Complete Placenta Previa/Acretta Question

Cynthia Flynn's picture
Experts: 

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.