Placenta accreta

[captainbarnacle]

OK so I went for my 32w scan today after the 20w scan showed the placenta was almost touching the cervix.

80% of placentas move up by 32w. I am in the 20%. In fact, it's total placenta praevia now - which means automatic c section :(

I spoke with the consultant and he was telling me about everything that can go wrong. This is DC3 - with DC1 I had an emergency section and he is concerned that the placenta could be attached to the old c-section scar and might come away causing massive bleeding during DC3 c section - called placenta accreta. Where I live the only way to stop this bleeding would be an hysterectomy (at 34yrs) - I could go to a hospital where they have procedures to add stuff to the blood to stop the bleeding without one, but that is 2 hours away.

Not sure what I'm asking here - apart from has anyone else any experience of placenta praevia or accreta?

[nunnie]

I haven't experienced it but I am 26 weeks with possible previa and also a risk due to EMCS 8 months ago to accreta. I will know more at my 34 week scan.
I had heard about the hysterectomy issue, but I am waiting till after my scan before I research as I will probably google and poop.

Hope someone can come on a reassure of advise you soon.

[captainbarnacle]

Yeah - don't google! I've only followed the wikipedia links and seen mortality rates which has really hit home. And there's nothing I can do about it. I am bricking myself. I wish OH was here :(

[TheRealMBJ]

Oh captain

I have no personal experience but do know someone who had to have an hysterectomy due to one.

Thinking of you.

[Withwoman]

Placenta previa is where the placenta is covering the way out. Placenta accreta or percreta is a much more serious condition.

Speak to your midwife... Ask her lots of questions... Also make sure you have another appointment with your Consultant. If there is concern then you need to be in the right place to deliver your baby staying in before hand if necessary.

[captainbarnacle]

I'm no longer MW led - I have to go to the hospital every week from now on from antenatal appointments and a further scan at 36w. I didn't have a consultant until today :) He is concerned. He's answered lots of my questions. I'm just looking for real life experiences.

[nunnie]

I forgot to mention I spoke to an anathatist about accreta as I had a meeting with one due to previous problems in EMCS and it was just after my scan. She told me it makes her job difficult and if it is accreta my c-section will be carried out by a Consultant and a Consultant Anethatist she has made a note on my notes that she wants to be beeped for my appointment after scan so she can be present at the meeting.

Can't give you anymore details in enough time though sadly because my meeting is after you are due. I haven't googled as I said earlier as I would rather not know until I know it is happening if that makes sense.

I agree with withwoman, do have a list of questions and concerns.

[Northernlurker]

No RL experience of placenta praevia or accerta but fwiw I bled far more with the third dc and the others. I don't think that's uncommon.
Try not to google - you will just freak out but I do think you need to think about the best place to give birth to your dc. I know it's two hours away but what you want on your side are the best medical team and equipment you can get. If the other hospital is more set up to deal with an emergency should one occur and hopefully it won't - then it's a no brainer really. That's where you need to be.

[captainbarnacle]

Forgot to mention the 2 hours away is by boat... it's not straightforward. Certainly not somewhere I can go in an emergency.

Thanks all. Yes, a consultant will do the op. A toddlergroup friend had the same issue 2 months ago and is fine but she haemorraged at 37w and had to have emergency section. The only difference in care between my hospital and the one a way away is the way in which they can stop the bleeding. We don't really have a choice here apart from hospital or home.

[ThePathanKhansWoman]

Captain so sorry to hear about your problems. I had a normal pregnancy, went into labour at 37 wks, had a brilliant home birth, very quick, then couldn't deliver placenta.

I live in a big city so transfer to hospital wouldn't usually have been a problem.However bad snow had gridlocked city and ambulance slow to arrive, i was in that high after labour and it was only when i noticed everyones panicky expressions,M.W, DH, i knew it wasn't good.I lost 2.5 litres before getting to hospital{i do think this was due to time it took to get there}.

I needed a blood transfusion, and was told i nearly lost womb because placenta was 'knitted' to womb. I didn't know anything about this condition,but my mum needed hers removed after my youngest brother was born, so did a cousin, and my mothers aunt did indeed die that was in the 40's tbf, so i'm wondering if there's a family link?

It was scary, i was so glad i had a large teaching hospital near. I'm sure it all goes well for you, Consultant will take very best care of you and your baby,your in best of hands and they will watch you like a hawk.

[Northernlurker]

In that case I would be asking for an elective section at 39 weeks if they felt that was the best timescale, at the larger hospital. If you labour before that then I would go to the nearer one.

[Panzee]

I had placenta previa for my only child so accreta was not a worry then. However they were constantly banging on about the risk of hysterectomy to me. It felt like they were trying to make sure I wouldn't sue.

One of the consultants I spoke to did reassure me, he said he'd done only 2 hysterectomies after C sections in his 30 years of practice.

It was fine. And I'm sure you will be too. :)

[captainbarnacle]

I had a manual removal of placenta (ouch!) with DC2 (3 years ago) because the umbilical cord detached - I had to have 2 blood transfusions. Now I am thinking it was something to do with that, or the EMCS.

I am having an elective section, prob at 38w. I just have to decide where. If it's at the other hospital I will have to go over there I am sure to discuss and prep. But then the hospital here will think it's the other hospital's responsibility and yet the local hospital is the one who will have to look after me in an emergency.

Thanks for listening to me thinking it all through!

[captainbarnacle]

Thanks Panzee - I'm sure you're right and they are just covering their own backs. I'll get more persepctive in a couple of days!

[nunnie]

We sound very similar captain, I had to have a manual removal with DC1 as the placenta was stuck to womb lining (not accreta), I spent my entire pregnacy with DC2 worrying about it happening again as the manual wasn't the most dignified procedure I have had! Then DS was born by EMCS due to being brow.
I was and still am hoping this one might be straightforward.

They do have to give you worse case scenarios though so you are fully informed when you consent.

[ThePathanKhansWoman]

nunnie captain i went for an epidural,and a bottle of gas for removal of placenta, thinking i was being smart, never had gas before just loved it {always knew there was a junkie trying to fight her way out}.Was chatting away just fine,looked up at theatre metal lamp shade and saw the procedure screamed bloody place down!!! Really thought they'd get salad servers out, and bobs your uncle.

Still huffy that wasn't explained to me,ended up with 2nd degree tear, and couldn't be intimate with my husband for more than a year after. Mind you i was 39 when i had d.d, you think i'd know something.

[nunnie]

I only had epidural but the lamp was at a dodgy angle thankfully. But it wasn't for the EMCS, thankfully I only saw the cathater go in before they knocked me out cold.

I had a tear and stitches after mine too.

[captainbarnacle]

I didn't have anything but G+A for the manual removal - worst pain ever!

[TheFowlAndThePussycat]

Hi captainbarnacle, I had placenta previa and accreta. It is possible to scan for accreta with a Doppler scan, ask your consultant if this is an option at the bigger hospital. Having said that I had a Doppler & it didn't diagnose my accreta because the placenta hadn't grown into my scar, it had grown into the back wall of the womb! I did not have to have a hysterectomy, but I did lose 7.5 litres of blood (all I had and then some - to save you the calculation ). My womb was saved by a very rare procedure called a Hu (sp?) suture, which basically involved stitching the front of my womb to the back.

It is a very complex and rare condition, and the risks are very high. I had 24 hours on intensive care after dd2 was born. I was lucky to have a world renowned teaching hospital on my back doorstep, but in reality, I would have been referred there from anywhere in the East of England. I received 13 units of whole blood and plenty more of plasma/platelets. If I was ever to get pregnant again I would insist on the biggest best shiniest hospital available!

It is pretty unlikely that you have got accreta, (even though you have pp & a previous section) but I'm giving it to you straight as some people (like me!) end up on the wrong side of the stats. I hope you aren't one of us! Best of luck.

[ariane5]

I had placenta accreta with my second pregnancy, the placenta had grown through the previous c section scar on one side. I had to have mri scans and was told that if they couldnt stop the bleeding they would perform a hysterectomy as a last resort.

I had to have a lot of drips put in in case i needed blood etc during the c section, it took a lot longer than my other sections and the scar was bigger as they had to cut round rather than straight in i think.I did lose quite a lot of blood but i was ok, the recovery was a bit difficult.I had been scared and begged for a ga but they said it would be much safer with spinal/epidural as it lowers blood pressure which meant if i bled a lot it would be slower and easier to control.

I went on to have a third baby two years after that and luckily the placenta was well away from the front of my uterus and i had another section which went perfectly.

Hope things go ok for you, all the best

[ifIsaynodontjustaskdad]

I had three lots of surgery for my endometriosis including them detaching kidney from some other bit of me and intestine from each other so my insides were basically mush and then I had placenta accreta with dd 1 and a manual removal. The consultant insisted that it was really unlikely to happen again but I had placenta percreta with dd2. Another lot of blood loss again and another manual removal. Manual removal are undignified but better than the alternative if dd2 had continued to be breech then with my existing starring it would have been c section and hysterectomy at 32 due to the amount of internal damage I already have especially as we also had placenta previa risk. My dad was a maternity anaesthatist and his position is that I am lucky that everything worked out but I shouldn't push my luck and try for any more just count my blessings mind you he thinks we should have stopped at one. It is rare but the complications are dangerous my consultant had my typed and matched before we went in with the surgical team briefed. It only hit home how dangerous this is when I got refused life assurance when I was pregnant due to the stats for complications on this. To be honest I had taken the view that I had one beautiful child and that the only important thing was to have dd2 arrive safely so hysterectomy didn't bother me if it meant I'd still be there for them. Do not Google it you will just worry yourself sick particularly stats as 1 in 2500 means very little on a personal level. What you can do is prepare with your consultant a worst case scenario birth plan and also think about whether you will really care if you've had a hysterectomy when you and.your baby are safe.up on the ward and you get that first windy smile good luck. Please let me know how you get on.

[deo357]

the last note on this thread was a few weeks ago, but im particularly interested in the accreta experiences as i have that & pp. I wanted to know if any of u had to go on High Dependancy unit after & if u still get to look after your baby? i have told them to go straight for the hysterectomy anyhow as i have read its safer & quicker & this is no 6

[TheFowlAndThePussycat]

I was on intensive care then hdu. Dd was in nicu so I didn't get to do anything much for her until day 6 I think, but to be honest I was in quite a state & couldn't really move. I saw her once or twice a day though.

[deo357]

so how long were u in for pussycat? although my situation is different because it is diagonsed already so at least they r planning for it , why was baby in nicu? early or breathing probs or because u were laid up ??

[TheFowlAndThePussycat]

I was in 8 days post birth. Dd2 on nicu because of breathing problems (slightly prem - 36 +2). Also they had stitched me up after cs before they realised how much I had bled & was continuing to bleed. I then had a massive allergic reaction to one of the blood products I was given so they put me under ga to open me up again to stop the bleeding. Woke up on intensive care with breathing tube, central line, the works!

As you say, yours is diagnosed & prepared for, if you are happy to go for the hysterectomy i'm sure that makes it a lot simpler for them. It's still serious surgery though, you might find moving around quite difficult for a while.

Have you had any bleeding yet? I was in hospital for 7 weeks before dd2 was born too - I hope you manage to avoid that as well!

[deo357]

oh blimey u really did have the works - at mo baby being delivered at 36 weeks but im gonna get given the steriods for babys lungs. Im not "happy" for hysterectomy but i know its the best action & really cant have anymore with all these problems & just want least dangerous op. Had a big bleed at 17 weeks - now 23 - so treading carefully. Thanks 4 the info though. i may pick your brains more as time goes on.