Succenturiate lobe and ELCS

[AJPJB]

I am pg with my second child and have a placenta with a succenturiate lobe or bilobal placenta) which while not totally uncommon is unusual.
Each lobe is the same size and one is posterior and one anterior. To add to this, they are low, currently 2.7cm from OS at 34 weeks.

The issue is that the vessels connecting the two can be quite vulnerable. I have had lots of scans and they said that only if the vessels cover cervix do they cause a problem; a major problem- Vasa Previa.

I am under a consultant as I have other medical conditions too (non-preg related) and he seems to think that the blood vessels are not covering the cervix and as the placenta has begun to move it will continue to do so and a natural delivery should be fine.

I was very keen to have a natural delivery but now and very anxious, firstly they say the blood vessels don't seem to be over the cervix- what if they are? If the rupture with waters or the pressure pushing the consequences are significant- rapid foetal blood loss.

The consultant is fairly easy going and will offer ELCS if I prefer, I think.

What would you do? I don't want a section but if it's the safest should I just insist on one? At my last appointment, the consultant said he'll do 50 c-sections in my situation and only 1 will turn out to have been a problem should they have delivered naturally vasa previa wise. He seems to say this suggesting it 1:50 was low but I think it's high. Don't want that one to be mine!

Advice please!

I had exactly this with DS. I had an elcs which was great! Quick, calm, lots of lovely morphine. I wouldn't risk a natural delivery if I were you.

Thanks for the reply! It's good to know someone else has had similar experience. Did they suggest a section or did you have to ask for it?

I think in my heart of hearts I know this is the best option. Were both your parts equal in size and low too? My OBs said that baby's head is below both parts ATM suggest natural is ok but I am worried about risking it.

My first son was born naturally and it was all quite quick and calm but I know I'd be a nervous wreck this time as the circumstances are different.

Basically my consultant said there was no point inducing me (I was 10 days overdue at this point) as baby was stuck ie couldn't engage as he was trapped between the 2 placentas. They actually didn't know till after he was delivered that both placentas were full size so I would say if there is any doubt, don't risk it. It will be fine!

don't know why you'd risk it. I agree, 1 in 50 is high odds when the outcome is potentially so awful but avoidable. Honestly, ELCS = walk in the park. Recovery is not exactly a doddle, but really not bad either.

I'm a huge fan of birth as natural as possible (I wanted a homebirth with DC1) but in this situation I'd opt for the ELCS too. If the worst happened I am not sure I could live with the regret!

I think because they can see the head is beyond the placentas slightly, they think he/she can engage. My last m/w appt she wrote that it was 4/5 engaged.
I have birth to my first son at 38+5.

Would they do a section before this?

Bump

I would not take the risk, my labour was clouded with all the problems my friends had, the 1% in a million ones....all sorts of things went wrong...honestly, this is not to scare you this is my reality. Nearly everything that is rare and could go wrong with each one they had this rare ting.

I just would not risk it. To be in labour, in pain with extra problems....no way. You could be in a wonderful controlled theatre with staff all round you to aid you immediately and with pain relief should there be a problem.

Why take the risk?

There is nothing wrong with ELC and many many people find them to be wonderful experiences....wonderful experiences...

Good luck. I guess I am speaking of course about how I would feel in your shoes, and labour was enough of a gauntlet to run, let alone with additional risks....

sorry meant to finish my saying it would be my worse nightmare and not an ideal frame of mind to be in labour with.

Hi there, I am new here, I have been looking all over for someone with this so I am glad I found this thread!

I am currently 17 weeks with my second. At 13 weeks I had a scan due to bleeding and was told I had a low lying placenta and a succinturiate lobe. I was told it should move up and shouldn't be a problem but when I got home I read up and noticed it put me at risk for vasa previa.

Have you had a colour doppler ultrasound? Apparently this is the only way to really know if the vessels are over the cervix. I don't think it's standard on the NHS so if they are not forthcoming at my 20 week scan I think we will get it done privately just to be safe as it will be essential to have a CS if I do have vasa previa.

Here is a bit more info in case you haven't had one...
www.vasapraevia.co.uk/vasa-praevia/diagnosis/

I bled at 13 weeks too but they put this down to cervical erosion- I didn't know my placenta was low then. I have known since 20 weeks that my placenta was low but only at 28 weeks did they mention a succenturiate lobe. Like you, I googled it and was quite horrified as criteria for Vasa Prévia is low lying placenta and in addition to this a succenturiate lobe. I have both as you do so panicked.

I was scanned again @ 32 wks at specialist Fetal centre but I don't think it was a Doppler ultrasound although I can't be certain. It was one of those appointments where you are almost expected to just nod and say nothing. The consultant just said - " you're fine" and that was it. I felt like I was rushed and didn't ask what they had used in terms of machinery but it didn't look any different to a usual ultrasound machine. I have 2 lobes of equal size too which I believe to be unusual too.

I am going bk a week on weds ( to see if placenta has moved- nothing to do with lobe) which will be 36 wks- I will ask then what they used and if they can't rule VP put entirely, I'm going to elect for a CS.
I don't want any risks!

Hi varicoseveins, sorry you are worried about this too.

I have been reading that if VP is diagnosed the management is usually CS around 35 weeks to ensure avoiding labour which would be dangerous.

I think after my 20 wk scan in 2 weeks time, if they won't do the colour doppler I will be getting a private colour doppler done ASAP. I have found a few places that do it, one near me is £50 but it has to be booked along with a regular scan so it will be a total of about £130 which we really can't afford right now but I feel we can't afford not to!

I believe the colour doppler is the same machinery as a normal ultrasound but they basically flick a switch to change the mode to colour doppler. I think they usually perform it vaginally too.

The other option would be just to go for ELCS anyway but I am not sure if they would go along with that unless VP was diagnosed first and of course CS in itself carries some risks so I would rather go for VB if I can get the all clear.