I need as much info as possible.

[ferrals5]

I posted this in the c section thread but thought i would pop one in here to.

I have to have a ceasar because of placenta previa is a grade 4 and i am 32 weeks
I need all the info from ladies who have had a ceasar because of placenta previa.

Did you hemorrage? doctor said more likely because the bottom of uterus does not contract as well after birth.

Did they have trouble removing the placenta from that postion?

Did you have to have a blood transfusion?

Did they watch you closely after the operation?

How many weeks were you when you had your c section?

Did you have bleeding before during pregnancy?

Did they make sure you had a good surgeon because it is high risk c section?

And any other information would be great.

Thanks ferrals.

[Mildez]

Sorry its taken me a while to get back to you Ferrals. So this is from a middy's perspective! I've changed your ? a little

Do you hemorrage? There is a higher chance due to the fact the placenta is imbedded in the lower segment of the uterus which is the area that doesn't contract so the part of the uterus that the placenta has seperated from doesn't have the contractions after birth to help seal the blood vessels of and reduce bleeding.

Do they have trouble removing the placenta from that postion? Usually no. Its pretty easy to get out. I haven't seen any problems with them getting it out. Sometimes depending on where the placenta is located (anterior/posterior etc) it can be a little harder to get bub out and require a different incision to ensure they don't disturb the placenta until the baby is out and cord is clamped. They don't want to cut through the placenta to get the baby out. I've heard of this been done once but not where I worked as apparently their was no other way. If the placenta is very much central over the cervix there is a good chance it isn't near the desired incision spot and same if it extends up the posterior wall.

Do you have to have a blood transfusion? I would guess approx 50-60% of women with PP have a blood transfusion (not factual its a guess based on the ones I have nurses) alot of these are due to bleeding before birth and then an emergency c/s so the two combined so if you have an elective c/s for PP the chances of needing a transfusion should be reduced.

Do they watch you closely after the operation? Yes. They will do regular observations (which can be one of the early signs you are compromised ie BP decreasing whilst your pulse increases). You should also be on a pad chart. If the bleeding starts quickly like whilst still in theatre they might use a catheter which they fill with water to put pressure on the area where the placental seperation occured. Then remove it the next day. I've seen this done a few times. Also if your blood loss is to great they might consider sending you to high dependancy instead of a normal postnatal ward (but then Idon't work in a high risk maternity ward so maybe its different where you are birthing at)

How many weeks were you when you had your c section? Most common seems to be the 37-38weeks. Earliest Ive ever seen was due to APH at 27weeks but there were twinnies in there and both had a good outcome. I've seen a number from 32weeks onwards but the majority of them are just at term or close to it. The latest I have seen was 41+3 where the mummy came in the day before for prostins to be induced. The prostins was used and the next morning when they went to do the ARM they could feel the placenta and there was blood loss despite the scan saying the placenta was clear of the os. Very scary stuff.

Do you have bleeding before during pregnancy? I'd say well over 50% of people bleed especially after sex. Many of these APH's are very mild a little bit of bright blood or some old blood which then settles after observation for 24hrs and then the lady goes home. As soon as the bleeding is getting to be of big concern or bub is showing signs its compromised through the CTG, scan etc then a c/s is done. Also once you get to term and a bleed occurs even if its small then a c/s often takes place.

Did they make sure you had a good surgeon because it is high risk c section? Yes I've only seen a c/s with a PP led by a consultant although the registraras are nearly almost there for the experience.

Other facts.

I've never seen someone have a hyterectomy because of any grade PP. Even PP with accreta (where the placenta grows abnormally into the uterine wall/endometrium) I haven't seen a hysterectomy performed (I have for other reasons during a c/s)

Finally I've heard about PP increasing the chances of placental insuffienency but am yet to see someone have this with a PP. And I've never seen a poor outcome for bub because of PP (except the twins born at 27weeks who did do well after the months of struggling but mum went on to have her next bub at 26weeks so I don't think the labour was caused by the PP) I have seen a few mums have big bleeds prior to c/s and after that have been unwell but their bubs have all done well.