# Low Lying Anterior Placenta Near Surgical Scar, also IUGR



## OnTheFence (Feb 15, 2003)

I am hoping some other moms here or some professionals have had clients with a similar situation. I am interested in knowing the outcome, and if there was a repeat csection were you cut horizontal or vertical.

First, let me say I know my placenta can move and that ultrasounds can be off.

I have had two ultrasounds that indicate I have a low lying placenta, and that my baby is not growing as expected. Her sizes are staying proportionate, but her growth rate is getting farther from my due date. Right now my placenta measures more than 2cm but less than 3cm from the cervical OS. The placenta is also anterior. I have had three other csection and my uterus is deformed so you can imagine that I have some concerns about this. I am currently 23 weeks and will have another scan on Jan 15th.(by the same sonographer, on the same machine)

I've been very fortunate in my other pregnancies not to have some of the complications associated with a mullerian anomaly (preterm labor/birth, placental issues, or IUGR) but it looks as if this time I am not going to get to escape it. My main concern is having a healthy baby, and my secondary concerns are how this may affect my birth, especially since the placenta is anterior.

Thanks for reading,
Kim


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## doctorjen (May 29, 2003)

I've had a few clients having repeat cesareans who had low-lying, anterior placentas. I've not had anybody have to deliver actually preterm - but I did have one client this year who had had 3 previous cesareans who started bleeding at 37 weeks and turned out to have a partial abruption at repeat cesarean.

Her baby was just fine, but she ended up needing a c-hyst for excessive bleeding that couldn't be controlled and on pathology she did have an accreta. In the end, she and baby were both fine, but she had a rough recovery, and needed 8 units of blood and an ICU overnight stay. She wasn't breastfeeding, though - but still, missed her baby and missed her first couple days since she was just still so sick.

The other couple folks I can think of did okay, although one did deliver a few days earlier than her planned repeat due to bleeding, with no other issues.

In my experience, they will still make a horizontal uterine incision, even though this goes through the placenta sometimes, since baby is delivered quickly. The transverse incision still is easier to repair and has less bleeding, so is preferable. Having an anterior placenta, and a low lying placenta increases the chance of accreta, which increases the chance of c-hyst, so it's probably good to be mentally prepared for that.

Not sure if the IUGR is caused by the placental site - could be if there is a lot of scarring there, or could be due to the underlying anomaly to begin with. Usually, as long as baby keeps growing, and fluids levels are good, and umbilical cord flow is good, and the placenta looks healthy, babe is allowed to grow as long as possible. If you had bleeding, though, or baby didn't appear to be growing anymore, then likely you'd need to deliver early. Hopefully, you can get as close to term as possible.


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## OnTheFence (Feb 15, 2003)

Thanks DoctorJen.

I was thinking about the c-hyst thing. My sister already told me it may be a bloody mess.







Here is a question, I guess they wouldn't know that ahead of time correct? So would they knock me out on the table for something like that if I went in with an epidural.

Thank you for sharing the experiences with me.


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## colobus237 (Feb 2, 2004)

I believe research has shown that MRI is the most accurate way of diagnosing a placenta accreta/increta/percreta, which would be my personal biggest concern with a placenta overlying a scar. But, I'm not sure that lots of doctors/radiologists are familiar with this, and have heard of people having a hard time finding someone who knows how to use MRI to assess it.

Question for anyone who might know - when thinking about this myself, pregnant after 2 cesareans and not really wanting more children, I wondered whether the safest way to deal with an accreta would be to deliver the baby through a high/classical incision and then do a hysterectomy without attempting to remove the placenta. One physician I asked confirmed that this would probably reduce the most serious risks of hemorrhage, but I don't know if it would really work that way?


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## OnTheFence (Feb 15, 2003)

Quote:


Originally Posted by *ccohenou* 
I believe research has shown that MRI is the most accurate way of diagnosing a placenta accreta/increta/percreta, which would be my personal biggest concern with a placenta overlying a scar. But, I'm not sure that lots of doctors/radiologists are familiar with this, and have heard of people having a hard time finding someone who knows how to use MRI to assess it.

Question for anyone who might know - when thinking about this myself, pregnant after 2 cesareans and not really wanting more children, I wondered whether the safest way to deal with an accreta would be to deliver the baby through a high/classical incision and then do a hysterectomy without attempting to remove the placenta. One physician I asked confirmed that this would probably reduce the most serious risks of hemorrhage, but I don't know if it would really work that way?

That is interesting tp think about. If things still look similar in a few weeks I will definitely talk to my OB about all of this.


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## liseux (Jul 3, 2004)

I dealt with the low lying placenta issue over my c/s scar with my last pregnancy. It did move, but I was definitely prepared for accreta by my OB. She said it would have to be an MRI that could accurately tell if accreta was happening or if it was confined to the scar or more than that. If you were dealing with something like that you would probably know before you delivered and have time to prepare for all of the details. As of right now, all you know is that the placenta is low lying, it may never invade the scar. Keep thinking positively about it moving. Like you, I have to have c births and your posts have helped me in the past as I prepared for my last birth. I am sending you good thoughts on everything working out as smoothly as possible.

I don`t know what this is worth, but I took more omega 3 oil capsules and added more flax & olive oil to my diet as I pictured the placenta moving and not getting caught in the scar.


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## doctorjen (May 29, 2003)

You can do a c-hyst under epidural, if it is functioning well. They do regular hysterectomies under epidural anyway. It's a much longer, more difficult surgery though so you might prefer to be sedated at least - and they might feel they have better control cardio-pulmonary-wise if they have you under.
It is a bloody mess, as you put it. It is much harder than a regular hysterectomy for the doc because the uterus is much bigger and much more vascular - and bleeding away while they operate. The 2 I've seen, I was so impressed the surgeon could figure out where the tissue planes were and get the uterus out. I was lost - and I scrub on cesareans and total abdominal hysts all the time.
I don't know that a classical incision would be much better - they bleed more to start with, and the placenta may well detach once the baby is out anyway. In my experience, surgeons have preferred to go transverse if they could.

The MRI thing is still newish - you'd want to be sure to go somewhere they've done it before. I think it is most accurate for more invasion - a partial accreta is probably harder to pick up. My client who had the c-hyst had only a partial accreta and we couldn't really tell even at surgery, only on the pathology.


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