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Major placenta previa

(130 Posts)
rek21 Wed 25-Feb-09 21:53:03

Well, I've been burying my head in the sand about this so far, but I think now is the time to ask for the collected mumsnet wisdom.

At my 20 week scan the baby's placenta was centrally positioned at the bottom of the womb completely covering the os. A repeat scan at 24 weeks showed no change of position although the sonographer felt that there was no sign of the placenta growing into the scar from my previous c-section (DD, 16 months was breech). I have another scan lined up at 29 weeks followed by a consultant's appointment.

I'd really like to hear from anyone with experience of this severity of the condition, either first hand or otherwise. Is there any chance of the placenta moving? I have found it hard to pin medical types down on this - the best chance I have been given is 50/50. Has anyone had major placenta previa and not had a bleed? If so when did you have a c-section? Do any other symptoms accompany bleeding? I have this fear that it will happen in the middle of the night and I won't even realise!

Really, I'd be grateful for any experience. I have read the RCOG guidance on the net but I would really like a more personal perspective.

Many thanks.

mags98 Wed 25-Feb-09 22:35:04

Well if it stays where it is you will have no choice but to hav a c-section of course. It would be incredibly foolhardy to even contemplate anything else.

It is possible it might move, but probably unlikely to move completely free from the os to a normal position. I would think the best you could expect would be for it to move off the centre to a lesser degree of previa. If you think it will stay where it is and work on that basis, then if it does move that's a bonus.

If it does stay covering the os then a c-section will be done usually at 38 or 39 weeks, or of course immediately should there be any sign of going into labour before that. I know a lot of people on here are very anti c-section, but honestly, there are many many worse options.

Not all women with this condition do bleed, but it is clearly a risk - if you do have a bleed, even a small one, they may well want to observe you in hospital, sometimes even for a few days - when big bleeds do happen it can happen quickly so you need to be prepared and in the safest place.

All this is not meant to scare you! Most women with plaenta previae have perfectly healthy babies and no major problems. But it is worth being aware of all the facts.

gigglewitch Wed 25-Feb-09 22:50:07

try not to scare yourself with googling. I had at 20 weeks, 'no chance' of it moving, and resigned myself to the 'safe' option of having a CS - until the 36 week scan, at which point it had moved to 4mm out of the way. Mine was moving anterior, which is another complication in itself, but what I got was the go at the 'normal' delivery that I wanted. Looking at it, and more the point looking at the width of my little finger nail which is probably around 4mm shock it wasn't the easiest delivery as ds1 needed assistance (ventouse), but tbh it wasn't awful.
I'd had bleeding at 26 weeks and again at 34 weeks, but it wasn't an abruption apparently. You most certainly would know about it, imo.
Go with the advice of the consultant smile

itchyandscratchy Wed 25-Feb-09 23:06:34

I had grade 4 PP with both my pgs (how lucky's that?!), but both had no bleeding at all. Both were anterior too.

I think I must have a womb shaped like a banana or something which encouraged the placenta to settle in the wrong place... hmm

Anyway, with dd1 I was re-scanned at 24 weeks and it hadn't moved so I had to go into hospital for more of less the whole of the rest of the pg, which really sucked but as I'd had no bleeding I was let out occasionally and then allowed home for 2 weeks but I had to have someone with me at all times and I was confined to bed. I went back in the week before I had dd1 and I had a planned c-s at 38 weeks. All went really well.

With dd2 same thing happened. I wasn't allowed home to stay at any point with her and was in hosp from 34-38 weeks but had some day trips out, again only because I'd had no bleeding.

I was quite blase about it all until I was queuing for dinner one night with a girl who told me she'd lost her 1st baby at 28 weeks through a bleed from PP sad so that made me shut up and put up with it.

Again, c-s at 38 weeks, all went well and dd2 was fine.

It really is worth listening to the advice you're given. My midwife told me about being at an abruption which she described as 'catastrophic' - again, don't want to scare you but it was what I needed to stop me moaning about it and that too scared me into doing as I was told.

It's very easy when you haven't had any bleeds to be really laissez-faire about it, but it's not worth taking any risks. Good luck. Do feel free to ask any more questions.

I haven't personally experienced this but my best friend has, she was told to expect to have a section, she was scanned on a reg basis to see if there was any change,luckily for her her placenta had moved enough for her to give birth naturally

itchyandscratchy Wed 25-Feb-09 23:08:10

sorry - I meant to say I was re-scanned at 32 weeks with dd1, and that's when I was admitted to hosp.

fruitful Wed 25-Feb-09 23:35:09

I bled at 34 weeks at about 2am. I dreamt I'd wet myself, and then woke up and thought "blimey, I really have". I woke up properly when I got to the bathroom. Lots of blood but I was still thinking "ooh, maybe it will stop and I can go back to sleep...". Dh phoned the ambulance smile. Spent 12 hours on the labour ward with everyone expecting the bleeding to stop; just when it had been long enough for them to start talking about moving me to the antenatal ward I'd bleed a bit again. Then I went into labour (womb irritated by the blood).

If I hadn't bled, they wanted me to go to hospital at 36 weeks and have the cs at 38 weeks.

Usually they send you home after the first bleed, and want to keep you in after the second (they can get worse).

PP bleeding doesn't hurt and is bright red (and lots of it). No other symptoms, all a bit surreal really.

I had pp again with my 3rd pg. You can search my name if you want more details but don't scare yourself. grin. Just, if the docs say you need to stay in hosp, please believe them. I can give you lots of tips for surviving a few months on the antenatal ward though.

Both my boys are fine and so am I (although I do have an awesome scar and a good tale).

It can move. But pack a bag and leave it in your car boot, always carry a charged mobile, and sort out quick-notice childcare for your older dc. Although I was told that I could take dd in the ambulance with me if I needed to.

twinklytoes Thu 26-Feb-09 11:23:34

you cansearch my name too for my experiences - shall not scare you.

on reflection I think my advice is that you need to prepare that you may bleed and that will incur at least a 24/48hr stay in hospital depending on which trimester you are in. prepare how you will organise childcare etc. also prepare that in worst case scenario you may be placed in hospital on bed rest after 33wks.

and now I've read fruitfuls bit and totally agree with all said!

kitstwins Thu 26-Feb-09 12:09:01

I had placenta praevia with my twins which was picked up at the 20 week scan. It was partial (i.e. half covering the cervix) and although there was a possibility that it would move, I was advised this was less likely due to the fact I had two placentas in there and less space. Plus, both placentas were posterior.

Mine did move slightly (a few mililetres away) but still within 2cms of the cervix, which is considered unstable. I also bled on an off - some light, some like a tap and had repeat visits to hospital with labour scares (the bleeding can irritate the uterus and trigger contractions). I had labour stopped with drugs at 25 weeks, 28 weeks and 31 weeks. From 30 weeks I was kept in hospital on bed rest as the bleeds were increasing in volume and frequency, which the doctors said was not a good sign. They warned me of a so-called 'catastrophic bleed' which is high-volume bleeding during which you can bleed out in 5 to 10 minutes, which could be disastrous if you were at home.

As Fruitful said, the bleeding isn't painful at all. The only sensation for me was of falling water, as if I was peeing myself. Some bleeds were very shortlived and slight but some were pretty big. My final bleed at 35 weeks was like a tap, although it stopped quite quickly. I was then given an emergency section.

I would have LOVED to swerve a c section but the threat of bleeding due to an unstable placenta was just too high. It wasn't worth the risk and the doctors gave me dire warnings about complications. Your consultant will be able to advise you of the best route for you, depending on whether your placenta moves and I'd go with their advice as they really do know best in this instance. If you don't have any bleeding and your placenta shifts away they may well 'allow' vaginal delivery, although you would probably be heavily monitored during delivery and they may well insist on a canula being sited in case they urgently need to access a vein to adminster drugs/blood.

NOt everyone bleeds. I know someone pregnant at the same time as me (also with twins) who had total praevia. The placenta didn't move but she had no bleeds, in spite of being warned that she was almost certain to. And yet I, with my partial praevia, bled non stop. All very random and proof that they 'worse' praevia doesn't necessarily mean bleeding is certain. It's just a lot more likely and you should be prepared for that.

So my best tip is to be prepared for a bleed. There's nothing to say you'll have one, but it's best to be prepared. Have a bag packed - enough for a stay in hospital for a few nights (mine had nightdress, cardigan, flip flops, small bag of mini toiletries, book, etc.) - and carry your hospital notes with you and a fully charged mobile. With one of my bleeds that triggered labour I was at home in bed and being able to just grab my bag and head to the hospital saved us valuable time - they were able to get the labour-stopping drugs into me sooner rather than later and they worked. Equally, try and be within fifteen minutes of your hospital so no long and always have access to a telephone.

It's not much fun as it does make things quite restrictive and it's no fun having the threat of bleeding/hospital stays hanging over you. But the good news is that it has been picked up and you will get an excellent level of care, which is always good in pregnancy.

Good luck. I shall keep my fingers crossed that your placenta moves.

MerlinsBeard Thu 26-Feb-09 12:22:41

if you search my name i too had grade 4 PP completely covering. It had righted itself by 34/36 weeks.

The risks ARE huge and tbh it would be worth knowing the absolute worst case scenario - well, i wanted to know. but the best place to get that info from is your MW or consultant NOT google! Also, carry your notes with your whereever you go, even if to the local shops - it was reassuring to me to know that if anything did happen then my notes were with me not at home/in my labour bag whatever.

rek21 Thu 26-Feb-09 20:12:39

Thanks everyone for your stories - I have to admit I had already googled, but I was able to have a chat with my consultant about it at the routine appointment which had been booked to discuss delivery options, so I wasn't too concerned. However, she didn't really tell me what might happen, there was just vague discussion of 'a bleed'. I think that might have been because it was still reletively early days (22 weeks). I suppose she will go into more detail at the appointment at 29 weeks.

I have resigned myself to another c-section, the operation itself was fine last time but I was utterly miserable on the ward afterwards, so I'm quite depressed at the idea of spending more time in hospital before the birth. I'm really interested in fruitful's tips for surviving that. I just can't imagine being without DH & DD for even a few days sad. Sorry that sounds really wet! I probably wouldn't have felt that way before my experience with DD - but then again I'd never been in hospital overnight before that.

We live a good 30 min drive from our hospital in light traffic, 20 mins in an ambulance (as we had the misfortune to discover a couple of weeks ago - DH this time, not me!) - although that wasn't with flashing lights etc. The consultant did raise her eyebrows at that, so I guess that's another one to discuss. My parents live 5 mins away from the hospital and have offered to do a house swap with us so that might an option.

I'm a bit startled at the amount of bleeding people describe - I'll just have to hope that I do wake up if it happens!

Right, well, forwarned is forearmed as someone once said so I'm off to pack my bag!

Thanks so much again everyone, you've been so helpful.

excitedandscared Thu 26-Feb-09 21:59:28

No personal experience but my mum had pp with my brother. It wasn't picked up on the scans so when she had a major bleed late in pregnancy (don't know when exactly, I was 14 at the time) it was pretty scary for all of us and resulted in a VERY quick drive to hospital and emergency c-section.

It seemed to be a very touch and go thing for both of them for while but he's about to 18 and none the worse for it!

Don't mean to scare you, but at least you know and are able to prepare yourself, and medical people will also be aware and prepared for anything that may need to be done to help sort things out when the time comes!
Good luck...

fruitful Fri 27-Feb-09 12:16:35

I have a house full of small children at the moment but I'll try to get on later with some tips!

Staying at your parents sounds fab - they didn't want me to go home cos we are 30 minutes away too. Took 40 minutes in the ambulance the first time - there wasn't an ambulance free to come shock. 5 minutes away would have been ok initially. Although saying that, when I had a catastophic bleed I was on the ward, and then on the operating table in about 4 minutes. But if you were in hospital, things would be a lot easier if your dh&dd were that close. Especially if your parents are on hand for lots of babysitting?

itchyandscratchy Fri 27-Feb-09 16:48:15

I do admit it was really hard to be away from dh and dd when I was in hospital the 2nd time. We sorted out a complicated system whereby MIL would pick dd1 up from pre-school, come and visit me, go back to MIL's then dh would pick her up from there every night after coming to visit as well, but at least he had dd1 every night. It was very stressful but we got through it and it seems a fuzzy and surreal episode in our lives now, although it was HUGE at the time.

I cried most nights being away from them both but it was worth knowing that dd1 was well-cared for and that dd2 and I were safe. Dd1 can't really even remember being away from me now.

Good luck.

VerityClinch Fri 27-Feb-09 20:30:43

rek21 - how many weeks are you? I've been told I have my placenta covering the os - at the 20 week scan (am now 21 weeks). I thought that sounded serious (ie it's covering the os, not just low lying. Is posterior, not sure if that makes any difference?), but they don't want to rescan until 36 weeks, which I am thinking sounds a bit late, if I could bleed out basically any time between now and then...

am going to tackle the midwife about it at my appointment next week, but the sonographer sounded so relaxed about it - was really no more than a throwaway comment at the end of the scan, but the more I look at it on my notes, the more I start to worry...

rek21 Fri 27-Feb-09 21:15:17

Hi everyone, thanks fruitful whenever you've got time, hopefully I've got a few weeks before hospital yet.

itchy I guess it's like all these things, you get through it cos you have to. Glad that the memory has blurred a bit now!

verity I am 27 weeks. My local hospital has introduced a scan at 24 weeks for women with low placentas who have had previous c section to see whether there is any indication of the plcanta growing into the scar (placenta accreta) which is v rare but can be vbad news. They said that it is a fairly new thing and theycannot always diagnose a problem anyway. Hence the scan at 24 weeks. They would have left a further scan to 32 weeks but I have booked a holiday and want to fly so I persuaded them to scan a bit earlier (29 weeks).

I would ask your midwife about it, there are lots of 'levels' of placenta previa, it could be that the edge of your placenta is just partially covering the os, in which case you have a good chance that it will move away. My sonographer was quite uninformative to, but then I suppose it is just their job to spot potential issues, not to give medical advice. I made an immediate appointment to see the midwife to ask all my questions, at least it might put your mind at rest. Hope all goes well.

cazzaben Thu 19-Mar-09 00:42:32

Hi all!! I just wanted to give you my story on the placenta praevia thing... I was told I had Low lying placenta at 20 weeks (with my second pregnancy) and was told it would move up. It didnt and I started to bleed at 29 weeks and was taken to hospital by ambulance. I was then told I wasn't allowed home until my baby was due.... 11 weeks later. My placenta didnt move and I didnt bleed again but still had to stay in for the whole 11 weeks. I was also told it was anterior. I had a General Anesthetic to have my c-section. They cut through the placenta to get my baby out. I just wanted to say though that everything is fine. I had quite a bad experience and waking up from the General hurt like mad!!!! I was in agony. But I'm here to tell the tale and my beautiful Boy is just about to celebrate his first birthday... I know how scary this can be. Its very rare these days for things to go wrong so have faith and think positive!! Good luck!!

rek21 Thu 19-Mar-09 20:35:13

Thanks for posting cazzaben, I've just had a scan at 29 weeks and the placenta hasn't moved at all, but the baby is growing well and I haven't had any bleeding. So far the plan is to take me in at 35/36 weeks and do the section at around 38 weeks. I don't want to go in but I'll take the advice, I'm trying to stay close to home too. I'm really interested to hear that they cut through the placenta, I was wondering about that. Glad to hear you have a bonny boy! Happy first birthday to him.

cazzaben Fri 20-Mar-09 00:30:21

Thanks rek21!! I cant believe he's 1 nearly!!!
Try not to worry too much. I know its easier said than done... I will be thinking of you. Just to let you know though there were 2 women that had Major Placenta Praevia while I was in hospital and neither of them bled at all!! One came in at 35 weeks and had her baby at 38 weeks the other lady came in 3 days before her c-section was scheduled. I hope that you don't have a bleed.
The cutting of the placenta thing was scary for me as I know it makes you bleed lots and lots.. I was very lucky I only lost 1 litre of blood during my c-section. If you want a chat or any advice just let me know
Take care xxxxxxx

rek21 Thu 26-Mar-09 07:17:05

Hello everyone, I just thought I'd update this thread as I noticed some other posts on similar subjects.

Well, on Friday night (29+5)I had a small bleed and went into the hospital. I was quite shocked to be given steroids to develop the baby's lungs as somehow i hadn't reall equated placenta previa to premature baby! I was hoping to come home on Monday morning but on sunday night I had big bleed and was told that I was 20 min from an em c-section under general. Fortunately the bleeding slowed so they kept baby inside but it looks like I'm here for quite a while anyway. They have told me that if I have a week with no bleeding I might be able to go home for 'a bit'. But as I haven't managed a day with no bleeding so far I'm not holding out too much hope!

I'm missing dd and dh like crazy but all our lovely friends and family are really rallying round which is so lovely. Baby seems tobe doing well and fingers crossed I'll make it to 34 weeks at least and I'm lucky enough to be in a hospital with a great neonatal centre.

So there we go! I'll update again if there are any developments, but at this stage I'm rather hoping there won't be!

twinklytoes Thu 26-Mar-09 07:39:52

good luck rek. guess you are up waiting for breakfast! hope you get a break at home soon.

rek21 Thu 26-Mar-09 09:39:28

Yes, rice crispies, yum yum!

cazzaben Mon 30-Mar-09 15:12:33

Oh rek21... I know how you must be feeling... You must be missing your DH and DD so much... It brings it all back for me... Have you got lots of books to read??? Isthere anyone in your ward??? I think the best thing you can do is chat and chat to everyone ... Get their stories and it might help you not think about your own... (well thats what I did) I'm gonna pray that the bleeding stops long enough for you to get home for a bit... You will more than likely have to go back though so just try and prepare yourself...
I know your gona hear it a lot but you are in the best place... And thats coming from someone who spent 11 weeks in there!!!!

Keep in touch and let us know how your getting on... Even if it is for a rant and rave or some sympathy... God knows you deserve all you can get...
May God hold you in the palm of his hand

cazzaben Mon 30-Mar-09 15:24:27

Oh and the steriods... Did they hurt you as much as they hurt me!!! I was in agony after those 2 injections....
Oh by the way another tip... You can request any food you like... Speak to the Matron or the Ward Manager and they will confirm that pregnant women are allowed (within reason) to ask for extra food... I know they rotate the menu's every 2 weeks... So on a monday was sausages and mash (yummy) and on tuesday was Chicken keiv (also yummy)
Breakfast in the morning would consist of 2 criossants and cereal...
You'll also be allowed to order any take-away and eat it. (sorry to go on)
Also you should be allowed to have your own pillows from home... I made my bed and surrounding area a home from home...
Anything else you wanna know just ask winkxxxxxxxxxxx

rek21 Mon 30-Mar-09 22:13:51

Thanks cazzaben I appreciate your kind thoughts. No chance of going home now as I had another bleed on Saturday just after I had got back to the hospital after an afternoon's 'home leave' (can you believe it...). It was only a little one (in comparison to the others) but they hoicked me back up to delivery and stuck me on a drip...

I think after 3 bleeds in 10 days no one is holding out much hope of me getting to term, so at the moment i'm just hoping to get to 32 weeks (Sunday). Dh and I were taken round the nicu on thursday which was quite a shock but everyone was very lovely to us.

I've now met another person on the ward with pp so we are able to comiserate with each other - and at least the stories you and other mners have told shows that alls well that ends well.

Thanks again. Rek.

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