Complete Placenta Previa

Just diagnosed with a complete placenta previa in my 3rd pregnancy at
my 20/21 week ultrasound. I haven't (to the ustech's amazement) had
any bleeding. I am already prone to preterm labor (and in the higher
risk category) and my doctor looked confused when I mentioned the
previa to him after the ultrasound. Guess the tech didn't tell him. I
didn't realize that it could mean more than a C section until I got
home (after stopping at Target and carrying my 20 month old around on
my hip for 1.5 hours.) No mention of restrictions or possible bleeding
or anything. Should I make some lifestyle adjustments (ie not lifting
the 20 month old or the 3.5 year old and not carrying the laundry
upstairs)? It is Friday, well after 5, and I can't talk to an OB until
Monday at the earliest.

Thanks!

Just diagnosed with a complete placenta previa in my 3rd pregnancy at
my 20/21 week ultrasound. I haven't (to the ustech's amazement) had
any bleeding. I am already prone to preterm labor (and in the higher
risk category) and my doctor looked confused when I mentioned the
previa to him after the ultrasound. Guess the tech didn't tell him. I
didn't realize that it could mean more than a C section until I got
home (after stopping at Target and carrying my 20 month old around on
my hip for 1.5 hours.) No mention of restrictions or possible bleeding
or anything. Should I make some lifestyle adjustments (ie not lifting
the 20 month old or the 3.5 year old and not carrying the laundry
upstairs)? It is Friday, well after 5, and I can't talk to an OB until
Monday at the earliest.

did the tech definitely say complete? it may be that the reason it wasn't
immediately flagged to the OB was that it isn't complete?

I hope someone else replies, but I think just right now, when there is no
bleeding and hasn't been any, that you just carry on as normal.

Cheers

Anne

wrote:
Just diagnosed with a complete placenta previa in my 3rd pregnancy at
my 20/21 week ultrasound. I haven't (to the ustech's amazement) had
any bleeding. I am already prone to preterm labor (and in the higher
risk category) and my doctor looked confused when I mentioned the
previa to him after the ultrasound. Guess the tech didn't tell him. I
didn't realize that it could mean more than a C section until I got
home (after stopping at Target and carrying my 20 month old around on
my hip for 1.5 hours.) No mention of restrictions or possible bleeding
or anything. Should I make some lifestyle adjustments (ie not lifting
the 20 month old or the 3.5 year old and not carrying the laundry
upstairs)? It is Friday, well after 5, and I can't talk to an OB until
Monday at the earliest.

I wouldn't do anything drastic at this point. I
don't think normal daily activities are going to pose
much of an issue. I would follow up with your doctor.
Ask exactly what the results of the u/s were. You
may have misunderstood the tech, or the doctor may have
missed something. Also, ask them what they mean, precisely,
by "complete." IIRC, complete just means that the placenta
is completely covering the os, but it might just be with
an edge of the placenta. In such cases, the growth of
the uterus can still result in the placenta not being
too close to the os for a vaginal birth, so you might
not need a c-section depending on how things go. If
the placenta is nearly centered over the os, it's
unlikely you can have a vaginal birth and, I believe,
the risks are somewhat higher. At any rate, you just
need to get all the details and make sure there aren't
any miscommunications going around After that, you
can figure out what really needs doing, if anything.

Best wishes,
Ericka

wrote:
Just diagnosed with a complete placenta previa in my 3rd pregnancy at
my 20/21 week ultrasound.
[...]
my doctor looked confused when I mentioned the
previa to him after the ultrasound. Guess the tech didn't tell him.

Technicians are not qualified to make diagnoses. Expect your physician
to study the ultrasound recording himself, then discuss it with you.
You might also expect to be sent to a specialist for a second
ultrasound and a professional evaluation of this suspected placenta
previa.

What did *you* see on the ultrasound? Did it look like a problem to
you?

I guess I have some trust issues about the OB and his practice
policies.

The placenta was truly completely covering the birth canal. I asked
the tech just to be sure of what I was seeing after she asked me about
the spotting or bleeding. I asked how much was covered and she said
that it was completely covered and it's between the middle of placenta
and the end on one side, closer to the middle. I asked my OB about it
during my appt., he didn't even acknowledge that I had asked. He
didn't even say "Oh, it might move," or "Well, we'll see at the next
ultrasound." In fact, he didn't mention a next ultrasound, the
ultrasound tech said that they would want to do another at 28 weeks to
see if it had moved out of the way or not. My husband (who was with
me) and I both weren't terribly alarmed, until we found out what
"complete placenta previa" meant. This is our 3rd baby, we don't
rattle so easily (preterm labor/premature birth with the other two),
but the ultrasound tech was slightly alarmed and rattled about it.
When I got home, I read up and found out that most OB's would have
started suggesting activity limitations as it appears with complete
previa that you are more likely to bleed in the second half of the
pregnancy. I asked the tech at the time what the chances of this
resolving itself were and she said it could happen. Upon reading, it
looks like it could, but is less likely than if it had been found
before 20 weeks or if it wasn't complete. Premature delivery/labor is
likely if bleeding starts. I doubt that there is much in the way of
miscommunicating with my OB as there has been really no communicating
about it or other issues (high blood glucose); I have doubts as to
whether or not he even really looks at the charts before he enters the
room. I had also lost 5 lbs last visit; this visit I asked about my
weight and he was confused about that as well (this is the ONLY guy I
have seen) and referred to the first page of the chart. I had gained
back 3 lbs. I was already going to change OB's as I am going to have
to move in with my mom (yipee) since my hubby travels 50% of the time
for work and with my history of preterm and being 2 hours from any
family, but I may make that move a little earlier than the May 20th
date I had planned because of this if I need to make changes in my
lifestyle (I can't really be home alone with the two kids under 4 and
not lift heavy items like children, groceries, and overflowing laundry
baskets since we live in a 2 story house.)

I just wish he had given me some direction. On Monday, I guess I need
to call an OB and ask for clarification about what I should and
shouldn't do, but I am not sure if I should bother calling these guys.
The last time I called, I was having major cramping (and after a 37
hour labor with my first when I say major cramping, I mean it) and I
called after it didn't resolve for 9 hours of laying on my left side
and drinking water. They told me "take it easy and call us in the
morning." And were nasty because I had called them after hours, even
though I called during regular hours the first time and they hadn't
returned my call in two hours. I am not sure they would even look at
my chart if I called. I do have to get my records to go to the new OB,
should I transfer out right away and get to the other people dragging
my chart with me?

wrote:
I guess I have some trust issues about the OB and his practice
policies.

Given what you have related here, I would switch immediately out of
this practice, with or without your file.

As a patient, you have a right to a copy of your file, but this
practice probably will not give you anything in their file from another
practice (eg, your ultrasound, if that was a referral outside the
practice): you can request those files from the originating
practice(s). Your new practice can get a copy too, but that will
reveal to the old practice where you went. The new practice probably
does not really need a copy of your file, and they may want to do their
own assessment anyway. So, I suggest you get your own copy of your
file, for your own records, but otherwise don't worry about it. And
meanwhile find a new practice. Those are independent tasks, so no need
to wait on one before you do the other: do them both in parallel, as
efficiently as you can.

Definitely plan to move to your mom's house sooner than later. Your
living situation already is too precarious for peace of mind.

Your current OB sounds laid back to beyond negligence. Most things
that pregnant women worry about turn out to be non-issues, but that
doesn't mean the OB can ignore all information and your questions too.
I wouldn't have further interaction with them, but I might write a
letter of concern to the state board that monitors OBs.

Previa is notoriously overdiagnosed in early ultrasounds. Many, many
times what appears to be a previa in a 16-20 week ultrasound turns out
not to be a previa on a 28-32 week ultrasound. I am surprised that the
sonographer who did your scan had this reaction, as the phenomenon of
the "disappearing previa" is very well known to everyone in the
obstetrics world. Of "previas" seen at 16-20 weeks, the vast majority
do resolve by the time it matters.

Some people would recommend that you avoid sex or sexual stimulation
for the time being. You should also, obviously, report any bleeding or
contractions immediately. You will have follow up ultrasounds every 4
weeks or so to recheck the placenta location.

What do you mean by "prone to preterm labor?" Were your previous babies
delivered term or preterm?

Was this ultrasound done vaginally or abdominally? It usually isn't
possible to define the relationship between the placental location and
the cervix abdominally. Also, a vaginal ultrasound would allow
measurement of your cervix. This would help to quantify your real risk
of preterm labor.

alath wrote:
Previa is notoriously overdiagnosed in early ultrasounds. [...]

Yes. But the OB should have been able and willing to explain all this
to Tracy during the scheduled appointment. This OB strikes me as the
kind of physician who works hard at making his job easier by "avoiding"
any patient who has anything other than a textbook normal pregnancy.
The purpose of this behavior is to encourage the patient to switch to
another provider and take all her potential medical problems away with
her. Such a physician will have great statistics, which is one major
reason why statistics are not a very sound basis on which to choose a
physician. Referrals from other patients and physicians may be more
reliable.

Thanks for your replies Pologirl and all!

I will run (figuratively) from this practice, not walk. Since I was 20
wks, 6d at my ultrasound, I feel like while it might yet pan out to be
a misdiagnosis, he should have at least talked about it to me as it
wasn't an early u/s. You're right; he should have at least answered my
low key questions, even if it was obvious that I wasn't panicked. It's
nice to hear someone putting her finger on something I hadn't thought
about, too. I think you hit the nail on the head with the avoidance
theory. I am not a textbook normal pregnancy: Pre-eclampsia and
premature rupture of the membranes coupled with a 35 week birth with
the first, borderline blood sugars and preterm labor at 33 weeks add on
a cord wrapped twice around her neck and blood pressures topping 145/95
with the second. Even given all of this, we had always wanted 3
children, and I have been doing so well this pregnancy (aside from the
3 days of cramping in my 19th week- due to minor fall, I finally pieced
together.) Blood pressure is great; voluntarily eating the diabetic
diet and monitoring my blood sugar as a preventative measure.

Ironically, I am not really a worrier and I have a high pain threshold.
I flat out missed the labor with my first (don't tell that to the 1st
time moms out there, it's probably their worst fear) until my water
broke. My best friend is a NICU nurse who worked in a level 3; hearing
her stories made me realize that most pregnancies are OK. I would not
have thought so much about restrictions except she freaked when I told
her that the OB hadn't mentioned it, especially with my history.

I actually interviewed 3 out of 4 local OB practices in my area. They
are in pitifully short supply here (the media uses the term "crisis"),
and this guy's was, believe it or not, the better of the lot. I don't
know many people here and none who have had babies recently as we have
only lived in this area for 1 year. My first was delivered an hour
north of here and my second an hour and a half south of here. I
haven't been able to figure out why a physician would not make any
mention of the possible bleeding (which, btw, if it wasn't a lot I
would have probably ignored as normal-jostled-around bleeding) or
probed for any restrictions (move the living room furniture around was
on my weekend to do list) that need imposed. When he came into the
room, I had my 20 month old dangling upside down from my lap playing
ride a horse; you would think that might have raised some questions.
Your insight makes it make more sense. I plan on picking up my
records, unapologetically, by hand on Monday and faxing them to the new
OB. I will also call her office (the nurse there was already wondering
why I hadn't had a fasting glucose drawn when I gave her my information
over the phone to set up my chart) and talk to them about what, if
anything, I should do.

Hey, stats makers, given my luck with being the one in *insert large
percentage here* should I go ahead and buy my lotto ticket?

Trying to keep my sense of humor,
Tracy

Thanks Ericka! I will get on the phone first thing Monday!