succenturiate placenta (accessory lobe)

I mentioned this in an earlier post but got no answers (maybe b/c no one has
any to give) but thought I'd give it another try with it's own subject
line.
I have an anterior placenta with a posterior accessory lobe. My midwife
looked concerned at the report and asked what I had been told at the u/s. I
said that my understanding was that we'd just have to make sure all of the
placenta comes out. The midwife confirmed this and said that it was likely
the lobe would have to manually removed. No further discussion of risks,
etc. so I figured that was that. Then, I went and did some research on the
internet (way to scare myself!) and found that a succenturiate placenta can
cause vasa previa, or hemorrhage of the umbilical cord, which if it happens
all the way is usually fatal to the baby. What I can't find is information
about how high the risk really is (ie did my risk of vasa previa go from 1
in a million to 1 in half a million or are we talking realistic risks?).
Also, is a pregnancy with succenturiate placenta managed differently?
Should I be asking about other testing, be more conservative in decision
making, etc. Obviously I'll be talking to my midwife at my next appt in
10ish days, but wanted to be armed with more info if possible.
So, anyone been told they have an accessory lobe of the placenta before
birth, and if so what was recommended, how were things done differently,
etc.?

Thanks!
Amy

V. wrote:
I mentioned this in an earlier post but got no answers (maybe b/c no one has
any to give) but thought I'd give it another try with it's own subject
line.
I have an anterior placenta with a posterior accessory lobe.

Sorry, I don't know squat. A little searching turned up
the following:

http://tinyurl.com/cpfhp
http://tinyurl.com/88rsn
http://tinyurl.com/bgwel

It seems to me that what matters here is the precise geometry
involved. It looks like there are ultrasonography techniques
that should be able to detect a likely vasa previa with some
degree of accuracy (though likely not perfect). What
reassurance have they given you that they have checked
adequately for vasa previa and come to the conclusion that
it's not likely to be an issue in your case?

Best wishes,
Ericka

I saw your original post, but have no answers for you. I would say this --
your midwife didn't sound overly concerned about it, so I wouldn't be
either. At least don't jump the gun. Ask your questions, but listen to her
answers. She isn't going to risk you or the baby.

Good luck.
--

Jamie
Earth Angels:
Taylor Marlys, 1/3/03 -- My Big Girl, who started preschool, and loved it!
Addison Grace, 9/30/04 -- My Little Walker, who wants nothing more than to
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"V." wrote in message
...
I mentioned this in an earlier post but got no answers (maybe b/c no one
has any to give) but thought I'd give it another try with it's own
subject line.
I have an anterior placenta with a posterior accessory lobe. My midwife
looked concerned at the report and asked what I had been told at the u/s.
I said that my understanding was that we'd just have to make sure all of
the placenta comes out. The midwife confirmed this and said that it was
likely the lobe would have to manually removed. No further discussion of
risks, etc. so I figured that was that. Then, I went and did some
research on the internet (way to scare myself!) and found that a
succenturiate placenta can cause vasa previa, or hemorrhage of the
umbilical cord, which if it happens all the way is usually fatal to the
baby. What I can't find is information about how high the risk really is
(ie did my risk of vasa previa go from 1 in a million to 1 in half a
million or are we talking realistic risks?). Also, is a pregnancy with
succenturiate placenta managed differently? Should I be asking about other
testing, be more conservative in decision making, etc. Obviously I'll be
talking to my midwife at my next appt in 10ish days, but wanted to be
armed with more info if possible.
So, anyone been told they have an accessory lobe of the placenta before
birth, and if so what was recommended, how were things done differently,
etc.?

Thanks!
Amy

V. wrote:
I mentioned this in an earlier post but got no answers (maybe b/c no one has
any to give) but thought I'd give it another try with it's own subject
line.
I have an anterior placenta with a posterior accessory lobe. My midwife
looked concerned at the report and asked what I had been told at the u/s. I
said that my understanding was that we'd just have to make sure all of the
placenta comes out. The midwife confirmed this and said that it was likely
the lobe would have to manually removed. No further discussion of risks,
etc. so I figured that was that. Then, I went and did some research on the
internet (way to scare myself!) and found that a succenturiate placenta can
cause vasa previa, or hemorrhage of the umbilical cord, which if it happens
all the way is usually fatal to the baby. What I can't find is information
about how high the risk really is (ie did my risk of vasa previa go from 1
in a million to 1 in half a million or are we talking realistic risks?).
Also, is a pregnancy with succenturiate placenta managed differently?
Should I be asking about other testing, be more conservative in decision
making, etc. Obviously I'll be talking to my midwife at my next appt in
10ish days, but wanted to be armed with more info if possible.
So, anyone been told they have an accessory lobe of the placenta before
birth, and if so what was recommended, how were things done differently,
etc.?

Thanks!
Amy


Succenturiate lobe of the placenta is when a vessel goes away from the
placenta to form a separate lobe. All the joins the lobe is a blood
vessel. This only becomes vasa praevia if the vessel is right down low
infront of baby's head. In this case, you must have a c/s AFAIK. If
your membranes rupture right where the vessel is, in some cases the tear
might go into the vessel and you would haemorrhage. It isn't the actual
umbilical cord though. An ultrasound should be able to detect where the
2 lobes of placenta are exactly, and where the vessel is that joins
them. If the vessel is not infront of the baby's head, your risk of
haemorrhage isn't anywhere near as high, and you can definitely have a
normal birth. The best way to avoid leaving the lobe behind though, is
to have a physiological 3rd stage, and have no one tugging on your cord
to remove the placenta... let it all come out gently and in its own
time. If someone tugs on the cord after giving the oxytocic they might
only get the main bit of placenta out if the lobe hasn't detached yet.

I strongly advise you to speak to your midwife about that issue, after
you confirm that you don't have vasa praevia. How many weeks pregnant
are you?

If your midwife isn't worried, maybe she knows that there is no vasa
praevia. When we midwives check the placenta after birth, we always
check to make sure there is no vessel leading away from the placenta to
'nothing'. That indicates a succenturiate lobe still insitu. So it can
definitely happen to people without an u/s picking it up!

Good luck, and talk to someone about 1) Vasa Praevia and 2)Normal 3rd Stage.



Jo (Mum to Will and a Midwife on maternity leave)

"Jo" wrote in message
...
V. wrote:
I mentioned this in an earlier post but got no answers (maybe b/c no one
has any to give) but thought I'd give it another try with it's own
subject line.
I have an anterior placenta with a posterior accessory lobe. My midwife
looked concerned at the report and asked what I had been told at the u/s.
I said that my understanding was that we'd just have to make sure all of
the placenta comes out. The midwife confirmed this and said that it was
likely the lobe would have to manually removed. No further discussion of
risks, etc. so I figured that was that. Then, I went and did some
research on the internet (way to scare myself!) and found that a
succenturiate placenta can cause vasa previa, or hemorrhage of the
umbilical cord, which if it happens all the way is usually fatal to the
baby. What I can't find is information about how high the risk really is
(ie did my risk of vasa previa go from 1 in a million to 1 in half a
million or are we talking realistic risks?). Also, is a pregnancy with
succenturiate placenta managed differently? Should I be asking about
other testing, be more conservative in decision making, etc. Obviously
I'll be talking to my midwife at my next appt in 10ish days, but wanted
to be armed with more info if possible.
So, anyone been told they have an accessory lobe of the placenta before
birth, and if so what was recommended, how were things done differently,
etc.?

Thanks!
Amy
Succenturiate lobe of the placenta is when a vessel goes away from the
placenta to form a separate lobe. All the joins the lobe is a blood
vessel. This only becomes vasa praevia if the vessel is right down low
infront of baby's head. In this case, you must have a c/s AFAIK. If your
membranes rupture right where the vessel is, in some cases the tear might
go into the vessel and you would haemorrhage. It isn't the actual
umbilical cord though. An ultrasound should be able to detect where the 2
lobes of placenta are exactly, and where the vessel is that joins them.
If the vessel is not infront of the baby's head, your risk of haemorrhage
isn't anywhere near as high, and you can definitely have a normal birth.
The best way to avoid leaving the lobe behind though, is to have a
physiological 3rd stage, and have no one tugging on your cord to remove
the placenta... let it all come out gently and in its own time. If
someone tugs on the cord after giving the oxytocic they might only get the
main bit of placenta out if the lobe hasn't detached yet.

I strongly advise you to speak to your midwife about that issue, after you
confirm that you don't have vasa praevia. How many weeks pregnant are
you?

If your midwife isn't worried, maybe she knows that there is no vasa
praevia. When we midwives check the placenta after birth, we always check
to make sure there is no vessel leading away from the placenta to
'nothing'. That indicates a succenturiate lobe still insitu. So it can
definitely happen to people without an u/s picking it up!

Good luck, and talk to someone about 1) Vasa Praevia and 2)Normal 3rd
Stage.



Jo (Mum to Will and a Midwife on maternity leave)

Jo, thank you so much! I must have misunderstood the stuff about vasa
previa, thinking that it had something to do with the umbilical cord (it did
occur to me last night that what I was thinking of sounded just like
prolapsed cord, so why would it have a different name?)
I will need to ask my midwife about it at my next visit (I'm 33.5 wks and
have a 35 wk scheduled visit), but I do remember the u/s doing a color
doppler during the u/s, I just assumed it was related to checking for
placenta previa/abruption which was the reason I was there. Before the
color doppler, I remember the u/s tech saying she couldn't tell if the lobe
was connected to the main placenta, so know I think that must have been what
she was looking for.
I'll check this all out with my midwife next week, but I feel so much
better! Thanks!
Amy

"Ericka Kammerer" wrote in message
...
V. wrote:
I mentioned this in an earlier post but got no answers (maybe b/c no one
has any to give) but thought I'd give it another try with it's own
subject line.
I have an anterior placenta with a posterior accessory lobe.

Sorry, I don't know squat. A little searching turned up
the following:

http://tinyurl.com/cpfhp
http://tinyurl.com/88rsn
http://tinyurl.com/bgwel

It seems to me that what matters here is the precise geometry
involved. It looks like there are ultrasonography techniques
that should be able to detect a likely vasa previa with some
degree of accuracy (though likely not perfect). What
reassurance have they given you that they have checked
adequately for vasa previa and come to the conclusion that
it's not likely to be an issue in your case?

Best wishes,
Ericka

I'll need to talk to my midwife about it at my next visit. After reading
those abstracts and Jo's post I'm thinking that it's already been ruled out,
so they didn't bother getting me worried about it. I did that all on my
own! (a little knowledge is a dangerous thing and all that!)
Thanks for the help Ericka, I knew I could count on you!
Amy

Thanks Jamie, of course you're right. I'm just one of those people that
reads a little info, understands a little bit of it, and goes into
worry-land! I could never go to medical school, I'd be the worst
hypochondriac!
I've only had two visits with this midwife, so while I trust her in theory
and like her a lot so far, I just don't have that implicit "she'll take care
of me" feeling yet. Due to all my switching of providers I think I've taken
the concept of "patient-directed health care" a little too seriously!

Thanks again,
Amy

V. wrote:


Jo, thank you so much! I must have misunderstood the stuff about vasa
previa, thinking that it had something to do with the umbilical cord (it did
occur to me last night that what I was thinking of sounded just like
prolapsed cord, so why would it have a different name?)
I will need to ask my midwife about it at my next visit (I'm 33.5 wks and
have a 35 wk scheduled visit), but I do remember the u/s doing a color
doppler during the u/s, I just assumed it was related to checking for
placenta previa/abruption which was the reason I was there. Before the
color doppler, I remember the u/s tech saying she couldn't tell if the lobe
was connected to the main placenta, so know I think that must have been what
she was looking for.
I'll check this all out with my midwife next week, but I feel so much
better! Thanks!
Amy


Glad to have helped, Amy

All the best

Jo

Elfanie writes:

: here is a picture I took at a birth of this...you can see where the
: doctor's hand is inserted - where the membranes had ruptured - and you
: can see the vessels connecting the two placental plates. If those
: vessels had gone over the opening...that would have been scary. (it
: was close enough as it was!)

Picture? What picture? There is no URL, and my newsreader does not
support attachments. Can you try again. Email if necessary.

Thanks,
Larry

wrote in message ...
Elfanie writes:

: here is a picture I took at a birth of this...you can see where the
: doctor's hand is inserted - where the membranes had ruptured - and you
: can see the vessels connecting the two placental plates. If those
: vessels had gone over the opening...that would have been scary. (it
: was close enough as it was!)

Picture? What picture? There is no URL, and my newsreader does not
support attachments. Can you try again. Email if necessary.

Thanks,
Larry

LOL, you're a braver man than me Larry....anytime the words "hand is
inserted", "membranes" and "ruptured" are used to describe a photo, I'm
pretty sure I don't want to see it!

Thanks Stephanie, the explanation did help.(without pictures and all!) I'm
feeling much more reassured since I recall the u/s tech checking very
carefully to make sure nothing was over the cervix. Since I was there to
rule out placenta previa due to bleeding, I thought that was the reason.
Now I'm thinking it was also because of the accessory lobe.

Amy

Amy