marginal placenta praevia (asymptomatic) c-section date after 38 weeks?

[avocado2019]

Hi mamas, I am looking for more info on if it is possible to schedule a planned c-section after 38 weeks, if you have marginal placenta praevia without any bleeding. Appologise for a bit lengthy post.

I was confirmed only on Monday at 36+5 scan that my placenta hasn't moved sufficiently and the edge covers the edge of os, so between marginal placenta praevia and low lying placenta. It was a senior registrar who met me after the scan and she booked me a c-section on 37+0 (Wed), saying that that is the medical recommendation from this hospital and also the RCOG guideline. We went in on Wed and the senior consultant who is also the surgeon said his guideline is between 37-38weeks for my situation, and it is our call if we want to postpone it. The team recommended next Tuesday 10 Nov when I will be 37+6. So after all those shock and panic preparation for early arrival of baby during the week, only on Thursday that we got our head around for a bit more research. Based on the research 2 questions arose, and that's what I want to hear what lovely ppl on mumsnet who has experience on this would say:

1.We found guidelines in other trusts varies and some suggested a c-section can be considered between 37-39 weeks with low-lying placenta, some even says the c section should be performed after 38 weeks, if there is not severe bleeding or another indication, for example the guideline from Sherwood Forest Hospitals. www.midyorks.nhs.uk/download/doc/docm93jijm4n5832.pdf?amp;ver=7147
www.sfh-tr.nhs.uk/media/6810/pil201911-02-llp20-low-lying-placenta-after-20-weeks.pdf

In that case I am wonder if I don't have symptom of labour or bleeding could I insist to postpone the c-section till 38+5 days, so baby will benefit more time to mature his lungs? Do you think it is worthwhile to insist on this?

1. I didn't have c-sections before, but I have had termination, multiple IVF treatment, and advanced maternity age (40) which are all among risk factors for placenta accreta according to the RCOG guideline. I would like to know my risk of accreta. As the nurse today said if I have accreta, they would send me to Royal London Hospital as they don't treat accrete here at Whipps Cross. That increased my concern to have an assessment to know if I am high risk or low risk for accrete.

Really want to learn some experience and opinions. This not my pregnancy but the first one that I made it this far through multiple rounds of ICSI/IVF, so really want to do the best for the baby. Many thanks!

bump! anyone?

Personally I wouldn't worry about an issue that is currently not an issue (placenta accreta)

At 37-38 weeks the lungs are developed and there would not be an issue in a normally developing baby. Babies born at this time are not premature and all that happens after this time is the baby grows larger. So it's again a non issue.

The small risk of going into labour and having the overlying placenta start to bleed is not major as a large area of the placenta is not overlying the os. However in high risk (older) pregnancies placental abruption with a severe risk to the mother and the infant and IMO not a risk worth taking. Again it's a small risk, but you will have a Csection anyway, so far better to have it in a calm, well staffed labour ward, than as an emergency in the middle of the night with low staffing levels.

I've not had any personal experience with this but by 37 weeks babies are classed as full term and plenty are born at this stage both naturally and by C-section- by this stage an extra week may not have many benefits to lungs maturing as they should already be ready but waiting that time and potentially starting labour could have huge risks with the placenta, personally it isn't a risk I'd like to take but like the doctors have said you can delay if you want although I would follow their recommendations

Thanks a lot @EllieJai44@goldenharvest seems like I may have over thought of things. I will ask the questions tomorrow to the doctor see what they they say. Many thanks

Ask about steroids if you’re having your section before 39 weeks .

As PP have said - listen to the doctors.
With Praevia, as a heads up, don't be surprised/worried if you have a heavy bleed and end up in hospital under observation. Partner had bleed 6 weeks before term, given steroids for lung development and over the next 4 weeks was prepped for emergency caesarian 3 times, the bleed stopping each time. Final bleed at 38 weeks, prepped for emergency, bleed stopped on the table - so they went for "normal" caesarian.

She has always grumbled that the 6 weeks in hospital meant she missed all the baby shop stuff after finishing work and had to rely on my incompetent self.

I had a crash C section at 36+6. I had already been in labour and bleeding for some time. My partial placenta praevia wasn't discovered until they went in, I found out during the debrief. DS was perfectly fine, no problems with his lungs being underdeveloped and a better APGAR score than my full term, natural birthed DD.