Posterior placenta previa

[Hydrangea]

Hi,

I have been following the Major placenta previa threads on here for a while. They have been a real help.

TBH I feel a bit pathetic posting, but I don't have anyone else to ask. So here's hoping someone can help.

To introduce myself: This is my 4th pregnancy. I have two daughters 19 months apart (and a miscarriage at 7.5 weeks in between them). Straightforward deliveries with both. I had to have a d&c 12 weeks after DD2 as a tiny piece of placenta never came out (very very rare for a piece so small not to shift I was told). There will be 17 months (God willing) between DD2 and this one.

The story so far (a bit of a ramble I'm afraid - I have a few things to get off my chest):

At 20 weeks I was told that my placenta was covering the internal os - rescan at 32 weeks - most move.
That was all I was told. I was left under midwife care. My community midwives never even bought the subject up. It was a very long 12 weeks and I was a nervous wreck by my 32 week appointment. I am petrified of a c/s and I felt completely abandoned.

At 32 weeks another scan, placenta reaches os but no longer covers. I was also told it was posterior - rescan at 36 weeks. Again, that was the sum and total of the info. Staying under midwife care for now. And again, not too impressed with the lack of info & support. Still an emotional nervous wreck.

So I googled. It said posterior placentas don't move in the third trimester when they are this close. Also, they won't let you have a normal delivery if it's nearer than 3cm. So it's got to move at least 3 cm in 3.5 weeks (the 36 week scan will actually be at 35.5 weeks).

So what do you lot think - is that possible? The internet says not, but the sonogropher obviously thinks it can.

Also, hints on how I mentally prepare for a c/s. Are there any good points?

Hello! I have recently been in very similar situation - please read the Royal College of Obstetricians and Gynaecologists Guideline available online - I found it really useful.

My outcome was great - I had no bleeding, and a calm, planned caesarian, and a lovely baby.

I definitely did not want a caesarian and cried and cried about it in advance, but actually I found the recovery much easier than I expected and were I lucky enough to get pregnant again I am not sure which I would prefer - and this is from a real hippy birth mother type who had done the full Hypnobirthing training and had a doula lined up!!!!

One thing I found helpful in the preparation was to think of the alternative ie not knowing at all (pretty sobering) and how lucky we were that it had been detected and that baby and I had a fighting chance.

Baby was born 2 months ago and I feel we are in the same place as first time around when all natural etc - its much less of a deal than it seems in advance!

Very best of luck

Thank you for the comforting words.

I have been researching c-sections on the internet and am beginning to come to terms with the possibility. It seems a posterior placenta is much better for a c/s, as it won't get in the way.

The scans have shown a healthy baby and it is certainly very active. So I can be grateful for that.

Hello Hydrangea...

First of all the chances of it moving up more is very good. The fact that its posterior is also really good news too...

A lot of Preavias move quite a bit towards the end as thats when your LO is putting on most weight and its more likely to pull the placenta upwards. If its moved a bit already then its a good sign...

To be honest I dont think you canever really prepare for a section. Read up bout it but until it happens you won't know how its going to be. IYKWIM?? Its like preparing for labour or having a vaginal delivery. You can only prepare so much.
As you haven't mentioned about bleeding I'm assuming you haven't had any!?!? which is fantastic and this is probably why you have been left under midwife care. I think they worry more when you have had previous surgery eg a c-section as the placenta can grow into the scar and that can be very very dangerous. Sounds like even though you've had this condition it hasn't been as bad as it could have been.

Look forward to the next few weeks and hope that your placenta moves a bit more!!!
I have heard that the day of surgery (c-section) a woman who had PP had a scan and they found it moved so much in 3 weeks (when she had a previous scan) that she was sent home and wait to go into labour!!

Hope it all goes ok for you xx

Dear Cazzaben,

Thank you for your reply. I'm glad you think it might move! I've seen your name on the other placenta previa discussions. Nice to have an expert opinion!

I haven't had any bleeding which I am relieved about. But, it made me rather hopeful that it had moved well out of the way by 32 weeks.

The other good thing is that the baby is head down.

This is what I found when I googled for posterior placenta previa:

www.popline.org/docs/1696/304523.html

Source citation:

Annals of Saudi Medicine, 2000;20(5-6):382-385.

Abstract:

The objective of this study was to assess the role of serial transvaginal sonography (TVS) in predicting placental migration and mode of delivery in pregnancy complicated by placenta previa during the third trimester. In this prospective observational study, all the cases had confirmed diagnosis of placenta previa before 32 weeks' gestation. TVS was performed between 28 and 32 weeks' gestation for 287 patients with either clinical suspicion or previous sonographic diagnosis of placenta previa. The lower placental edge was found to cover the internal cervical os, or was found to be within 3 cm from it in 63 patients. A two-weekly TVS was performed for every patient until delivery, or until migration of the lower placental edge to a distance of more than 3 cm from the internal cervical os was observed. Detailed information on the placental postion, its distance from the internal cervical os, and its relation to the presenting part were recorded at each examination. Placental migration to a distance of more than 3 cm from the internal cervical os occurred in 24 patients (38%) by 36 weeks' gestation. Of the 63 patients, 19 (30.2%) delivered vaginally. The last scan of these patients revealed that the distance between the internal cervical os and the lower placental margin were more than 2 cm and 3 cm in the anterior and posterior placenta previa, respectively, and the presenting parts were below the placental margin. Placental migration was not observed sonographically in any of the eight patients with posterior placenta previa when its lower edge was initially located within 1 cm from the internal os. It was also not observed in either the 16 patients with total placenta previa, or in any of the other patients beyond 36 weeks' gestation. Posterior placenta previa lying within 1 cm from the internal cervical os and total placenta previa do not migrate during the third trimester. On the other hand, other types of placenta previa may migrate but not beyond 36 weeks' gestation. The mode of delivery does not depend only on the placental degree but also on the placental position (anterior or posterior), and the relationship between the presenting part and the lower placental edge. (author's)