# Anterior Placenta Previa



## SeattleRain (Mar 15, 2009)

I've been told that I have an anterior placenta previa and while its possible that it will move, I'm not all too hopeful as it is covering most of my cervix (the least likely of all previas to move). I'm preparing for a likely c-section, but I'm wondering how having an anterior placenta will impact my c-section? Will they have to cut in a different place due to the risk of bleeding?


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## MeepyCat (Oct 11, 2006)

You'll have to talk to your doctor about this (it's perfectly reasonable to ask for a consultation with the surgeon who would do your section if the placenta doesn't move, if that surgeon isn't your doctor). My understanding (from back when my placenta previa looked anterior) was that the anterior placenta would affect a section, that they'd have to locate the placenta and do the uterine incision so as not to damage it.

I'm sorry you're going through this. And I hope your placenta migrates and all this concern turns out to be for nothing.


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## SeattleRain (Mar 15, 2009)

Would that mean they'd have to do something other than a bikini line incision? This is my first baby and while I realize that you can't exactly help a c section for previa, I'd like to think I can have a vaginal birth with subsequent children and I'm pretty sure that the kind of incision impacts that kind of decision.

The placenta is DEFINITELY anterior, and has been since the beginning, we've actually had 3 ultrasounds thus far and the OB can hear it in the front on the doppler. The question will be even if the placenta gets off of the cervix, will it move away enough for comfort. Aren't there additional risks of birthing such a low lying placenta?


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## rhiOrion (Feb 17, 2009)

I think I read somewhere that anterior previas are more likely to resolve (though my source was "the internet" so who knows).

I had a *very* marginal anterior previa at 18 weeks, and it was completely resolved with room to spare at 28 weeks. So hopefully even a complete previa could resolve by labor.

So definitely don't give up hope on it moving!!!

Sorry I don't have an answer to your actual question- I just wanted to give you some hope


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## AlexisT (May 6, 2007)

Quote:


Originally Posted by *SeattleRain* 
Aren't there additional risks of birthing such a low lying placenta?

I can't answer about the incision (I think you'll need to ask your OB, unless someone who had this problem sees the thread) but there is a required distance that the placenta should be. If it's at least that far (and I can't remember how many mm) there's no extra risk. If it's closer than that, a section is safer.


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## triscuitsmom (Jan 11, 2007)

I don't have advise on the c-section... but I had a complete previa when I was pregnant with Frog. It was also anterior I was told by more than one person that they were more likely to resolve (not sure if it's true, but it's what I was told).

Mine did and I went on to have a successful vaginal birth at 38 weeks. I hope for the same for you.


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## SeattleRain (Mar 15, 2009)

Thanks for the well wishes, I go for another ultrasound in 3 weeks, and we'll see if its resolved.


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## MeepyCat (Oct 11, 2006)

Quote:


Originally Posted by *SeattleRain* 
Would that mean they'd have to do something other than a bikini line incision? This is my first baby and while I realize that you can't exactly help a c section for previa, I'd like to think I can have a vaginal birth with subsequent children and I'm pretty sure that the kind of incision impacts that kind of decision.


Incision type definitely impacts the potential for vaginal deliveries.

I still think you need to consult with the surgeon. When you do, I wouldn't use the words "bikini line incision" - the phrase may lead them to think that your concern is cosmetic, which might get you a really annoying and unnecessary lecture, and patronizing assurance that you'll look fine in a bathing suit in a year or so. Go with "low transverse cut", and be clear that you're worried about the impact of the surgery on your plans for subsequent pregnancies.


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## SeattleRain (Mar 15, 2009)

Quote:


Originally Posted by *MeepyCat* 
Incision type definitely impacts the potential for vaginal deliveries.

I still think you need to consult with the surgeon. When you do, I wouldn't use the words "bikini line incision" - the phrase may lead them to think that your concern is cosmetic, which might get you a really annoying and unnecessary lecture, and patronizing assurance that you'll look fine in a bathing suit in a year or so. Go with "low transverse cut", and be clear that you're worried about the impact of the surgery on your plans for subsequent pregnancies.

Thanks for the tip, I actually thought bikini line incision was what it was called! I could not care less how I look in a bathing suit as you would never FIND me in a bathing suit for religious reasons, I just want to heal as easily as possible. I asked my OB today about what the procedure would be and she told me that she does c-sections for anterior placenta previas all the time, as they can often go together. She said there is a higher risk for hemorrage which is why they work VERY quickly, and one of the reasons they like to do these surgeries earlier than usual. Her policy is typically to do c-sections at 39 weeks, but for previa she likes to do them starting at 37 weeks because it is harder to manage the risks once you've already started dialating and bleeding.


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## RoseDuperre (Oct 15, 2007)

I had an anterior placenta previa that went from complete to partial to completely off my cervix.







Just to give you some hope. Here's the good news: anterior placentas are the most likely to migrate, as this is the way the uterus grows - it grows up and out! It's not like the uterus grows downward, or back towards your spine.

The catch to that is that the uterus does the MOST upward growth in the last trimester - and not just the last trimester, but the last PART of the last trimester. Case in point: though many previas resolve by 28 weeks, when we went in for my scan at that point - it basically hadn't budged. I was DEVASTATED. But we returned for one more at 34 weeks - they wanted to do it at 32, but I insisted on giving it a little more time. Meanwhile, after that 28 week scan I was doing acupuncture treatments to encourage upward growth.

Lo, at 34 weeks it had moved almost three centimeters - and two is all you need to be in the clear for a vaginal delivery I went on to have a wonderful home birth at just over 37 weeks. NEVER BLED A DROP prior to going into labor. Not once, not since a tiny implantation bleed before I even knew I was pregnant.

So the moral, besides thinking positive, is to make sure you continue to get it checked if it hasn't resolved by 28 weeks. Check it again at 32, or better yet, 34, and I remember one woman on this very forum who asked for ONE FINAL scan, just a few days before her scheduled section - and it had moved.

Quote:


Originally Posted by *SeattleRain* 
The question will be even if the placenta gets off of the cervix, will it move away enough for comfort. Aren't there additional risks of birthing such a low lying placenta?

Like I mentioned above, it's generally considered safe to deliver vaginally if the placenta is 2 cm away. The CNM/OB practice I was getting parallel care from even said that SOMETIMES a marginal can even be worked with, though they would of course recommend (insist on) being in a hospital - and if that were my situation I would have agreed.

I've been meaning to do a blog post about this whole experience forEVER. I should get down to it.

Quote:


Originally Posted by *SeattleRain* 
Thanks for the tip, I actually thought bikini line incision was what it was called!

Well, you're not wrong - that is definitely the official nickname for a low transverse cut! But I agree with the point about using that terminology to underscore your seriousness.

Good luck mama! Don't throw in the towel yet! I know you're just wanting to look at all your options, and it's a good thing to make peace with a c/s if it is truly necessary, but really, think positive. Things can and do change dramatically.

And hope you're coping well with the pelvic rest, ugh!


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## Cheshire (Dec 14, 2004)

Placenta previa is a risk factor for vasa previa. Vasa previa is when the cord vessels transverse the os and tear during delivery (usually when the water breaks) causing the baby to bleed out.

I had a marginal previa that finally moved enough to be cleared for a vaginal delivery at my 37 week scan.

The doctors/ultrasound techs missed that I had a velamentous cord insertion (where the cord vessels insert into the amnion, travel through the amnion and then go into the placenta - once the vessels insert into the amnion they are not covered by wharton's jelly and are completely vulnerable to tearing) and vasa previa. Sometime during my labor my son's cord tore and he lost the majority of his blood before we got him delivered. He fought for 12 more hours after his birth but his body started to shut down so we removed him from life support and held him while he died.

It was horrible and it could have EASILY been prevented if they had done their jobs right. I should have never been allowed a vaginal delivery. My son would be alive today if I had been given a c-section.

If you are cleared for a vaginal delivery just ask them to visualize the placental cord insertion and verify that the vessels insert correctly into the placenta and that there are no vessels that transverse your OS. This is all really easy to see on an ultrasound.

Do a little Googling and be prepared. Ask them to humor a pregnant momma and look for it.

I don't post this to scare you. I post this because when I came to these boards looking for research on marginal previa I wish someone had told me what to ask for. I had never heard of velamentous cord insertions or vasa previa and how I would give just about anything to have heard of it just once to know what to ask about.

You've been given the gift of knowledge - there is still plenty of time for your placenta to grow away from your OS and give you the vaginal birth you want. In the time you have left in your pregnancy you have the ability to ask more questions - armed with knowledge they may think you're nutty but I'd rather be branded a difficult patient than live without my son.

Best wishes to you and congratulations!


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## SeattleRain (Mar 15, 2009)

Quote:


Originally Posted by *RoseDuperre* 
And hope you're coping well with the pelvic rest, ugh!









Thanks for your post, its really encouraging. I'm not on pelvic rest actually. My doctor has taken a very hands off approach to this and said that if I'm not having bleeding there's no reason to be on pelvic rest. I also don't work out of the home and I don't lift heavy things, so I basically have a pretty easy life in general, making me less likely to have complications.

Quote:


Originally Posted by *Cheshire* 
Placenta previa is a risk factor for vasa previa. Vasa previa is when the cord vessels transverse the os and tear during delivery (usually when the water breaks) causing the baby to bleed out.

I had a marginal previa that finally moved enough to be cleared for a vaginal delivery at my 37 week scan.

The doctors/ultrasound techs missed that I had a velamentous cord insertion (where the cord vessels insert into the amnion, travel through the amnion and then go into the placenta - once the vessels insert into the amnion they are not covered by wharton's jelly and are completely vulnerable to tearing) and vasa previa. Sometime during my labor my son's cord tore and he lost the majority of his blood before we got him delivered. He fought for 12 more hours after his birth but his body started to shut down so we removed him from life support and held him while he died.

It was horrible and it could have EASILY been prevented if they had done their jobs right. I should have never been allowed a vaginal delivery. My son would be alive today if I had been given a c-section.

If you are cleared for a vaginal delivery just ask them to visualize the placental cord insertion and verify that the vessels insert correctly into the placenta and that there are no vessels that transverse your OS. This is all really easy to see on an ultrasound.

Do a little Googling and be prepared. Ask them to humor a pregnant momma and look for it.

I don't post this to scare you. I post this because when I came to these boards looking for research on marginal previa I wish someone had told me what to ask for. I had never heard of velamentous cord insertions or vasa previa and how I would give just about anything to have heard of it just once to know what to ask about.

You've been given the gift of knowledge - there is still plenty of time for your placenta to grow away from your OS and give you the vaginal birth you want. In the time you have left in your pregnancy you have the ability to ask more questions - armed with knowledge they may think you're nutty but I'd rather be branded a difficult patient than live without my son.

Best wishes to you and congratulations!

I will definitely remember to ask about this at my ultrasound in 3 weeks. I'm so sorry for your loss and I'm so glad that you're using the information you gained as a way to educate others on how to manage their care.


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## allical1284 (Mar 17, 2009)

My story is pretty much identical to RoseDuperre's! Don't give up until the very end. We were also cleared somewhere around 34 weeks and went on to have a wonderful vaginal birth (never had any bleeding). Insist on a final scan if if comes down to it. Relax and try not to worry about it too much (I know it's hard not to)! I did A LOT of visualization exercises where I would meditate and focus on my uterus growing and stretching and pulling that placenta up and out of the way. Positive energy never hurts


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## SeattleRain (Mar 15, 2009)

I have already let my OB know (and she totally agreed) that before anyone is cutting into me, I want another ultrasound. We agreed that the day before a scheduled C-section, we'd do an ultrasound to be sure which would be between 37 and 38 weeks. I figure it'll for sure be clear by then!


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