Low anterior placenta over c-section scar - did you have MRI?

[schmee]

I had a low lying anterior placenta diagnosed at 21 scan (possible complete previa). I had a private scan at about 25 weeks to see if it was still previa. It's about 2 cm from the os, but is completely covering my old c-section scar.

I'm meeting the consultant this week to discuss the birth. I'm worried of course about placenta accreta. I know it's rare, but understand that placenta covering c-section scar makes it much, much more likely.

What protocol should I expect? I understand that accreta can be excluded or diagnosed by MRI. Should my consultant refer me for this on the NHS? Did you have one?

If you did have accreta, what happened next? e.g. were you given medication to build up your blood in advance of the operation?

I want to make sure that I'm getting the best care and I'm really worried that it will go unconfirmed before delivery - i.e. they'll just give me a section and find out whether it's accreta when they go in.

Thanks very much

I thought you couldn't have an MRI whilst pregnant? X

There was a woman on here a few months back who had a MRI for this, I will try and locate the thread, as there was a reply on there from another woman with a positive outcome and more information.

I had grade 1 pp with dd1 and same with dd2, partially caused by scar from 1st section. Placenta was anterior with second but not accreta, afaik (have actually not heard of this - sorry).

Both times I was hospitalised for a fair while before the births (5wks & 4wks) and was given steroid shots & regular blood taken in case of emergency. However I had no bleeding at all with either. I also had no other means of diagnosis other than regular external scans (no MRI nor any mention of such).

I also had the Head Honcho of the consultants doing the 2nd section as it was anticipated it might be very tricky with the placenta being anterior but the op went very well, no complications, luckily.

I don't know if this helps at all? Biggest pain by far was the hospitalisation, but I just had to accept it in the end. I hope all goes well.

www.mumsnet.com/Talk/pregnancy/1138215-Placenta-attached-to-uterine-wall-post-2-csec-Help

There is a lady half way down the first page who gives some details of her experience.

Hope this helps.

Thanks for the link - it's helpful although worrying that only one of the posters had an MRI. Most of the posters seem to be recommending going to see a private consultant, and I can't work out what I should expect from the NHS in terms of next steps. It seems from oneofsuesylvester's experience that they don't routinely MRI - it's more a suck it and see approach?

I will say I haven't had my scan yet, but due to falling pregnant 11 weeks post EMCS I asked about this, and what happens. I I was told I would have a few scans never mentioned MRI, and that if they couldn't diagnose for definate then they would go with caution and say it is.
Didn't want to know what happens if it is, and Consultant seemed pretty happy to tell me I will have a meeting after the scan if there is a concern and all will be discussed then.

To be honest with that link there is only 1 who had placenta accreta who did have an MRI, the other was undiagnosed because it was attatched to old scar tissue but not from section, so they might not have known she had old scar tissue if that makes sense. And I think the OP was going for an MRI if that helps.

Can you ring your midwife and find out more information off her?

I had a low lying anterior placenta after three sections, I was at fairly high risk of accreta - but it was fine.

Bottleofbeer - did they just wait until the section to find out?

Schmee - kind of. My 20 week scan revealed a low lying placenata covering the OS, it was also anterior. My consultant put the fear of God into me, then said "we'll re-scan at 32 weeks". I didn't go for a private scan and waited.

In the meantime I googled and half killed myself with fear. My 32 week scan showed the placenta had moved away from the OS which I assumed meant accreta was ruled out. What they didn't fo was check if it ws still covering scar tissue. When I got down to the delivery ward on the day of the section my surgeon had read my notes and took me off for a quick scan s he wnted to make sure it wsn't covering the scar - his exact words were "it'll make things more interesting for me if it is but it might give the anaesthetits a hrd time so we'd best check", I realised he was making light of what could have been a very difficult situation so he didn't worry me. Luckily it was literally a couple of centimetres higher than the scar. With hindsight my risk was high enough to warrant an MRI - certainly it should have been looked at during the 32 week scan but for whatever reason it wasn't.

My point is my risk was higher than yours and it wasn't accreta. Just because the placenta is over the scar tissue it doesn't mean it's abnormally attached. My placenta would have been over my old scar for a fair bit of my pregnancy but it DID move up. They will never go right in for a section without making sure it's not an accreta, if it is you'll hve a team on standby and you'll be ok, just don't google, ok?! :)

PS there are other indicators at scans so if nothing so far has revealed anything untoward it's in your favour that it's just an unfortunately positioned placenta (by that I mean one that looks like it could be ccreta but isn't) good luck!

Oh and my A isn't working heh!

I know you're right bottleofbeer - I should step away from the Google. It sounds like it's normal not to have an MRI and that's what I should expect unless we can find some way to sort things out privately (extremely unlikely).

I'm just one of those people who would rather know and plan for the risk. If there's a chance I'm going to end up with a hysterectomy I want to plan extra help, etc. If I can reduce my chances of a blood transfusion by taking medication beforehand, I really want to.

And the person on the other thread who had been recommended to go for a VBAC and thankfully didn't as she had accreta - eek!!

Thanks everyone for helpful comments.

Schmee, I really do understand the place you're in right now, it's scary and you want to know. If I had my time over again I'd make an app with my consultant, tell him wht you just said to me, you might be surprised and they'll help you.

Google doesn't help, if you enter 'headache' the first ten sites will bring up brain tumours yet only one in ten thousand headaches are because of a brain tumour. All you'll find is worst case scenarios. I gave birth at Liverpool women's, which has a huge birth rate because it covers an entire large city. On average they see one accreta a year, and we know the section rate is high.

Thank you Bottleofbeer - you are absolutely right about Google!

I really feel for you, any questions, feel free to PM me :)

Saw the consultant today who is insisting that I have a VBAC. When I mentioned accreta she said: "Oh, I haven't even looked at your notes to see whether your placenta is anterior or posterior" - so obviously she doesn't think it's a worry but I do. Don't really know what to do next :(

Seems very odd, Consultant/registrars rarely read notes ime they wait for you to tell them something then they look. I am suprised she never gave you more information once she knew it might be a possibility. Maybe speak to your midwife and see what they suggest.

Thanks for the response nunnie.

Yes, the registrar said I'd almost definitely have a repeat section but she'd just check with the consultant (as I can be referred privately if it's medically necessary). Then the consultant came in all guns blazing and told me I'd be having a VBAC unless the placenta was still covering the os. Ignoring the fact that the baby is 95th centile and currently in an oblique tranverse lie as well....

Unfortunately I don't really have a midwife I can talk to (it's shared care between the hospital and the community midwives and I haven't seen the same one twice), but I thought I might see if my GP could help.