.<br>
fwiw my husband is an MFM at that hospital so i am not describing a rumor or urban legend or whatever.<br>
good luck with your birth; i also had a classical and i know how disappointing that is.<img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/greensad.gif" style="border:0px solid;" title="greensad">
 
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