Risks for placenta accreta after previous CS?

[MolotovCocktail]

Just wondering if anyone knows the statistics for this? Also wondering about percreta, praevia, etc. If anyone has a link to NICE, that would be great.

I'm asking because I had a ELCS almost 2 years ago (2nd baby, 1st CS). We are considering another but I'm currently weighing things up and managing to worry myself silly about this because I've googled it

TIA!

Any of these any good?

www.rcog.org.uk/womens-health/clinical-guidance/placenta-praevia-and-placenta-praevia-accreta-diagnosis-and-manageme

www.acog.org/Resources_And_Publications/Committee_Opinions/Committee_on_Obstetric_Practice/Placenta_Accreta

www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0052893

www.karger.com/Article/Abstract/10010

I had my first cs with my 2nd baby 6 months ago. I was told at 20,32,34 and 36 w that I had a low lying placenta, and as a result was admitted at 36 w and told I would have elcs at 38 w.

Then, at 37w, I was told the placenta had moved to 3cm from the os and I was sent home. Then at 39 w I had a big bleed and ended up having an emcs anyway

Anyway, I had numerous debriefs its still seems to be a point of consternation about if I actually had placenta praevia or not. the consultant said my risk of having it again is slightly increased, not because I have had it before but because of the cs, which mean the placenta is more likely to
Attach below the scar and not move.

In terms of accreta, she said there is a slightly higher risk of this, but I would still be v rare. My risk is the same as anyone who had has one cs before. She said the risk would be much higher with multiple CSs. She said the placenta would have to be low, anterior and then stick to the scar which is all v unlikely but if it happened would probably require hysterectomy

Tbh although the risk is low, It is the main da tot which is putting me off having a third child, so I totally sympathise.

Thank-you for those links

I think the ACOG article put a second CS risk rate for accreta at 11% (meaning 89% for not developing it). The Jordanian study put it at 40%, but I only read it quickly and I think this was in women who had placenta praevia developing accreta.

I'll read more about it later where the info will sink in more; my head is spinning a bit. Just seems like a large risk I'm thinking about this and not even pregnant. Thanks again for the links.

Gosh loulou that sounds scary. Good to read that things seemed to have turned out well, though.

My children are 5yo and almost 2yo. My dh would like another baby and although I am not adverse to it, I have a few concerns (this one is new).

I don't have a history of placenta praevia. I used Clomid to help conceive dd2 and had an ELCS to deliver her. I absolutely freaked myself out last night reading about accreta from the results google bought up (I know I shouldn't have read them).

Scary

I am pregnant with my 4th child and have had 3 previous C-sections. My placenta is completely covering the OS and an MRI I had couldn't tell one way or the other if I had accrete. I am due to give birth next Wednesday at 38 weeks and they are proceeding as if I have it.
Hysterectomy has been mentioned as a very strong possibility, my chances of needing one are at 1 in 10 at the moment according to my consultant.
I knew nothing about previa or accreta before this, it has definitely been a learning curve.

I know my problems are very much in the minority and very very rarely happen regardless of the amount of C-sections.

I had elcs for macrosomia. I had two further pg (vbac 1 & 2) and although we knew there was a theoretical risk, it was treated as so vanishingly small by the medical community, it didn't even feature.

My (female) obstetrician had elective cs herself, and the male consultants I saw preferred cs to vaginal birth for their wives, because they were more conversant with the later life side effects of vaginal births (loss of continence, prolapse etc). The tiny risks associated with post cs pg were inconsequential in terms of living with the consequences of vaginal births, later. Truly a medical interventionist viewpoint, but interesting in itself.

I honestly wouldn't give two seconds thought to it. As long as you are aware of symptoms, and what to do 'if', then subsequent pg can proceed as normal.

That said, for any post cs labour, do request continuous fetal monitoring throughout labour in line with NICE recommendations.

Thank-you wurst, your post is very much appreciated. It feels like you've read my mind because (weirdly), now a 3rd baby is something we're thinking about, I'm having guilty feelings about my maternal request ELCS.

I requested it due to the fact that I developed coccydynia from the labour with dd1. It was extremely painful for monts post-partum and I had private physio to help me out. The physio suspected I'd displaced a disc but this was never investigated.

Anyway, in my mind, there was a very real medical reason why I asked for that CS (I also saw a chiropractor at about 32w pg with dd2 who said I was much more likely to do the same damage, and perhaps more).

My OB however, was very unsupportive. Although he eventually agreed, he frightened the bejesus out of me at the time. The 'impact on future pregnancies' thing is echoing, as are his comments about cs hysterectomies.

But, I find your comments comforting and of course, the long-term after-effects of VB are something I considered when deciding to go for a CS. I just seem to have forgotten at the moment that my reasons were real and in my panic I'm feeling guilty and stupid.

Phantom, you have my very best wishes for next week. I really hope that everything works out for you (gives a very big unMN hug)

Please tell us how you're doing, when you're ready, if you feel you want to x

No worries. as a matter of interest, (pg aside) would you be more comfortable going for a second elcs?

In hindsight, I probably should have had elcs for dc3 (so, elcs, vbac1, elcs) for issues completely unrelated to original cs, and my consultant advised that should I have any further dc (I won't) that I am to have planned cs regardless. Oddly, I had asked if cs were possible earlier in the 3rd pg (around 30 weeks) and was told no clinical reason for cs because I had 'successful' vbac1. For me personally, cs are a safer option with my history, but I'm a firm believer in maternal choice.

Good luck, phantom x

Thank you very much =). I have a week to go now, im very nervous but massively reassured the hospital know what they are doing. I have to have bloods taken on Friday so they can source blood if I need a transfusion, which I have gathered is quite likely.
I will let you all know how I do, fingers and everything else crossed it will be ok.

Wurst, in answer to your question, I think if we were to have another baby, I would prefer a repeat ELCS over a VBAC. This is due to the original reason why I requested the first CS (coccydynia) and now the fact that I have already had 1 CS and am not prepared to take the risk of uterine rupture through labour as well as damaging my tailbone again.

A third baby would be our last baby, too.

I definitely overthink. I have no idea why I googled placenta accreta on Sunday night: I just remember dh being asleep and thinking 'oooh, I'll look at that'

I'm finding it hard to make the decision as to whether to try for #3 and maybe I'm trying to think of EVERYTHING.

I don't get pg quickly (or easily). DH definitely wants another and as dd2 is almost 2yo I am feeling a pang of broodiness (I'm 31yo, if that accounts for anything). I go from thinking 'yeah, let's just see' to 'jesus, if I get pg again it will implant over my CS scar and I'll need a hysterectomy. Best steer clear'.

Then there's other parenting issues in that on some days, my hands are full with the two I already have.

I'm swinging wildly; not actually making any rational sense at all, and I've been blowing hot and cold sincr January.

Phantom, my fingers and toes and all else are crossed for you, too. I am wishing you all the best for next Wesnesday. Please do let us know how the birth went. Hope you're okay. I imagine it must be a frightening experience, to say the least xx

Molotov I gave exactly the same conversation with myself on a daily basis wrt #3.

Ds2 is only 6m so I was hoping it might settle down a bit- everyone says once he's on the move/talking and wilful like his big bro I'll decide to stop at 2 but I'm not so sure. I think id really like another but don't know I could handle another high risk pg and birth again and then there's childcare but that's a different thread . I'm 30 so I feel in too young to be 'done' yet!

loulou, the decision about whether to move from 2 to 3 is one where I'm using my head a lot more. With dd's 1&2, I wanted them and that was all there was to it. But this decision is more complex, probably because of how another pg/baby/child would affect our dds. Selfishly, my body.

I've started (and joined) numerous threads lately about this. I just can't get a strong feeling one way or the other