Placenta adhered to uterus in previous birth - advice please?

[Bilbomum]

I am currently having the VBAC/C-s debate with myself and am 24 weeks pregnant with second baby.

I had a section for my first pregnancy (Aug 2006) which was recommended because of previous back surgery but it wasn't straightforward. My ds was completely stuck and after going through the notes with the consultant last week he didn't think I would have got him out naturally either(it took 25 minutes to extract him during cs). I also haemorraged (sp?) after ds was delivered which apparently was due to my placenta being well "knitted in" to my utertus. They apparently had to do a larger J shaped incision to my uterus but I'm not sure if that was because of the difficult delivery or to remove the placenta. Because of the length of time all this took I ended up under GA which I wouldn't want to happen again.

Question for midwives/anyone with experience out there - what would have happened if this was a vaginal birth? Presumably the placenta couldn't be delivered so would it have to be extracted by c-s anyway? Would it be likely to happen again?

Sorry for the long post but I'm not seeing the consultant again until 34 weeks so I could do with some help with my decision - thanks in advance!

hi bilbomum - 25 mins seems a very long time for the delivery in a first c/s unless that is the time to get the spinal working etc, normally the time from starting the c/s to delivery is about 5 mins or less. The J shaped cut sounds most like they had to extend the cut on the uterus to get baby out, which is not that unusual.

Its difficult to say if you would have had a vaginal delivery if you had laboured, if it was difficult to get baby out, its usually bbecause baby is well down in the pelvis, if baby is high the c/s is normally easier. If your placenta was adherent, it sounds like you would have ended up in theatre for a manual removal anyway. There is a slightly increased risk of the same again this time, both due to the c/s and to the previously stuck placenta.

Sorry Im not being a lot of help with a decision, I assume your back problem is still there this time?

You could have a short trial of labour and see how it goes, and move to a c/s if no progress, that way you have a chance of a VBAC if ecverything does go smoothly.

They can do a scan to see if your placenta is adherent again or not. The scan wouldn't tell them for definite but can give them an idea. I had this at 26 weeks.

Thanks for your replies,

Mintpurple - unfortunately it was 25 mins to extract ds. Although it was a planned section I went into labour early and was 6cm dilated by the time they believed I was in labour and checked. I got to 9cm before they got me into theatre, it was a very quick labour for a first time. DS was very very low down in my pelvis and had been for a few weeks, he also had a huge head which didn't help matters!

Back problem is still there but I was thinking of risking it to avoid another c/s.

Fruit - that's good to know, I've got a scan booked to check size at 34 weeks so I'll ask them to check if they can tell then.

I don't know about your VBAC dilemma, but a friend's placenta go stuck after a vaginal delivery, and she did have to go into theatre but they can remove it vaginally. She said that the consultant stuck his hand up there and pulled it out . I imagine that there's a bit more to it than that, but she wasn't that bothered by it! It didn't happen the second time, though, so your placenta may come away fine this time.

I had an emergency section first time around, a VBAC second time but the placenta was retained (MW pulled the cord, it snapped, trip to theatre), baby 3 was VBAC and I delivered the placenta myself.