Placenta attached to uterine wall post 2 csec. Help!!

[snowcake]

I have just come from my 12 week antenatal scan with this info: placenta accreta (or even increta, an MRI scan will show). Meaning the placenta is anterior and the uterus has attached itself to the cesarean scar.

I have had 2 previous csecs, this will be my 3rd baby. My youngest is 4 months old so the gap is very small and hence the tissue not fully healed.

I have decided to go back to Europe to have this baby as we're in Dubai, UAE and the medical care here cannot deal with such a high risk pregnancy (doctor's own words).

I need to send the CD with pictures on to at least 3 more doctors to give me feedback and tell me what my chances are of having this baby, needing a hysterectomy and last but not least surviving to care for my older children.

I am quite worried now after having googled this complication. Are there any mumsnetters who have experience with this? Can you tell me your stories? Could you point out doctors for me that helped you? What should I look out for? What would you have done or not done?

I am very confused. I saw my baby kicking and sucking on its fingers today, I can't bear the thought of giving up on it. I really need some guidance.

I can't be of much help im afraid but just wanted to say good luck, I'm also in Dubai and pregnant, my doctor here is fantastic if you wanted another opinion,

Adrian Lower is an expert on adhesions. I know he deals with adhesions post-birth/miscarriage/ERPC but not sure if he knows about ante-natal adhesions. Google him and maybe contact for opinion.

Good luck.

hukran abayababe, I am currently with Dr. Rosalie Sant. Always open for suggestions.

Thank you sh77, I will google him!!

shukran...sorry

Hi - not sure i had the same thing as you are describing, but with my dc3 I went into labour at 35 weeks - all of my children had lain transverse throughout my pregnancies, so I knew a 3rd c-sect was on its way .

Throughout my 3rd pregancy my urine tests had tested positive for infection - but I had no symptoms - and took the antibiotics anyway. The pregnancy was fairly uncomfortable and we nearly lost DS3 on a number of occasions.

When he was born the surgeon said that my bladder and uterus had adhered to the old scar tissue and that my bladder was in a bad way. I had to immediately have bladder surgery on the operating table after ds3 was born. The urine samples had been contaminated by bugs or something growing along the adhesion between my bladder and my uterus.

I've been told never to get pregnant again.

I've heard she is very good, I'am seeing Dr Hibba Mutasib, she delivered my 2nd child and this being my third all going well, both pregnancies have been straightforward, I do know that she specialises in high risk pregnancies, she used to be at the American Hospitol, but is now at a clinic at Health care city called Dr Sulaiman al Habib, she delivers at city hospitol, best of luck whatever you decide to do:)

uptomyeyes, gosh, how terrible for you and the little baby. You must have had the worst case scenario of placenta excreta.

I am staring down the barrel of loos of the baby, loss of my life, hysterectomy, etc. Very confused and not quite willing to accept it is really that bad.

abayababe, I will check out both doctors and get another opinion. No place in Dubai is too far away. Thanks a lot for the contacts!

Are there any more MNs who have had this? It can't be that rare.

sorry, placenta percreta...

God snowcake, what an awful position to be in, definitely get some more opinions, Dr Hibba's clinic is very near Wafi, she spent 20yrs in the states and has five kids of her own, I would trust her with my life, let my know if you need a number, its not difficult to get an appointment, she is not half as manic busy as when she was at the American.

Hi snow cake, I'm so sorry to hear about what you're going through, I would second contacting Mr Lower, he really is the expert in the UK in uterine adhesions and related complications. I know of one other lady who had the same issue as you and she was under Mr Lower's care. I have been treated by Mr Lower in the past and he is a great doctor, and very approachable and easy to contact, I'm sure if you called his office or sent him an email he would be willing to give you some advise as to what the next and safest step would be for you.

Please let me know if you need and of his contact details.

I had placenta accreta with my second pg (after an em elcs with first ) the placenta had grown through the previous scar tissue (confirmed by a mri scan), i had to have an elective cs at 39 weeks, it took a lot longer than previous cs and they had to cut in a slightly different place and cut was also a lot bigger so that they could avoid cutting into the placenta. I lost quite a bit of blood and it was very painful after. I had antibiotics and my recovery was quite slow. However, i went on to get pg again 2 years later and had the most trouble free pg and cs out of the three, i wasnt even in any pain after my 3rd cs.

My local hospital dealt with the placenta accreta as well as they could and i was mostly happy with the care i received (apart from when they were discussing my case on the phone at one point in same room as me in far too much detail and in worse case scenario-made me a bit nervous to say the least!)

good luck I hope it all goes ok for you, with proper care and management the outcome is nearly always a good one, all i found was that there was a lot more prep at time of cs, things like having 2 drips in rather than one, extra checks, extra surgeon there just in case,etc.

all the best

In fact, if you email Adrian Lower directly and explain your situation, he will respond. I was worried about adhesion after ERPC and so wrote to him for advice. Luckily, period arrived and all was ok so I didn't need to see him. But, given his expertise, he is probably the only person I would see. I don't think he does NHS work (I could be wrong).

Hi, I had placenta accreta with dd2, it wasn't diagnosed until delivery as in my case the placenta was not attached to the scar from my previous cs but to the back of the womb. I also had placenta previa so I had been in hospital for 8 weeks anyway at that point.

My main problem was bleeding, I lost 7 litres in total, had a 13 unit transfusion of whole blood + other products. I was stched up after my c-section but had to be re-opened for a second surgery under GA to stop the continued bleeding before which I had to sign consent forms for a hysterectomy. Fortunately they managed to save my womb with an unusual procedure called a Hu (sp?) suture which basically involved sewing the front & back of my womb together! I have since had investigative procedures which show that all is well in that department, I could have another baby, but have been strongly advised not to, because of the risk of a repeat.

From what I have learnt, loss of baby or mother is still very very rare, even in these circumstances. I remember being told before my second op that the hysterectomy would definitely stop the bleeding, so you may have to come to terms with that as a possibility. I know there is another mnetter I have spoken to on occasion who did have a hysterectomy after her placenta accreta.

I was treated at the Rosie in Cambridge which is an excellent teaching hospital, it happens to be my local but it deals with all exceptionally complex cases across the East of England. I would highly recommend them for a second opinion, my team of consultants were Professor Christoph Lees, Charlotte Patient and Gerald Hackett.

It's not great news I know and you may well have some rocky times ahead but you & your baby should be fine in the end dd2 is a bubbly bouncing 20 month old now, you wouldn't have a clue to look at either of us what we'd been through! Best wishes, I hope you find someone to take over your case soon, that should help you feel more confident. I'm going to sneak in a little un-mumsnetty [hug] here .

Ps Ariane5 I'm in awe that you went for another baby after accreta, I'd love another but dh goes white at the thought. Did you go for any advice about risks etc?

It wasnt planned and was a source of great worry throughout the pg untill it was confirmed that the placenta was nowhere near previous cs scar and hadnt grown through where it was (back of uterus).

I did panic at first when found out i was pg for the third time as it was an experience i didnt want to go through again. I think i was very lucky!

I'm sorry ariane5, reading it back I realise it was a rude question! I really wanted a bigger family but know that it would be crazy to risk it again. I know that I'm very lucky to have the two that I have. I'm really glad that it all worked out for you .

Not a rude question at all ! i hope my reply didnt sound like i was offended, it was a bit short and sweet as dd2 was wriggling on my lap!

I dont think id have actively tried for another but after having an accident and it all going well (too well maybe, a painless cs and quick recovery but then again after ds i had the pain of ten cs!)if you want another you could get ref to see obstetrician to go through it all ? I had a terrible time with ds but it was so different the next time

No, you didn't sound offended, but it is a bit rude to question people on their family choices I realise! I have been thinking about asking to go through my notes again with my consultant, she took me through them briefly when dd2 was 6 weeks old but only a limited amount sank in, and at that stage I had no desire to ever have another child. But in reality it's a bit pointless as dh is dead set against it anyway.

Anyway, I should stop hijacking poor snowcake's thread now . Thanks for replying!

pm me if you would like to chat more

Hello snowcake

I would also recommend Dr Adrain Lower in London, He treated me for Ashermans Syndrome (scar tissue in the uterus which is one of the the causes of placenta accreta) and is an expert in this area. He is one of only two experts in UK. The other is Dr Anthony Trew who works out of Hammersmith, he works for both NHS and private (Dr Lower only sees private patients) I think its really important that you see someone who has dealt with this kind of problem before. I live abroad and flew back to London for treatment, I was able to set it all up beforehand via email and phone consultation. If you want to know more about him, there is a video link here

I know you must be really scared and worried, but you are doing the right thing researching where to get the best care. The single most important thing you can do is get yourself in the hands of an expert. I know Dr Lower is respected internationally for AS treatment, I am not sure how many accreta cases he has dealt with, but I would consider him first.

Good questions to ask any doctor you see are:
how many similar cases in the last year have you dealt with?
What was the outcome for those women?

I am happy to provide contact details for Mr Trew and Mr Lower if you want, just PM me.

best wishes

xxxx

Haven't experienced accreta but have had 5 c-sections and that is what they threatened could happen to me every time so have read up on it a lot . My feeling is find the right doc with experience & u will get thru, these things r more common these days with c sections rising. I am considering no 6 even though there is a risk of accreta , but the john readcliffe hospital in Oxford looks like a good place to deliver with complications .

abayababe, I have made contact with Dr. Hibba and will see her for a second opinion. I've heard of her before, she sounds very knowledgeable.

helenlouisey, thank you for an update on DR. Lower, when sh77 recommended him I did a google search and he does indeed sound to be the man for the job. I would very much appreciate any contact details you can give me as the website only offers an online form whereas I'd like to be able to send through my scan pictures and the doctor's report.

I will be in London the first week of February to try and get a referral but even if he doesn't do NHS work my DH and I have decided to go private. Here in Dubai we have to pay anyway, Germany, too. I'm still on NHS and we pay NI and taxes as registered as expatriates.

I do not know how the referral system works as I had both my previous babies abroad and paid privately. However, now that I'm staring down the barrel of a prem baby, weeks in NICU and complications for myself I don't think we can afford all of this on our own

Any suggestions?

ariane5: Wow, you managed to go till week 39? I'm impressed, I have been told about bedrest, steroids to ripen the baby's lungs, etc. I hope you don't mind me asking a few more questions: did you have a placenta anterior (under belly button, in front of your tummy basically)? Did you bleed at any point in time? Glad to hear you overcame the problem and went on to have a great 3rd pregnancy!!

TheFowlAndThePussycat: oh no, you must have lost all of your own blood, you poor thing. That is horrible. I cried reading your post, the enormity of the procedures and the risks involved, I think you are very, very lucky to be here. Would you mind if I asked you for the details of the medical team that cared for you? Can I just get in touch with the Rosie and name the doctors you had? Did you do it on the NHS? If yes, how did you get a referral?

I am registered in central London on the NHS, Westminster, Knightsbridge. Not sure if I can request the Rosie... Can really do with a hug now. Thank you. Not hijacking my thread, it's very interesting to hear how people have gone on to have more babies and complications free. Hope you can find a good consultant to go through things with your DH.

mummyabroad: thank you for sharing your experience. Was it difficult to get back on the NHS for you? Sorry, not sure if you actually went through NHS. I'm still registered with our old surgery and would like to go back there, they normally send you to Westminster&Chelsea Hospital.

Thank you for the link. Very interesting, he has great experience. I would appreciate the contact details for Dr. Lower and Dr. Trew. I will PM you now.

deo357: 5 CS!! Wow!!! I am very impressed, you must have muscles (and nerves) of steel Thank you for the hospital recommendation, I shall google it straigthaway.

Thank you so much for sharing your stories and giving me your recommendations. I can see a light at the end of the tunnel. With the right care and the right doctor I hope to be able to have my baby.

Please keep on sharing. I am always checking this thread.

xSC

good for you snowflake, just gather all the information you can and make your decision based on that, it certainly sounds from the ladies on here that there is light at the end of the tunnel, if you fancy a coffee in Dubai at any stage give me a shout:)

snowflake I have just sent you Dr Trew and Dr Lower's details. I paid private with Dr Lower, because I wanted to be treated quickly and getting the NHS to recognise I had AS would have taken months. I have also still kept up my residency requirements in the UK, but annoyingly the hospital (Princess Grace) charged me as an overseas patient! Dr Lower's fees were the same though. So please be prepared with your paperwork and get things straight from the outset.

Hi Snowcake, I'm sorry I made you cry! It was a huge thing to go through, but its over now and dd2 is sooooo worth it .

I'm not at all clued up with how you go private/get referrals etc over here, I was treated on the NHS and referred to the Rosie as my local hospital and to be honest it wouldn't have made any difference to go private, I would have been on the same ward, same doctors, same NICU, everything.

I think your first point of call must be your (UK) GP, I am sure they will be able to put you in contact with people who can review your scan photos and if you request that someone at the Rosie (contact here) look at them I'm sure they'll oblige. (The names of my team are in my earlier post). Your GP will also be able to advise on the referral process I'm sure.

Sorry not to be more help!

yes, it was anterior very low over the previous cs scar and just touching the cervix, i had bleeding at 36 weeks which is when they scanned me,thought it might be placenta praevia but referred me for an mri just in case where they then realised it had grown through the scar tissue.

I had steroid injections at 37 weeks once id had the mri,it was an nhs hospital and only recently had come off special measures but they dealt with it as best they could although in hindsight there was probably more they could have done (at the time i hadnt heard of placenta accreta before and didnt really know what i was dealing with ).
The cs took much longer than my other 2 and scar was big and curved round as they had to cut differently to avoid cutting into the placenta.It was painful afterwards i wont lie but it did improve and i was made as comfortable as possible with pain relief.They did mention to me that it was better to have epidural/spinal block as i was scared and had begged for a general but they told me with epidural your blood pressure is lowered so it would be better as if i bled heavily it would be slightly easier for them to control.

I was told that if i bled too much i would then be given a general and would have to have a hysterectomy as a last resort but i was fine and although i lost quite a bit of blood it asnt life threatening.

Getting pg again (not planned) was hard as i was scared it would happen again but i was lucky as the placenta was away from the scar.