grade 4 placenta praevia at 32 weeks - drat

[fruitful]

• just got back from 32-week scan - placenta is attached to back wall, covering os, and going a bit up the front. Just grrreat! I have another scan booked for 36 weeks - the consultant said it might move but he'd bet money that it won't. If it hasn't, they want me to stay in hospital for the next 2 weeks and have a cs at 38 weeks.

I'm a bit p'd off about the cs - had an elective cs with dd too cos she was footling breech. But I see that there's no option with a placenta in the way.

But - does anyone know what the odds are that the placenta will move? Seems unlikely to me but the consultant didn't say it was impossible (and they're usually pretty pessimistic aren't they?).

And 2 weeks in hospital before the birth - nooooo! Do I have to? (I mean I know I don't have to, but should I?) If I do start to bleed, how long have I got, to get to hospital?

They haven't said anything about not doing exercise, just no sex (cue dry laugh from dh, who didn't realise it was possible for a pg woman to have sex). Please tell me that hoovering is banned?

Yes, hoovering probably is banned! Think you're prob right about chances that it will move, especially since you'd need an awful lot of movement from the sounds of it! I know being in hospital will make the last weeks of pregnancy drag out even longer (I felt like I was pg with #2 ds FOREVER, especially at the end-), but it will be worth it to assure a safe birth for both of you. You wouldn't want to be home with dd if anything went wrong, right? At least you wouldn't have to cook, do housework, etc. and you can watch lots of crap tv or be intellectual and catch up on the reading we never get to do when at home with small children! Best of luck to you, I hope it all works out alright!

fruitful - sounds as though your placenta won't move very far but you never know. If it doesn't then you are definately best to be in hospital as advised. If you start to bleed heavily then the less time wasted to get you delivered the better. There isn't a time limit on it because there are different types of bleeding episodes. It could just be spotting or you could have a full on haemorrhage with no warning. Any bleeding at all from now and you should go immediately to hospital. I personally would ban hoovering

Aloha had placenta previa and had a lovely birth (though I think she was glad to get out of hospital!) Hopefully she will see this.

I didn't think that any pg woman was allowed to hoover...

ooo poor you - this is exactly what i had with dd. i hadn't had any bleeding at all but they still made me go to hosp at 32 weeks and said i'd have to stay there until they did a c-section at 38 weeks!!!! i cried my eyes out! there seems to be a big difference in the ways different consultants view pp grade 3/4. some will say you need to be admitted in case you have a 'catastrophic bleed ' (their exact words to me - scary!) and some will say that, if there has been no bleeding/spotting, you can stay at home. I made such a fuss that they allowed me home again at 34 weeks but i had to promise to have virtual bed-rest and someone else with me at all times, in case i haemorraged. deffo no hoovering then! I was lucky and had no more spotting - i had to go to hosp weekly and have bloods taken in case i needed a transfusion but other than that i was able to stay at home for a while longer. i then was admitted at 37 weeks and had to stay in hosp for the week leading up to the c-section. i had dd at 38.5 weeks and everything went brilliantly and it was a very positive experience (the birth i mean, not the bloody hosp stay!) one good thing about being in hops for so long was that i made some lovely friends amongst the other long-term 'inmates' and we're all still close now and our dds are all friends.
very very good luck - and don't do a stitch round the house!

Fruitful

Sorry to hear about the placenta praevia. I had exactly the same thing, only I started bleeding at 27 weeks and was admitted to hospital then. They tried to discharge me after a week once the bleeding had settled down, but I bled again on the very night I was discharged and ended up staying in until dd was delivered at 36 weeks.

I think, from my experience and from what I was told, that it's very very unlikely that your placenta will move. I'd plan for a cs if I were you. I don't know what your experience with dd1 was like, but certainly my elective section was a brilliant experience (although I must say it took me most of my 2 months in hospital to get my head round the idea ... I had wanted a home birth) and very unlike the experiences I've heard about from friends who had emergency sections.

I can sympathise too about not wanting to stay in hospital. All I can say is that two weeks, in the overall scheme of things, is not that long (I was in for 10 in total... thought I was going round the twist... aaaaaaaargh!) and it's worth it to ensure that you and your baby are both fine.

The problem with placenta praevia is that it is so unpredictable. I had three heavy-ish bleeds in total, plus a few episodes of light spotting. Thankfully I never had a full-blown haemorrage, although I did (it seems) lose a 'small lobe' of the placenta during one of the bleeding episodes. (I didn't realise this at the time, thought it was a clot, but when dd was born they realised that the placenta wasn't all there, so surmised that a bit had broken off - we think this is why dd was pretty small for dates.) However, if you do haemorrage it could happen with no warning whatsoever and could be very serious. I was very keen to discharge myself from hospital at the beginning (see above, re. going round the twist!) and they called my husband in and basically told him that I HAD to stay in because I could bleed to death between our house and the hospital (... and we only lived between 5 and 10 mins drive away). I have a feeling that they were exaggerating a bit, in order to stop me discharging myself, and also because I had a history of on-off bleeding, but even so, it did convince me of the importance of staying put. (On the negative side, it has also convinced my dh that pregnancy is highly dangerous and he could lose me at any minute, which made for a stressful pregnancy with dd2, even though I had no complications whatsoever... but that's another story!)

If I were you, I'd avoid doing any kind of strenuous activity (e.g. hoovering!). I'd also be quite nervous of being on my own too much (I'm with Moomin on this one), just in case. Chances are, you'll be fine, but better safe than sorry.

I'd also be asking my midwife if there are any other precautions you/they should be taking. Like Moomin I had bloods taken to be cross-matched and saved twice a week, just in case I needed a transfusion. I also had steroids (dexamethasone) to help mature the baby's lungs on a weekly basis. However, this may have been because I went in so early (27 weeks) and at the beginning they were planning for dd to arrive there and then (they even showed us around the SCBU, in case she needed intensive care... thank God it never came to that). By 32 weeks your baby's lungs may be developed enough to cope even if s/he were to be born now.

Hope this helps, and I hope I haven't scared you.

Thanks for all these replies; I was quite calm when I left the hospital yesterday but I've been looking it up on the internet since and now I'm terrified! Yesterday I was planning a home VBAC and hoping my baby would get to come when it was good and ready, and today I'm thinking that reaching 38 weeks and having a calm cs would be a great outcome.

If it wasn't for dd, I'd be thinking a couple of weeks in hospital would be lovely - first decent rest I've had in 2.5 years and the last for a while too! But what about my poor girlie? I've spent all day playing with her and ignoring the jobs I have to do (think she thought it must be Christmas). And crying about this baby and the fact that its probably got to have the same abrupt premature entry into the world as she did.

Dd kept me supplied with doll's cups of "tea" when she saw me crying - she has obviously taken lessons from dh on what to do when a woman is upset!

sorry to hear you're a bit scared and tearful, fruitful - it's only natural but i'm sure everything will be ok. will your dd be bale to come and see you a lot in hosp? dd was my 1st but others in there long-term had children already and they were around the ward a lot; i think it helped the other mums no end.
as soon as they told me i had pp i knew i'd be having a c-section and i just accepted it; it was much the easier way. it helped that dh is a theatre nurse and he atteded a few c-sections in his training so he knew exactly what would be happening and we also knew a fair few of the staff on that day. still, i'm sure they'll take very good care of you anyway.
btw, on the same vein as Ellbell, i too had a steroid injection at 32/33 weeks just in case they had to deliver dd in an emergency.
start choosing the music you want to welcome your little one into the world with - you can have a cd on in the theatre. it really can be a very positive experience; dd was born to the strains of let there be love by nat king cole and it was so lovely and calm.
are you able to rely on your dh and family to help with your dd while you're in hosp? if she's well looked after, then try to enjoy the rest you'll have. she honestly won't remember too much about you not being around after the event - i'm sure it'll be you that suffers more! all the luck in the world to you - do let us know how you get on.

forgot to add - as for dd having a premature start - she was 7lbs 7oz at 38 weeks!! she was also very calm and chilled out as a baby. they say that elective c-section babies are often like this. was your 1st dd an emergency c-section? it's a whole world away having an elective one, i promise.

I was in hospital - but only after TWO bleeds. Both were sudden (I had total PP too) but they both resolved themselves and it was OK. Very, very boring be in hospital but after two bleeds I did feel a bit nervous anywhere else, frankly, and it was nice to know that if I had a big bleed then I would be in a safe place. Of course, this was with my first child, and I really, really sympathise with you having to be in hospital with a child at home. What a bummer. Bleeds with PP can be very variable - I had two - both felt quite spectacular in that the blood literally fell out of me and splashed on the floor - but they were very short-lived and posed absolutely no risk to me or the baby. Other women have more severe bleeds and have to have an emergency c-section. I was told to rest as much as poss - not to stay in bed, but just to take it really easy, which I found surprisingly hard at home. From everything I have understood about PP, when you have a total PP at 32 weeks, you should really assume that it will stay PP and make your plans accordingly. Hoovering is DEFINITELY banned
Good luck. It is scary, but I was completely fine and so was ds.

I was in for five weeks btw! And the worst thing was the revolting food.
If I were you I'd start thinking about a c-section birth plan - ie you want the baby straight to you and dh (no weighing first) if that is what you want. You don't want him/her washed first, you want to discover the sex...stuff like that. It might make you feel a bit more 'empowered'. I chose a spinal block as it wears off very quickly and you feel nothing and I did have a very emotional and calm section (iyswim!) - and ds was 8lb 8oz at 37+5 weeks, so not so very unprepared for the world. I'm sure you will be fine. Do take it easy and don't be sad - you will soon have a lovely baby.

Fruitful

Sorry you're feeling so scared . I hope I didn't scare you - not what I wanted at all. I do think it's best to know the facts, but there is every likelihood that you will get through to 38 weeks with no problems whatsoever. All the time I was in hospital they kept telling me how unlucky I was and that they really didn't see that many cases like me.

I do know what you mean about worrying about your dd. When I was pregnant with dd2 I was terrified that the same thing would happen again and I'd be in hospital for 10 weeks and would have to leave my baby (there's less than 2 years between my two). Thankfully, it seems that lightning doesn't strike twice!

Like Moomin, I had SUCH a positive experience with my elective section. It wasn't what I'd originally wanted at all, but it couldn't have gone better. The anaesthetist kept me talking through all the preparation and was generally lovely (female anaesthetist and she managed to do all the technical stuff she needed to do while keeping up a friendly conversation with me and dh!) then once dd was born everyone just backed off and let me and dh hold her. I have a picture of me in the theatre, holding my baby and just grinning from ear to ear! It was all really calm (apart from me getting into a bit of a panic beforehand and going into the shower without a towel - I had to try to dry myself using paper hand towels !) and everyone was wonderful to me.

Even though my dd was pretty small (4lb 12oz at 36 weeks) that was almost certainly down to the piece of placenta that I'd lost meaning that she hadn't been getting much nourishment for the last 9 weeks of the pregnancy or so. She was fine (all the steroids had given her a fine pair of lungs all right ) apart from needing to be kept warm on one of those 'hot pads' that they use for the first 24 hours or so and apart from some problems with feeding. She is now 4.5 though, and as big as all her classmates and has certainly not suffered any long term effects of her small start. She met all her developmental milestones at the normal times and was a very early talker (and has been talking continuously ever since!).

I'm really sorry, Fruitful, if my post worried you. Sending you (((hugs))) and hoping that everything will go well for you. Keep us posted.

Ellbell - don't worry it wasn't you that scared me - there is far too much medical info freely available on the internet!

I had dd by planned cs too - well, planned from the day before, when we found out she was coming feet first. The cs itself was fine but she got some kind of infection, had a lumbar puncture, scared us that it was meningitis, then she didn't feed so they gave her formula through a nose tube (and dh has a dairy allergy!) and it was all a bit of a shock when I'd been planning a homebirth. And she was quite small for 38 weeks (5lbs 9) although it turned out that was her natural size (is still on the same centile). Oh no she was not chilled out - still isn't!

But I'm ok about the cs part. I know what I can ask for this time (music and photos and all that) and I can fight my corner over the feeding if necessary. Not looking forward to recovering from a cs with a toddler to look after - but as this would have been my first labour, I had a 20% chance of ending up with an emergency cs anyway, didn't I? Planned is definitely better.

Its just the whole bleeding to death business that scares me... And the thought of MIL having free range of my house while I'm in hospital for a fortnight .

Ah yes, Fruitful, I'm with you on the MIL business . I forgot to say that, although my pp happened with my first, there were other people in hospital with long-term problems whose children were more or less permanent fixtures (not overnight, obviously, but they were allowed to stay all day). Also, I was given a single room (which I didn't have to pay for) as soon as one became free. That was one of the best things the hospital ever did for me (anyone from the Royal Berks out there... THANKS ). I'm sure they'd let your dd spend as much time with you as possible.

My dd1 was fed by NGT for nearly 2 weeks too. That was one of the worst things for me, actually. They all told me that by 36 weeks she'd be fine, and I was expecting a slightly small but otherwise normal baby. I suppose that compared to how she'd have been if born at 27 weeks they were right, but I was totally unprepared for not being able to feed her. However, once again, those problems were put down to her being slightly malnourished during the last two months of pregnancy. If your baby is born at 38 weeks there's no reason why s/he should have any of those problems. After all, 38 weeks is counted as 'term' ... in fact, my dd2 was born perfectly naturally at 37 (and guzzled like a pig from day 1!).

Good luck with it all. Keeping everything crossed for you.

You won't bleed to death! Promise! This is one of the huge advantages of having a baby in the 21st Century. Hooray for high-tech medicine!
Take care and good luck - you may get all the way to 38 weeks without a bleed at all.

I agree with the others... the reason why the location of the placenta isn't definate at this stage is that your uterus (lower segment) isn't totally fully formed and there is a possibility it will still move out though my inclination is to say that it is unlikley but mot unheard of.... there isn't anything you can do about this but have positive thoughts basically.

I'm feeling a bit more positive now. We talked to dd about granny coming to look after her, and she said "yes good idea! and you will go away!". We said, "well, daddy will be here for bathtime" and she looked a bit disappointed. . And MIL is very excited about getting dd to herself for a bit. So perhaps I should relax and look forward to a little holiday in hospital. DH is busy setting up his laptop so I can take it in and watch lots of dvds . Now I just need to persuade him to take a month off work afterwards!

Fruitful
So glad you're feeling better about it all. Honestly, it will all be fine and once your baby is here it won't matter at all how s/he arrived. (My placenta praevia dd has just drawn me a picture of me 'in the hostipal' with a baby in my tummy (huge tummy, smiling mini-person inside) and informed me that it was her 'before the doctor got me out'. Oh, and I'm eating a plate of carrots 'because you like healthy food'???)

Take care and try not to worry.

Top tip on getting around revolting hospital food is tell 'em your a muslim, you get yummy currys/nice spicey food instead! much better imo!