What happens to placenta in a c section?

[CareerGirl01]

Wondering if there are any obs out there!!? Starting to worry about my bleed at 30 weeks - am 38 now and having elective c section for dd2 week on Wednesday. Okay sounds a gross question but how do surgeons detach the placenta from the mother and what are the risks I may bleed and need a BT.

[WeAreSix]

The anaesthetist starts an IV which makes the uterus contract and it is then removed in a similar way to controlled cord traction. They should check that the placenta and membranes are complete.

There's a risk of haemorrhage with all surgery - you should discuss your own personal risk with your surgeon.

HTH and good luck!

[BraveLilBear]

Sorry to slightly hijack the question OP but I was also interested in what happens if you have a low and anterior placenta - in my mind they'd have to cut through the placenta to reach the baby, is that right?

Good luck with yours OP - fingers crossed it goes smoothly!

[WeAreSix]

No, they'd never cut through the placenta - that would put the lives of mum & baby at risk.

[BraveLilBear]

Thanks Wearesix that was what I'd thought (about massive blood loss risk) god knows how they'd get to baby in that case then. Fingers crossed (a) my placenta moves up and (b) junior gets bored of lying breech/transverse then!

[WeAreSix]

How many weeks are you?

My days as a theatre nurse are a dim & distant memory but there's several ways of getting around the placenta. The surgeons usually check the scan reports to see where the placenta is before they start the operation. It'd be massive blood loss if they properly went through it. I have seen one 'nicked' but never cut through.

Have a google of Jean Sutton - Optimal Fetal Positioning for some ideas to get babe head down.

[CareerGirl01]

Don't worry brave I was just interested i.e cord clamping and whether its relevant in an elective c section but it sounds like the placenta effectively starts failing as soon as the IV drip is administered. Also worried about bleeding out - but have been told am low risk.

[WeAreSix]

The cord is clamped and cut fairly quickly and baby handed over to be dried / wrapped IME. Theatre tends to be quite chilly, and baby needs to be kept warm. This coincides with the surgeon giving the nod for the synto to be started.

The placenta is usually given to a MW to be checked to ensure it (and the membranes) are complete. Once they're happy that there's nothing left in the uterus, they start sewing up. The theatre nurse checks all the instruments and swabs are accounted for at this point, too :)

[KamikazeeKid]

Good question about where do they cut when you have a low placenta? Particularly if you already have a previous c section????

Career - can I ask why you have an elective planned? Just out of interest really, I've got to make decisions about vbac or c section following emcs but low placenta covering cervix may make that decision anyway!

[VivaLeBeaver]

As far as I know they do cut through placentas if they have to. I've known women with low lying, anterior placentas have sections in main theatre with a consultant rather than in obs theatre with a registrar. Loads of staff, cell salvage and blood on standby. Icu have bed on standby.

I didn't go with the women I'm thinking of to theatre but I seem to remember the plan was just to go as quick as possible to minimise blood loss.

[WeAreSix]

Really Viva? I'm shocked. I've never met a surgeon who would willingly cut through a baby's lifeline before delivery unless in an obstetric emergency and as a very last resort. I'm glad I worked in a relatively small DGH now!!

[VivaLeBeaver]

Yes, but if you can get baby out in less than a minute of knife to uterus it's very likely to be a good outcome. No worse than a long bradycardia and if baby isn't compromised already which it shouldn't be for an elective then it'll be fine.

[CareerGirl01]

Kamikazee have no issues with placenta - reason for ELCS is my age. (42) combined with an emergency CS when having DD1 and an unexplained bleed at 30 weeks in this pregnancy. I was on course for a VBAC but even though baby is fine the bleed made my mind up. Because I had a touch and go labour with DD1 they left decision up to me. If I go into labour before I will see if I can cope for a few hours with monitoring - any issues/problems and its still a CS.

[KamikazeeKid]

Good luck career girl! Do you feel calmer as its elective? Im hoping I'll feel better about an elective versus previous emcs!! But thebonus with ds....I was so flipping tired and out of it I'd have agreed to birthing thru my nose at the time just to get baby out! ;-)

Hope all goes smoothly