Placenta- velamentous insertion & succenturiate lobe...what does this mean?

[amandine07]

Hi everyone

I had my gorgeous son 12 days ago via ELCS.
Itwas for maternal request but in the end he remained in breech position so all a bit academic, he would've come out that way in any case.

Reading through my notes, the surgeon wrote about my placenta that there was: velamentous insertion & succenturiate lobe, plus also ragged membranes.

Has anyone had experience of this?
I know that DS has arrived safe & well, thank God and we are both doing ok.

However, I wonder what the implications would've been if I'd gone for a VB?
Indeed, certain midwives were pushing for me to have VB despite breech position.

I googled re the placenta, as you do, and it sent a chill down my spine as I read that those features put you at much higher risk of:

1. Post-partum haemorrhage and infection

1. Retained placenta...

obviously then the need to have it manually removed in theatre & the potential trauma surrounding that especially if you've managed a 'natural birth' and then subsequently end up in theatre with a spinal block etc (happened to a good friend).

So, despite having had a CS- can anyone comment of what this may have meant if I'd ended up having a VB?

None of the scans picked up this information- is it something you find out post-partum...?

Thank you for reading this far!

I don't blame you at all for googling, I would have done. Although it is easy to misinterpret and yes, you could scare yourself to death!
In your situation a CS would definitely be the safest thing to do, but that doesn't necessarily mean a VB would have ended in disaster. Many women do give birth naturally with velamentous insertion and succenturiate lobes because it is not always possible to see it on scans and they are just fine.
Occasionally it will escalate to an emergency it luckily this is rare. Infection is more common and sometime it's necessary to have further surgery, but it's relatively minor.

Thank you for the reply.

Do you mean that CS sounds like it was the best option...due to the breech position...or due to the features of the placenta? I think you mean due to position.

Yes I read about increased risk of PP infection.
When you refer to possible need for surgery- is that regarding the removal of retained placenta?

I do not regret having ELCS at all, the awful experience on the PN ward was a different matter altogether but sadly it seems par for the course nowadays.

Also I found the midwives generally v slow to sort out pain relief on the PN ward- they kept commenting that a "CS is very painful" without then delivering the pain relief that would've helped me manage better.

Has anyone had personal experience of having a succenturiate lobe and/or velamentous insertion?

Was it picked up prior to birth? And did this influence mode of delivery?

I meant CS would be the safest option due to the clinical features of the placenta. Especially so as the baby was breech. If trying to turn the the baby manually that increases the risk of the vessels rupturing. From the sounds of things, I don't think the midwives knew about your placental abnormalities.

Yes, the further surgery I refer to is removal of retained placenta. This can be done under spinal or general and to put it very simply, the contents of the womb are gently sucked out trans-vaginally and the lining of the womb is scraped with a small, blunt, spoon like instrument. (Curette) Typically takes less than 10 minutes.

I'm very pro-CS. Both of mine were maternal request CS, I never even entertained the idea if a natural birth. Like you, the operation itself was fine. The PN ward was a load of shit and that was when they knew I was staff! Luckily for me I had a steady stream of colleagues visiting so I got everything I needed but I still sent a strongly worded letter of complaint to PALS and to the Matron.

It is absolutely shocking that they withheld pain medication and that they were so patronising about it - telling you CS is a painful operation! Of course it bloody is that is why anaesthetists prescribe a shed load of analgesia! There is absolutely no reason a patient should suffer post op, it's completely unacceptable.
I once had to report a nurse working in a post surgical recovery unit (neuro this time) for withholding analgesia.
The patients would complain that they were in pain and she would say "well of course you are sweetheart, you've just had an operation"
It was just plain laziness on her part because she couldn't be bothered to prepare the morphine and get another nurse to do the second checks and signings.

I'm glad you and DC are ok and doing well but I do think you need to write to the hospital and complain about the ward.

Sorry missed a bit;
When I was born my Mother had velamentous cord insertion that was a natural delivery.
When I had DS that was velamentous cord insertion but he was CS.
Neither had shown up on scans. It is possible pick it up on ultrasound but usually only shows in later scans.

Thanks for the detailed reply.
None of the placental features were picked up on scans prior to the birth. Midwives I met with were very pro natural birth (obviously) despite the breech position.

I turned down ECV as I felt it was too risky- have seen it done when I was a student, looked unpleasant plus the babies fairly quickly turned back into their previous position.
This convinced me it was not worth the risk.

However, despite the breech, I did go for maternal request- because if the baby turned I would be lined up for a VB without doubt. Wanted to ensure I had a CS whether he turned or not.

Saw 'maternal request' written in my notes.
A couple of the midwives made reference to the request while on the PN ward- really hope this didn't influence their treatment of me, but I do wonder.
They kept on about how painful a CS is, how it's not the easy choice etc...really not helpful or appropriate when I reflect back on it now.

Yes I am in the process of drafting a letter to PALS- the maternity ward has a shit reputation locally but even so they need to be told about these things.

Although the ELCS went smoothly and both me & DS were absolutely fine, the absolute worst bit was the PN ward, I never felt that my pain was properly managed from leaving recovery. Crying in pain & literally begging for oral morphine are what I remember clearly .

Now I feel so am finishing that letter today.
It's a shame- I went in with an open mind willing to be proved wrong about midwives, that they do care & are not borderline sadists. Unfortunately the experience has definitely NOT improved my opinion of them!

Oh dear, I have gone on & on!
To get back to the original point- I feel that CS was the safest option for me despite not knowing about the placenta.
Maybe I had a sixth sense, as absurd as that sounds!

A close friend had retained placenta- she had manual removal which was more traumatic than the birth itself. She was in the birth centre, completely natural just G&A...so ending up in theatre with a spinal & a doctor's hand up her vagina left her traumatised.

This made me fearful of retained placenta, despite knowing it's not that common...I feel like I dodged a few bullets perhaps by pushing for CS.

Thank you for bearing with me- extremely long post!

Well my midwife had been truly amazing and has exceeded all my expectations. I would happily pay for the service I have recieved so far.

I think it's a bit cruel to generalise the whole profession because of your own bad experience (which is inexcusable).

I think we are lucky that there as so many hard working midwives out there willing to work horrendous hours and for little reward. The nhs is run on goodwill. Poor staffing, and an increasing birth rate is the problem. Shame the government don't sort these things out...

I know that there are so many fabulous midwives out there, who work tirelessly and devote themselves to their vocation.

Sadly, I didn't see any of that kind of midwife during my PN experience.

Yes, a bit cruel to generalise like I did but then again, how myself and other women on the PN ward were treated was also a bit cruel, in my opinion.

I now truly understand why people would choose to go private- personally I am totally for the NHS despite recent experience.

Also I can now see how PN depression can be triggered off/made worse by a poor PN experience.

Oh dear my post got deleted- sorry MNHQ, I was having a bit of a rant!

Well I saw your post and I'm inclined to agree!
Yes I do think you may well have dodged a bullet.
And yes, from someone who works with Midwives day in day out and gets to hear their 'private' conversations in the coffee room, most some are miserable bastards who seem to have found their registration in a box of cornflakes. Luckily there are nice ones who carry the rest.
The same could be said for Nurses, surgeons, anaesthetists, paramedics etc. etc.

InPursuit
I think you're definitely right about the wide, er, spectrum that you get in each profession or specialty.

My only previous experience of midwives was when I was a student and your comments about what you heard behind the scenes rings true for me- some of things I heard shocked me and I never forgot some of the poor women I saw, left in pain or not given adequate analgesia for certain necessary procedures following childbirth etc.

It wasn't my intention to denigrate the whole profession of midwives but it was more an emotional reaction to a pretty bad experience...I cannot pretend that all the midwives were angels, far from it.

Anyway, letter sent to PALS, it won't make any difference but at least I'll have my voice heard, if only briefly!