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Hi,<br><br>
I had a question birth professionals with experience in this area or for those who are planning to deliver vaginally or have already delivered vaginally with a low lying placenta. In my case, I've gone from a partial previa at 21 weeks to a marginal at 34 weeks to a low lying (1.1 cm from cervix) at 36 weeks. My OB would like a 2 cm clearance to okay vaginal birth. I'm really hoping that happens by week 39. I haven't had a bleed all through my pregnancy. So these were my questions to those of you who have assisted in, gone through, or are in a similar situation.<br><br>
1) Have any of you or your care providers (midwives/obs) okayed vaginal birth at less than 2 cm from OS?<br><br>
2) For those who have been cleared for vaginal birth, are there any special precautions that your care provider is taking? (I'd still prefer an unmedicated birth but would take a controlled/medicated vaginal over c-section if that's possible.)<br><br>
3) Those of you who had successful vaginal births or attempted vaginal births, what was your delivery like? Were there issues with bleeding/detachment of the placenta after baby was delivered?<br><br>
4) Finally, those of you who had c-sections, when was your surgery scheduled for? 38 or 39 weeks? Were any of you allowed to start labor on your own?<br><br><br><br>
Thanks!!!
 

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Here are some articles-I think the results speak for themselves.<br><br>
I'd recommend an IV lock (no IV bag hanging) for a vag birth.<br><br>
Best wishes!<br><br>
Jennifer<br><br>
BJOG. 2003 Sep;110(9):860-4. Links<br>
Placental edge to internal os distance in the late third trimester and<br>
mode of delivery in placenta praevia.Bhide A, Prefumo F, Moore J, Hollis<br>
B, Thilaganathan B.<br>
Fetal Medicine Unit, Academic Department of Obstetrics and Gynaecology, St<br>
George's Hospital Medical School, Cranmer Terrace, London SW17 0RE, UK.<br><br>
OBJECTIVES: To correlate transvaginal ultrasound findings with mode of<br>
delivery in cases of placenta praevia. DESIGN: Cohort study. SETTING: A<br>
London Teaching Hospital. METHODS: Retrospective review of all cases of<br>
placenta praevia diagnosed by transvaginal ultrasound between February<br>
1997 and March 2002. MAIN OUTCOME MEASURES: Likelihood of vaginal delivery<br>
and major obstetric haemorrhage. RESULTS: A total of 121 pregnancies were<br>
studied with a mean scan-to-delivery interval of 10.5 days. In the 64<br>
women who laboured, the likelihood of vaginal delivery rose significantly<br>
as the placental edge to internal os distance increased. <b>Caesarean section<br>
rate was 90% when the placental edge-internal os distance was 0.1 to 2.0<br>
cm, falling to 37% when this measurement was over 2.0 cm (P < 0.00045).</b><br>
CONCLUSION: <b>Trial of vaginal delivery is appropriate in cases with a<br>
placental to internal os distance >2 cm. The term "praevia" should be<br>
restricted to cases where the placental edge is < or =2 cm from the<br>
internal os, as the likelihood of operative delivery and significant<br>
postpartum haemorrhage is high. Cases where the placenta is more than 2 cm<br>
from the internal os have a greater than 60% chance of vaginal delivery<br>
and should be defined as "low lying"</b> in order to reduce the clinician's<br>
bias towards operative delivery.<br>
Am J Obstet Gynecol. 1991 Oct;165(4 Pt 1):1036-8. Links<br>
What is a low-lying placenta?Oppenheimer LW, Farine D, Ritchie JW,<br>
Lewinsky RM, Telford J, Fairbanks LA.<br>
Department of Obstetrics and Gynecology, Mount Sinai Hospital, University<br>
of Toronto, Ontario, Canada.<br><br>
Transvaginal ultrasonography was performed in 127 women thought to have<br>
placenta previa. In all cases of complete previa, placental location was<br>
confirmed at cesarean section. Where the placenta was situated in the<br>
lower segment of the uterus but did not cover the cervical os the distance<br>
from the placental edge to the internal cervical os was measured. This<br>
distance was analyzed in relation to the route of delivery. <b>No patient</b><br><b>with a placental edge greater than 2 cm from the internal cervical os<br>
required cesarean section for the indication of placenta previa, whereas<br>
seven of eight patients with a distance of less than or equal to 2 cm<br>
underwent cesarean section because of bleeding characteristic of a<br>
placenta previa.</b> These preliminary results suggest that transvaginal<br>
ultrasonography measurement may indicate the optimal delivery route and<br>
make the traditional classification of placenta previa obsolete.
 

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This is good info to have.<br>
I had a marginal previa with #3, I don't remember the measurements.<br>
I had a c/s with her because at 35wks I started having a pretty good bleed, we held on for a week and delivered at 36wks.
 

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I had a complete previa until my 38 week pre-op appt. for a c/s. Never had any bleeding with it though. This was my 2nd baby. The dr. (wonderful guy) did "one last u/s" per my request because I so did not want a c/s. The previa had moved 1.9 cm off the cervix. So he said he felt good about me waiting and going for vag. birth. A week later he checked again and it was 2.1 cm off. Baby came at 40w4d after a short no meds labor <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/smile.gif" style="border:0px solid;" title="smile"> The only thing he said was for me to come in as soon as I knew I was in labor, so they could check my cervix in the OR (so I was prepped for a c/s, but no meds; anesthesiologist was ready to put me under general if needed), and they did have to break my water to make sure there was no bleeding. I did have some bleeding as soon as I was in labor at my house, but baby and everything were just fine (scared me though). Good luck! Hope it moves more for you, every case is different.<br><br>
C
 

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I think it is pretty likely that your placenta will move enough for a vaginal birth. The uterus grows a lot between 34 and 39 weeks and it is the growth of the uterus that helps the placenta move up.<br><br>
Good luck!
 
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