Risks of placenta praevia/accreta after one previous CS?

[Molotov]

I have 2 children: one born via assisted vaginal delivery in 2009 and one by ELCS in 2012.

I think I would like to try for another (and last) baby.

However, for as much as I would like to try, I keep putting myself off because I'm scared of what my chances are of developing placenta praevia or accreta. I am 31yo, if that matters.

I have it in my head that accreta develops in something like 25% of women who have praevia with prior CS, but I don't know what the praevia rate is in such cases and I'm driving myself bit loopy because I'm broody but worried to do anything about it.

Please, does anyone know the statistic, or have a direct link to what the risks of such things occurring after one previous CS?

TIA

[comeawaywithme]

I had an EMCS in 2012 and have just started TTC #2 and have similar concerns (along with the usual worries of potential for scar rupture etc). Was the reason for your ELCS placenta praevia?

Have a look at this study:
www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0052893
The investigators found that the incidence of placenta accreta/increta/percreta was 577 per 10,000 in women with both a previous Caesarean section and placenta praevia. So not 25%! I'm no good with stats, but someone might be able to work it out for you

Age does matter as the risk increases with age.

The conclusion seems to be that clinically significant placenta accreta is uncommon, but doctors should be extra vigilant in those with previous placenta praevia/c-sectio. I could easily put myself off having another as I found my EMCS fairly traumatic, but my desire to have two DC is stronger than my fear of everything that could go wrong.

[comeawaywithme]

Some more stats here under the 'Placenta previa and prior caesareans' section. Not sure if any of these are helpful to you.
wellroundedmama.blogspot.co.uk/2013/05/placenta-previa-and-prior-cesarean.html

[MummyA1984]

I've had a low placenta until 35 weeks (major placenta previa) and it's finally moved. This is my third. Even when u do get placenta previa it's most likely to move. I won't lie it has been worrying. Feel like I can finally enjoy my last few weeks. I don't think u should be put off personally x

[Molotov]

Thanks for replying both, and thanks comeaway for those links. I couldn't get the first link to work, but the second one I worked out to be a risk of 17.3%, which of course means 83.7% of NOT developing praevia with accreta after one previous CS.

I requested my CS. I had coccydynia after the birth of dd1 in 2009 and I was terrified of going through that pain again - or making it even worse. I could have birthed dd2 vaginally, but I knew there was a higher risk of me hurting my back again. So, I chose the.morr predictable risks of ELCS. So far, so goos. Until now I am broody for another baby and am seriously worried about the long-term implication & consequences of CS delivery (want specially one that I requested. Guilt is never a welcome addition).

I found everything about the ELCS preferable. I had an episiotomy with dd1 and actually found the abdominal wound from the CS more tolerable. Healing was predictable; I had no agonising back pain. I could lift dd2 from the minute I was mobile again.

Yet, I remember how vulnerable I felt after the CS and there is a part of me that just doesn't want to feel that way again.

I forgot to mention here that neither of my babies were easily conceived: dd1 naturally after 9m and dd2 two years and 6 cycles of clomid.

What if we tried and I couldnt get pg?

What if I got pg and had another ELCS? I don't think I would feel safe with a VBAC.

What if I got pg and developed an awful complication because of the previous cs I requested?

My pp appearance worry of an overhang would be the least of my concerns ...

FWIW, comeaway, I've heard that an EMCS differs greatly from an ELCS. You had no choice in the matter. I think my mind would rest more easily because of this, and the fact that you are ttc #2. For me, I'm worrying because I chose to have the first CS: all subsequent consequences (if any) are ON ME. Also, we have 2 dcs, who I am delighted with. Sometimes it feels like ttc a third would be an indulgence, iyswim?

[Molotov]

And MummyA, glad that it all worked out well for you. Good luck with the birth and congratulations! xx

[Molotov]

Terrible type-o's in my first post this evening Hope it makes sense.

[AuditAngel]

I have had grade 4 (total) placenta praevia twice, with DC2 and then DC3.

I am not certain that the statistics fit with my recollections, although that was based on the consultant's comments rather than hard statistics.

I suffered unstable pp which meant I bled. With DC2 I was admitted at 33.5 weeks and apart from a 24 hour discharge, was in hospital until CS at 37.5 weeks. With DC3 I had 6 admissions from 24 weeks onwards.

The consultant who looked after me (although I was not actually on her list as my conditions weren't complex enough ) had previously undertaken a study into the incidence of PP following manual removal of placenta (which I had with DC1). The consultant told various medical students that I was a very rare case, having had PP twice.

While in hospital waiting for DC3 I was given an MRI and extra scans as they were trying to determine the best way of diagnosing Acreta (which I didn't have).

After having DC2 I asked about the risk of having PP again, and was told not to worry about it. I would suggest speaking to your GP about your fears.

[Molotov]

Thanks, Audit, I hadn't thought of raising the question with my GP

[comeawaywithme]

I know what you mean about indulgence. Our DS is a perfect little boy and in some ways we feel like we're being greedy by trying for another and do worry that we're tempting fate in some way.

I don't think you should feel bad about requesting an ELCS last time. I felt all my contractions in my lower back, I don't know if DS was in a funny position (well, I know his head was and that's why I ended up having the EMCS as he was stuck), but if I sit for a while I get terrible pains in my tailbone and I'm sure that's mild compared to what you felt/feel.

I would also feel uncomfortable with a VBAC. Although I laboured really quickly and it was simply DS being stuck, I wonder if my fears of scar rupture would somehow impede the labour as I just wouldn't feel safe. Also, I think it's a case of better the devil you know when it comes to the c-section although I guess you at least know what a vaginal birth feels like.

Here's a different link to that article, it is very interesting
discovery.ucl.ac.uk/1382784/
Hope it works!

When the worrying starts to take over, I always think about the women I know who have had a couple of c-sections and they've all been fine. I know that doesn't mean I will be of course, but it gives me hope.

Hope you end up making the decision that you feel most happy with!

[AuditAngel]

I asked for a VBAC with DC3, but then I had my second scan which confirmed placenta praevia, so it wasn't possible. (We had asked at the 13 week scan, if the sonographer could see where the placenta was, even though it isn't checked until 20 weeks here, she said she couldn't see it, which meant either top or bottom, we immediately said, oh well, PP again then!)

[Molotov]

Yeah, I know what you say makes sense, comeaway; that I know of lots of women who have gone on to have at least one more problem-free pg after a CS: whether thay had a repeat CS or VBAC is immaterial.

We had unprotected sex 3 days before I was due to ovulate this month. I panicked for a couple of days and we've used condoms since. I doubt I'm pg. But there is a part of me that would like to be. To be able to have the decision out of my hands!!

[comeawaywithme]

Well fingers crossed that you are