QuestionI was diagnosed with a complete placenta previa (posterior) at my 18 week ultrasound. The doctor saw almost no chance of this resolving, but a new doctor had some hope. I will have it checked in a week at 24 weeks. What do you think my chances are of having a normal vaginal delivary (I have had one baby 18 months ago from an uncomplicated vaginal birth)if a) it is still complete at 24 weeks or b). It has begun to move at 24 weeks.
thanks,
Marissa
AnswerDear Marissa,
Total placenta previa occurs when the internal cervical os is completely covered by the placenta. If you have placenta previa, your doctor will monitor you and your baby carefully to reduce the risk of these serious complications:
1. Bleeding - One of the biggest concerns with placenta previa is the risk of severe vaginal bleeding (hemorrhage) during labor, delivery or the first few hours after delivery. The bleeding can be heavy enough to cause maternal shock or even death.
2. Premature birth - Severe bleeding may prompt an emergency C-section before your baby is full-term.
3. Placenta accreta - If the placenta implants too deeply and firmly into the uterine wall, the placenta may not spontaneously detach from the uterus after delivery - an uncommon condition known as placenta accreta. This can result in severe bleeding and, often, the need for surgical removal of the uterus (hysterectomy).
Typically, for a total placental previa, the treatment is a scheduled C-section as soon as it can safely be performed (usually after 36 weeks). If you were to begin bleeding heavily prior to that time, an emergency C-section may be required and your doctor would give you corticosteroids to mature your baby's lungs as quickly as possible. Until you get close to delivery time, most doctors will recommend bed rest and a pretty strong limitation of activity, including no sexual activity.
If by chance the placental would move off of the cervical opening a bit, your chance of a vaginal delivery increases slightly. However, in consideration of the potential very serious complications, a C-section is not the worst thing that could happen - by a long shot. In fact, if I were in the same situation, I would much rather have the C-section, in a controlled surgical environment, than attempt a vaginal delivery where things could get out of control very fast. But - that's my personal opinion, having seen quite a bit in labor and delivery. Emergent situations are never pleasant and I tend to err on the side of caution.
I hope this has helped you and answered your question. I wish you well and will have a good thought for you.
Brenda
