Grade 1 Placenta praevia birth advice

[InFrance2014]

Hi,

Am 35 weeks 2nd pregnancy, had 3rd trimester scan (normal in France), and told that placenta is low, 3cm from cervix (on the right hand side, not posterior or anterior). Baby is head down but apparently not engaged.

Was told initially that there is enough distance for a vaginal birth, but then advised to take an epidural in case of haemorrage and need for manual extraction of placenta, as it would potentially save 20 minutes compared to needing emergency anaesthetic.

I was keen to avoid epidural as I managed very well for DC1 without, but labour was fast (6 hours). I know the hospital here is quite risk averse in general (they only allow 30 minutes for 3rd stage before manual extraction!), but following the scan I'm now worried about risks of haemorrage, emergency CS etc.

I've read the guidance online from Royal College Obstetricians etc about managing placenta praevia, but I finding it hard to know what to do regarding going for natural birth, or taking epidural in case of an emergency situation (but risking other things going wrong because of it! Mobile epidural not an option here).

Any experience of and advice re: minor placenta praevia welcome, thanks

[Junosmum]

I was scanned at 34 weeks due to PP. I was told my placenta was 3.6cm away from the cervix and therefore not considered a risk. So yes, I do think your hospital is somewhat risk averse. Having said that, I did end up with manual evacuation of the placenta due to it being retained! I had no pain relief until being taken to theater for that.

[InFrance2014]

Thanks Junosmum
Do you know if you had retained placenta because it was low-lying, or just bad luck? And (if you don't mind sharing), what was the experience like? Was it a rushed situation? Were you able to see the baby very soon after?

Am finding it hard to get information for actual risks of things like this or haemorrage when it's not a serious placenta praevia.

[IllBeAtTheBarIfYouNeedMe]

With my first pg the placenta was 2.5cm (ish) from os. My consultant decided as my dd's head was engaged she would 'risk' a vaginal birth (quite a lot of panicking when I went into labour a few days later because of her flippancy). I had a straight forward labour and birth without epidural and no problems delivering the placenta after.
Good luck and enjoy your new baby

[IllBeAtTheBarIfYouNeedMe]

2.5ish cm from os at 38wks that should have said...

[MadameJosephine]

I'm a midwife sonographer and our guidelines would not consider a placenta 3cm from the os to be a placenta praevia. We would refer anything 2cm or under for consultant opinion but further than that would be considered normal. As far as accreta etc is concerned as far as I am aware a low lying placenta is only high risk if it reaches a scar from previous Caesarean section.

[InFrance2014]

Thank you I'llBe and Josephine, that is reassuring!

So maybe the extra 1 cm might make a difference to outcomes.
Hoping to find out from hospital whether the perceived need for the epidural is because of greater haemorrage risk and therefore urgent need for operating, or because of increased risk of manual extraction, which I assume doesn't have the same need to be done at speed...

[Junosmum]

Just bad luck with regards to retained placenta. The surgery was done under spinal block and I was in theatre for a total of 45mins. Husband took the baby when they dressed me for theatre. It was quite rushed but not alarmingly so, they started dressing me after 45mins of the placenta not arriving.

Once out of theatre I had a catheter in which was taken out 12hours later and I fed baby whilst in recovery- husband and baby were waiting for me in recovery room. I was in recovery just over an hour before going to the postnatal ward. Feeling had returned to my feet by then but due to the catheter I couldn't get out of bed. By far the worst thing was the morphine as it made me really really itchy for 36hours- ended being given antihistamines.

[InFrance2014]

Thanks for reply Junosmum.
Hospital here seem to be saying that I might have to have manual extraction or other things with no pain relief if it all kicks off, as there won't be enough time for an epidural. Guess I'll just have to cross my fingers that this doesn't end up happening!