Complete Placenta Previa/Acretta Question

QUESTION

Dear Midwife,
At my 28 wk u/s it was confirmed that I have a complete placenta previa. Because of my 2 previous c-sections, it is suspected that I may have an acretta. I scheduled an appointment with a peri for a more detailed u/s at 29wk. They canceled the appointment and with 2 little ones at home and being on bed rest, my schedule is tight.

When does my OB need to know about the acreeta and will a peri give me more information on the previa, or is all I need to know is that I have one? I'm on modified bed rest and to watch out for bleeding. Any advice would be greatly appreciated.

Allison, 29wk 4d

ANSWER

Most women do not know that having a cesarean (never mind two) increases their risk for both placenta previa and placenta accreta. I am so sorry that you have the previa and that there is concern about a possible accreta besides. Your OB needs to know about both conditions before you go into labor. Hopefully, that will not happen before your baby is full-term.

A placenta that is a complete previa is unlikely to move much prior to delivery so I'm assuming that you know you will have a third cesarean. If it turns out that you do indeed have an accreta (and I'm not sure that they can be absolutely certain one way or the other based on ultrasound), the only option the OB may have is to remove your uterus in order to save your life. If you do keep your uterus, with this history I would probably be suggesting a tubal ligation if you were my client, for the sake of your children and husband, who need a mom and a wife. Besides which I would like to see you raise those kids!

--Cynthia, CNM. PhD.

Cynthia Flynn

Cynthia Flynn, CNM. PhD, is the General Director of the Family Health and Birth Center which provides prenatal, birth, postnatal, gynecological and primary health care to underserved women and their families in Washington, D.C. Recently Cynthia served as Associate Professor of Nursing at Seattle University. There she not only taught, but remained in full scope clinical midwifery practice at Valley Medical Center where she cared for pregnant and birthing women, and practices well-woman gynecology, family planning, and treatment of sexually transmitted diseases.

Cynthia founded Columbia Women's Clinic and Birth Center, where she took care of pregnant women and infants up to two weeks of age and attended both birth center and hospital births. Before Cynthia earned her CNM, she worked as a registered nurse in labor and delivery and postpartum and is a certified Doula and Doula trainer.