Placenta previa - c/s at 36w?

[ladygrey]

Not me, but a friend was just informed by her doctor that she has complete previa (she is 28w) and is recommending a section at 36w. I understand not wanting to go into labor with this condition, but if there are no complications (bleeding, etc.), doesn't that seem awfully early to take a baby from the womb "just because of what COULD happen" (her dr's words). Would you push back if you were in this situation?

[annieh22]

You could push back I guess, but the friends I've had irl that had this all delivered at or before 36 weeks and they were not scheduled, just went into labor/bleeding.

[Velar Fricative]

Is this her first pregnancy? Any other complications like GD or something?

I might ask for 37w and see what the doc says but I wouldn't fight it if doc says no. The potential complications of previa scare me way more than the potential complications of having a 36-weeker, IMO.

[cmarie11]

At my hospital we deliver uncomplicated previas at 37 weeks, but yeah, things can go bad pretty fast if you start laboring or rupture membranes with a previa, therefore it is one of those "better safe than sorry" situations.

[carolinagirl831]

That can be very serious with things going seriously wrong very quickly. I think 36 w is not that early given the risk. I would listen to her Dr on this. It's a standard recommendation

[mlvmd]

Anecdote: I had a 36 weeker with spontaneous labor that turned into a c-section. Baby was great. They were going to induce at 37 weeks though, so they did feel that extra week was important.

[lolo]

I would ask about the risks of going a bit later and whether anything can be done to mitigate that risk. From what I have read, 37w is a bit more common of a recommendation.

[hopecounts]

I'm as against unnecessary and early C/S as you can get but for complete previa, yeah this plan makes sense.
It's rough but things don't just go bad they go horribly bad, they go life threateningly bad and not always with the time to safe mom and baby.
Some will wait to 37 weeks but 36 weeks is the conservative plan of action.

[pinotgrig]

Somebody on GP with me had a CS around the same time for the same reason.. I can see her avatar but can't remember her name. It's on the tip of my tongue. :/ Argh.

There was a tiny uproar on the board about it which was ridiculous seeing as how we're not anyone's ob. If her doc has suggested and she's comfortable with her doctor, I see no issues with it.

[pinotgrig]

Jun 18, 2015 19:28:20 GMT -5 pinotgrig said:

Somebody on GP with me had a CS around the same time for the same reason.. I can see her avatar but can't remember her name. It's on the tip of my tongue. :/ Argh.

There was a tiny uproar on the board about it which was ridiculous seeing as how we're not anyone's ob. If her doc has suggested and she's comfortable with her doctor, I see no issues with it.

Myrrhine

I remembered!

[barefootcontessa]

I think 36 weeks is standard of care. My cousin just had a complete previa and she was scheduled for 36 weeks but went into labor early and it was emergency situation.

[vanillacourage]

The only way I would push back is if I could do the extra week or two on hospital bed rest (and have insurance lay for that).

eta - not bed rest like being restricted to the bed, I mean being inpatient and right there if they needed to do an emergency c/s. 

[Deleted]

Complete previa is a really scary complication so I wouldn't argue over a couple of days at 36 weeks. Good luck to your friend. I hope her placenta moves.

[Velar Fricative]

Jun 18, 2015 19:48:45 GMT -5 pinotgrig said:

Jun 18, 2015 19:28:20 GMT -5 pinotgrig said:

Somebody on GP with me had a CS around the same time for the same reason.. I can see her avatar but can't remember her name. It's on the tip of my tongue. :/ Argh.

There was a tiny uproar on the board about it which was ridiculous seeing as how we're not anyone's ob. If her doc has suggested and she's comfortable with her doctor, I see no issues with it.

Myrrhine

I remembered!

I'm sad that there was uproar. Placenta previa is easy to determine. This is not like a weight estimate that could be very inaccurate, and the risks are clear. I'm allllllll for baby staying in as long as possible but 37w would be the absolute longest I'd be willing to go for something like this.

[toutsuite]

I had complete placenta previa with my first. I was on hospital bed rest for quite a while because of it. They cab do an amnio to check on baby's lung development beforehand if she wants but really I wouldn't bat an eye at 36 weeks. You can go from being fine to hemorrhaging in a matter of minutes and that is down right scary. During my c section I don't even know how many units of blood they had on hand in addition to a urology team for potential accreta. I was supposed to initially deliver at 32 weeks but then when I went on hospital bed rest everything was seemingly well controlled. She can also get steroid shots for baby's breathing but it loses its effectiveness after a certain point...I forget when. Really though of her doctor recommends ac section at 36 weeks, that's not a c sectiom for the doctors convenience. That's a medical necessity and can turn into a medical emergency really fast. I belonged to a cpp group when I had it and there were several maternal and fetal instances of cpp going terribly array.

Sorry for such a bleak outlook of it but after going through it with my first, I would do what the doctor says since that's a serious, potentially life-threatening complication if you go into labor.

[toutsuite]

One other thing. There is a private cpp support group she can request to join. It was really helpful both in terms of support and information. I found the real stories to be incredibly useful and they certainly helped me prepare and manage my expectations for delivery/pregnancy. All she needs to do is search placenta previa on fb and submit a request to join. There are thousands of people on it.

[heygrey]

I would absolutely listen to my doctor in this situation and a section at 36w is well within standard medical care.

My sil just dealt with this and she was on home bedrest for 2-3 weeks and then hospital bedrest for another 3-4. Her doctor said they would section at 36 weeks without hesitation, but would extend it to 37 if everything was okay. that's only because she was already in the hospital and being closely monitored. She made it just shy of 37.

[stretchad]

I had a complete previa as well. My c-section was scheduled for the very tail end of the 36th week. Didn't make it that far...Almost delivered at 31 weeks (massive bleed at work turned into labor, but was stopped thank goodness) and ended up on hospital bed rest a week, then regular bed rest at home for another week. 33 weeks another massive bleed at home, this time way worse. From the time we called the ambulance to the time of delivery was less than 2 hours. And I needed a blood transfusion.

It's a serious complication and 36 wks is fairly standard practice. They'll continue to check her previa and if it does move at the last minute the will move the c-section out (or may not even need it at all).

[fbf2006]

I'd trust my doctor on this. 36 weeks is really not that early to me, but I'm coming from a perspective where that was the ultimate goal for my pregnancy. 28, then 32 then 36.

[hainesherway]

I had complete placenta previa and had a csection at 37.5 weeks. However as @starry mentioned I was hospitalized at 32 weeks with contractions and a massive bleed. I spent 5.5 weeks in the Antepartum ward of the hospital on bed rest before delivering. With previa there's not much planning that can be done because you don't know what might happen, but your friend can ask her doc what he/she thinks about stretching to 37 weeks.

[Deleted]

Jun 18, 2015 21:00:56 GMT -5 @cookiemonster03 said:

This is the sort of complication where it is prudent to trust your highly trained medical professional.

Yes. Doctors, especially in these situations, don't just do things "willy nilly."
We don't know her medical history, measurements, etc. Every pregnancy and case is different.

Most authorities recommend delivery between 36-37 weeks. 

[rugbywife]

Could it have to do with her distance from a high risk hospital? Maybe the concern is that if they let her go longer and she goes into spontaneous labour it might make for a dangerous situation.

[Myrrhine]

Jun 18, 2015 19:48:45 GMT -5 pinotgrig said:

Jun 18, 2015 19:28:20 GMT -5 pinotgrig said:

Somebody on GP with me had a CS around the same time for the same reason.. I can see her avatar but can't remember her name. It's on the tip of my tongue. :/ Argh.

There was a tiny uproar on the board about it which was ridiculous seeing as how we're not anyone's ob. If her doc has suggested and she's comfortable with her doctor, I see no issues with it.

Myrrhine

I remembered!

I wondered if you were thinking of me!

I had partial previa (which eventually resolved itself) and then a scheduled c-section at 37 weeks because of a previous myomectomy. And there was indeed a bit of a hue and a cry including at least one poster declaring it was not medically indicated. Considering that it was recommended by the surgeon who performed the initial surgery, my ob, and ACOG, I am not sure how she came up with that.

Anyway, I was undeterred and was pleased with the result.

Attachments:

[Brie]

I think aqualuv also had this.

[aqualuv]

Thanks for the tag Brie.

I had a scheduled c-section set for 37 weeks on the dot. However, the morning of 36w, 3d I woke up with heavy bleeding and went straight to the hospital. While at the hospital the doctor on call felt it was in my best interest to go ahead and have the c-section since it was just a few days early than the scheduled c-section. My son was born weighing 6 lbs, 7 oz. He had to spend no time in the NICU and other than low iron initially he was healthy. There has been no other impacts so far to him being born early and by c-section. He has nursed well and he continues to be at the high end of the growth charts. If I had to do it all over again, I would trust my doctor's judgement. I would not want to put myself in a position where I could be putting myself or my child in distress. Good luck to your friend!

[eddy]

I had placenta previa that turned into vasa previa. I had a c/s at 36 weeks.

The problem is she can not I repeat can not go into labor. If she does that is death to the baby if that placenta bursts and there is blood loss. Most of the time they can't get you into the OR quick enough to save the baby. It is oxygen loss for them, which is no good.

Obviously having gone through this I wouldn't question doctors. It was very stressful.

[eddy]

Also I was really grateful to even make it to 36 weeks. 36 weeks is a fucking blessing when you have placenta previa.

And not that you are doing this OP, but it really got my shackles going when people would gently question my doctor about my prognosis and plan. It was such a stressful situation. I didn't like having to have the "My baby will die if I go into labor, therefor 36 weeks it is." It sucked having to justify it all.

[pugz]

I wouldn't risk it. I know someone that ended up with a placental abruption and despite getting to the hospital quickly and going under general for a c-section 20 minutes after arrival, her daughter had a disruption in oxygen to the brain and is now severely disabled. I do not know if she had a previa or not, but the placenta is not something to mess with.