anterior placenta/placenta accreta

[min]

Just wondering if anyone else has or had an anterior placenta (sitting at the front of the uterus) especially if you had a previous caesarian, and at risk of placenta accreta (placenta imbedding into the scar tissue) and if it caused any problems in your pg.

I am trying for a VBAC this time, so any complication such as this slims my chances of being able to achieve that. I am having a scan by an obstetrician past 30 weeks to rule out the condition, but just curious for some more info.

[Trish]

Min I had an anterior placenta with Tehya and had a VBAC homebirth with her. Yes I was worried about the placenta, but I was only concerned if for any reason that I would need a c section that they may cut through it.

Try not to stress too much on it hun. I hope all goes well and you get your VBAC.

Caro, nope your placenta can change places with each pregnancy. The rest of mine were on the posterior wall, only Tehya's was anterior.

[Trish]

Nope, doesn't make birthing any more difficult than normal. Just saying that it's not a problem no matter where it is. Unless of course it's over your cervix

[min]

Caro, apparrently the place where your placenta attaches to your uterus is the place where the egg first lands in the uterus, so like Trish said, it can be different for each pg. And in answer to your question the scan after 30 weeks is to determine if the placenta has grown into my caesarean scar tissue.

I am told by my Doc birth is only made more difficult by an anterior placenta if it has embedded into the scar tissue. It can commonly cause bleeding in the third trimester if this happens which if it did would pretty mych rule out a VBAC. It also depends how deeply it has embedded into the scar, after labour, it may come away relatively easily, the problems mainly lie if it is embedded too deeply and has to be surgically removed which can cause huge amounts of blood loss and hysterectomy in worst case scenario.

I am not stressed at this stage, no point until after I have had scan, am a lot more relaxed this pg than last time, we live and learn I guess!

[monnie]

I've just found out that my placenta is anterior. The only thing the sonographer told me was that it may take longer to feel the baby...I don't know anything about it impacting the birth...

Did you guys find that? (ie. feeling movements later than most)

[min]

I didn't feel movement any later, both my PG's I felt at around 14 1/2 weeks. I do feel this baby a lot less often, I don't know if that is because of the placenta or because this one is quieter and lazier, I am hoping for the latter!!!

[Trish]

I felt Tehya move heaps later than the others. I was assured it was because of the placenta's position.

[gardeningkate]

I have a 2nd grade placenta prevaria and it is anterior, the hospital is talking about accreta and hysterectomy, I suppose that serves me right for considering vba2c even though I have birthed naturally after 2, after I clearly stated that I knew all about trial of scar and so on and that I was not deterred they threw the accreta at me, it has not been confirmed yet, they want me to have a scan at 28 weeks and then another one at 32, why I have to have 2 more to check the placenta's movement I don't know, it is not going to change how it moves. If the placenta is anterior I have a high risk of haemorage during c section should that occur, how is accreta determined, and how is it treated?
Hmmmm, I suspect that the IM I was going to use for my homebirth might not be able to help now, I am so much more risky than we thought, what to do? I wanted to home birth to avoid all these issues, but to cover the IM with all the new rules we were doing the paperwork for the hospital transfer just in case, and a scan to make sure that nothing was amiss.
Why does it have to be so stressful and problematic, and I am so tired of the big baby comments, it was the 2 c sections that have put me at a higher risk of accreta than the size of my babies, grrrrrrr

[Mildez]

gardeningkate I am having bub no3 and they aren't ruling out placenta accreta for me. The sonographer told me she thought thats what it looked like but my Ob said it was impossible to tell. Apparently it looks that way due to large placenta lakes and abnormally large vessels down below and a very odd looking placenta where they can't determine what is uterus, what is placenta as it looks like it all together except for the placental pools. Apparently its almost impossible to diagnose before birth. You can diagnose placenta percreta (more serious) so I am told. I've been doing alot of research on it (talking to midwives and obstetricians at work) about placenta acreta and none of them have ever seen a placenta accreta diagnosed before birth. And most of them you don't need a hysterectomy. They can get them out without taking the uterus, they can leave them in there ir can take a section of the uterus out and join it back together similar to a c/s. A placenta precreta on the other hand is more serious and invades the bladder/bowel etc as well as the uterine muscle.

I have not had a c/s before but have had 2 NVD although my first daughter they said I had a mild accreta when the placenta wouldn't come out and I went to theatre to remove it (and haemorraged) and have since had two procedures done to my uterus which increases the risk. I'm having another scan at 32weeks to try and get a better look at it but I'm still told I probably wont get any clear answers. My placenta is also posterior and extending to the internal os. I am told an anterior placenta is much more likely to move up then a posterior one also.

Is there a chance your Dr is trying to scare you of having a home birth? How far along are you now? I found out at 19weeks so its been an anxious time waiting until I have more answers that I am told probably they wont get until birth.

[gardeningkate]

I think that they are absolutely trying to scare me out of having a homebirth. They lost the trial of scar argument (I vba2c so I know my scar will hold, first and second baby were emergency (but not really medically necessary) cs at 9cm, third was a natural birth in a caseload hospital. I have moved to another town, and there is no caseload here. They lost the big baby argument, they lost the but emergency cs are more dangerous than elective argument, and so I guess they resorted to accreta and hysterectomy. I have an anterior placenta extending to the internal os. I have been researching accretas too, they are almost impossible to diagnose for sure, I can't have an MRI as I have a titanium knee and thigh, I don't want unnecessary ultrasounds. I doubt that pertinent information will double from having two scans, I think I will say no, and have another later for the potential praevia. With an anterior placenta, and a previous scar the risk of accreta increases by 30 - 40%, which sounds drastic, but the general risk is 1 in 2500, so increasing that by 40% still makes it only about 1.4 in 2500, just under 3 in 5000, not so high after all.
Did you birth vaginally with your mild accreta (there are 3 levels?). and in theatre what did they do, open you up to remove it? I am 24 weeks now.
I have to talk to my IM about this, she is already on dangerous ground taking me, such a risky patient, however to be honest I have not felt much affinity with her. I don't know if I want to birth with her or not, I do know that I DO NOT want to birth at the hospital now, when I said that I wanted to birth in a safe, supportive, gentle environment the ob told me I was welcome to have my lights dimmed and my aromatherapy, a fundamental misunderstanding of what I meant by supportive. I would love to hear what your research throws up, I was very rattled when I left the hospital today. I only went to organise the paperwork just in case I need a transfer from home, I was expecting them to disagree with my choice, but not the hysterectomy talk!
Keep in touch!! And good luck with bub no3, this will be my 4th, all boys for me!!
Kate

[Mildez]

This is no3 for me and will be my 3rd girl. If I was an IM I could be your midwife lol. I'm a midwife but work through the hospital setting (and its the medical model not midwifery based so not pleasant) I would look for another midwife if your concerned about the relationship between you both. You want someone your confident in and feel comfortable with to support the birth you want.

No my first birth was fairly typical of a first timer. It was long and exhausting and I pushed for over 2hrs. My DD was posterior and I refused all intervention mainly because I was scared anything they did would increase my pain so I couldn't handle it (I was 17 at the time, aspiring midwife so I read and read and read) everything I read said an ARM, Synto, monitoring would increase pain and not support the natural process of labour so when it was taking along time and they wanted to intervene I wouldn't allow it (DDs heart rate was always very reassuring) as I felt I was barely coping as it was and anything they would do would throw me over the edge.

When DD was eventually born vaginally the placenta wouldn't budge. After an hr and the typical drugs the Drs managed to snap the cord but then were able to stick the clamps up there to clamp it of. I was waiting for theatre (rural hospital, not enough staff etc) for 4.5hrs before I started haemorraging and was rushed of in an emergency. I had a general anaethetic and during the procedure they Drs (they were both registrars) couldn't get it out so called in the consultant who later said the placenta was growing abnormally into the uterine wall or lining or something. They mention accreta then but by that stage I was good again (just very anemic) and only had concerns for my new DD who I hadn't seen for a number of hours. I didn't have no2 until 6years later and there were no problems with her birth. Because of what happened with DD1 I had extra drugs to prevent a PPH although I don't think it was neccessary as by the time I had them the placenta was already out and the placenta not coming out was the problem with DD1 that caused all the bleeding.

Funny thing is with this pregnancy at my first appointment my Ob at 15weeks (who has been wonderful treating our infertility and commencing the IVF process which didn't eventuate as I was already pregnant) he mentioned my risk of accreta due to DD1s birth and the 2 surgical procedures I have had done in the months leading up to this pregnancy. It was then at the morphology scan that the risk factors for placenta accreta were discovered (multiple large placental lakes as seen in both previa and accreta) as well as a very vesselly placenta. I had a few sonographers come and give their opinion. The first one thought it was a previa and the second was concerned about accreta. My Ob down played it when I saw him last at 21weeks and basically said at this stage he will put it down to been a variation with a follow up scan at 32weeks to see if they can get a better look. So thats where I am now waiting for answers I'm told I most likely will get at birth not my next scan.

Provided my placenta moves up as its going to the os but not over it the risk is after birth. If I knew it was an accreta I'd transfer to Sydney for birth (as I am currently going to birth in a rural hospital) with the plan for a vaginal birth, go to theatre to have most of it removed (through the vagina) and leave the roots in there to fall out at their own time. It sounds so gross but thats one of the main successful treatment options to save the uterus which I would want to do. The other option is to have a c/s and for them to remove the placenta during the c/s and part of the uterus thats affected by the accreta. If thats to occur their are much greater risks for future pregnancies as they do take a part of the uterus out. They would be my 2 options before a hysterectomy which I think would only be neccessary if the placenta was a precreta which is worse case scenario. I'll be extremely unimpressed if it is an accreta and nothing was done about it until the birth not giving me the option to transfer to a high risk delivery hospital which is skilled in the area.

So did you find out this bub is a boy? I found out my bub is a girl so it will be 3 DD's for me. Hopefully it wont be the last (but it very well could be) so preserving my uterus is very important to me not to mention having a hysterectomy usually starts menopause which then increases your risk of other health problems so I need it because of that also.

Yes keep in touch.

[gardeningkate]

It is typical of the attitude towards childbirth, that the first resort is to state that if you have placental accreta then will have to have a hysterectomy. It just goes to show that obs in general and hospital policy have not kept up with medical advances and evidence that support other options. I have researched, and there are other options. Unless it is the third stage precreta then I will aim for a vaginal birth, (imagine the horrendous haemorage should they cut the placenta while doing an planned RCsec) with the placenta to be removed via the vagina afterwards. If I have previa this could be complicated, and I will seek out a very specialised hospital, in Melbourne it could be the Mercy, and several opinions. I also suspect that accreta cannot be diagnosed for sure until birth, I have a titanium joint in my leg, so I don't think I can have an MRI. I may want more children, if I can only have 4 well, I am still blessed with 4. I also believe though that our uterus is an essential part of our anatomy, and removing it unnecessarily can cause other things, not just infertility. I also think that this is going to become a big issue with the rising CS rate, and the hospital system is going to need to get their act together to accomodate the increasing no. of women who will present with it.
There don't seem to be any other midwives around that are comfortable taking on a double CS Home VBAC with all the new rules etc. I am just angry, on the other hand, if we can raise awareness for other less investigative women who simply accept the hospital/obs opinions, then maybe this can have positives too.
I will keep in touch, information is the key, we can all help each other out!
XX

[Mildez]

gardeningkate how are things going? Any more news on your end? I have an Ob appointment this week and I should have a repeat scan shortly where hopefully I'll get some more answers.
Hope all is going well on your end.

[gardeningkate]

I did lots of research and spoke to a previous care giver who I trust, and generally accreta can only be alluded too, not diagnosed for sure unless they can see bits in your bladder. My main problem would be if the placenta which was touching my internal o/s at 20 weeks does not migrate upwards, which is very rare. Accreta is rare, not worth basing my whole birth plan around it, and the first 2 forms of it can be managed quite well without drastic action. Percreta, which is when the placenta gets into the bladder is serious, but extremely rare. If the placenta doesn't come out at home, I'll have to go to hospital for a bit of help, they can even leave it in and just keep and eye on things, or do a manual extraction, not the end of the world!
I am still having a home birth, unless of course my placenta is covering the cervix, which I won't know until my 32 week scan. So all is good for now! How are things on your end, how did your appt go?
XX

[Mildez]

gardeningkate how did things turn out with the concerns with your placenta?

[gardeningkate]

It turned out all fine, and was just scare mongering and bullying I think! I had the follow up scan at 32 weeks to check the position of the placenta, and it was still a little low, but not in the vicinity of the cervix, which was fine. Then the hospital called me 5 weeks later to tell me they thought I might have vasa previa, a horrible thing to happen (especially considering I was then 37 weeks) and the person who called stated quite frankly that while rare it was almost sure death for the baby.....so off I went for another scan, and this was ruled out as well! The man doing the scan could see any evidence of any kind of previa on either the 32 week one, or the 37 week one, so again, I think the hospital were just being mean, my homebirth midwife also works there, and she has experience bullying before!
Then a day later, I went into labour, and birthed a healthy 4kg boy, a posterior (he just wouldn't turn, in spite of all the optimum positioning etc) and brow presentation birth, without much fuss at all! I found out later that apparently that is quite an achievement! It was just lovely, my midwife was so calm and gentle, I couldn't imagine doing it any other way now, although I might stop at 4 kids. We'll see......
How have you gone, you must have nearly had your baby.....I hope all is well!
XX
Kate

[Jellybean29]

I've just found out that my placenta is anterior. The only thing the sonographer told me was that it may take longer to feel the baby...I don't know anything about it impacting the birth...

Did you guys find that? (ie. feeling movements later than most)

I had an anterior placenta for my first, and I didn't feel movements till 21 weeks. Then it was non stop! I had an emergency C-section at 38 weeks (because he'd summersaulted into a position where his cord was cutting off his circulation), with no complications.

[Mildez]

Thats great to hear about your beautiful healthy boy. Shame about the bullying. Its so common. I work as a midwife and there is alot of bullying that goes on.

My 4kilo bubba girl arrived in March and everything went well. I had a difficult birth but it had nothing to do with the placenta. That turned out to be completely normal just very large. My bub is now 16weeks old and just divine. I'd do it all again in a heartbeat lol.

I'm so pleased to hear the placental problems turned out to be nothing. Horrible to think that we spent time worrying over it.