Placenta is low and anterior - when is the best time(s) for an u/s

[KrisM]

I had first trimester screening, which included an ultrasound. At 11.5 weeks, the placenta is low and anterior. Since I've had 2 cesareans, my risks of placenta previa and placenta accreta. And, since the placenta is over the area that is to be cut this time, I'm thinking this poses a problem for the surgery.

I'm not having much luck finding a lot of information on any of this. I'm about 17 weeks now. When should I have ultrasound(s) to monitor this? Is there a benefit in following the progress, or can I just wait until further along? What do they do with the incision during the surgery?

Thanks for any info.

[bubbaray]

My placenta was low and anterior with DD#2 at my 8w u/s and my amnio @ 16w. My peri was not concerned as he fully expected it to move (and it had moved laterally by the time of my 16w procedure, so that it wasn't near the incision, more off to the side).

I would discuss it with your dr. I'm sure s/he is on top of it, but it will probably help alay your fears to discuss it at your next appt.

Good luck!

ETA -- DD#1 was an emergency c/s and DD#2 was a scheduled c/s. With #2, the incision was exactly over the first one and there were no issues with the placenta at that time. IIRC, the placenta had moved to a completely safe position (though still low) by the time of my level II u/s, which was about 20w.

[egoldber]

Are you having a 20 (ish) week anatomy/Level 2 ultrasound or is that what you are trying to decide?

If the placenta is not covering the cervix at the 20 week ultrasound, you're clear. If it is, then most OBs will typically monitor it to make sure it moves. Even though you're a planned C, as you know, a previa at term after 2 sections is risk factor for accreta. But I believe it is after the third section that the risks for accreta with a previa at term get to be very high.

I think that typically in a surgery with a low, anterior placenta, they just make the incision a bit higher than normal. Unless there is also an accreta the surgery shouldn't be that complicated.

[KrisM]

Are you having a 20 (ish) week anatomy/Level 2 ultrasound or is that what you are trying to decide?

If the placenta is not covering the cervix at the 20 week ultrasound, you're clear. If it is, then most OBs will typically monitor it to make sure it moves. Even though you're a planned C, as you know, a previa at term after 2 sections is risk factor for accreta. But I believe it is after the third section that the risks for accreta with a previa at term get to be very high.

I think that typically in a surgery with a low, anterior placenta, they just make the incision a bit higher than normal. Unless there is also an accreta the surgery shouldn't be that complicated.

I wasn't planning on having a 20 week u/s. I'm trying to decide whether I should schedule one for then or if it's better to wait a bit longer to get more accurate results. I don't know if my care would change if an earlier u/s shows previa or accreta. I know quite often previa resolves itself, so if that was the only potential issue, I would wait until longer. It's the accreta that I know very little about.

And, I just was reading something that previa and accreta are quite often solved at birth by a hysterectomy. Not a happy thing to read.

[o_mom]

I had a low-lying placenta with DS1, as revealed at the 20w u/s. They did a repeat later - I want to say 26-28 wks to see if it resolved (it did). If it hadn't they were going to just repeat again at 32-ish wks I think.

[erosenst]

I had a VERY low and anterior placenta with Abby. (Only time I've given birth.) If the placenta is still low-lying at 20 weeks, they'll likely check again at 32 weeks. A significant majority (can't remember - but a LOT) have moved up by then. If not, they'll continue to monitor you as you get closer.

To shorten a longer story, I ended up having to have a c-section. As you may know, the biggest risk with a c-section and an anterior placenta is to you - there's a risk of significant bleeding because they do have to cut through the placenta to get the baby out. My OB wanted her partner, rather than a resident, assisting her. She also had another IV line put in (ready for a transfusion) and had blood from the blood bank on hold prior to beginning the c-section. I was also supposed to be blocked slightly higher during the epidural in case there were complications. (I had a bad reaction to the epidural, and ended up not having any feeling in my arms for a few hours after delivery - but that had to do with my reactions to drugs.) Everything else was text-book, and both Abby and I were fine.

Feel free to PM me if you have more questions -

Emily
Abby - 4

[caleymama]

I had a low-lying placenta with DS1, as revealed at the 20w u/s. They did a repeat later - I want to say 26-28 wks to see if it resolved (it did). If it hadn't they were going to just repeat again at 32-ish wks I think.

Same here with DD2. I had a follow up ultrasound at 27 weeks and it was resolved - moved out of the way. Doesn't address all your concerns because I have not had a c-section and I'm not sure of the impact of the dual conditions you mention. I was initially quite concerned but both the doctor and the research backed up the fact that most resolve on their own, which turned out to be the case for me.

[KrisM]

Thanks everyone. I think I'll probably wait until 24 or 26 weeks for another u/s and give it time to move and not be previa. I am most worried about accreta, which really sounds scary. Hopefully, they'll be able to see on u/s whether it's there or not.

[tnrnchick74]

I have recently been diagnosed with placenta previa at my 20 week US. They are going to rescan me at 28-30 weeks. I have a history of multiple abdominal and uterine surgeries as well as fibroids. There is a CHANCE that it might move, but my OB recommends planning for a c-section if the 28-30 week US still shows previa because more than likely it won't move much after that point.

[egoldber]

Accreta can be scary. But knowing ahead of time is key. That way they can take the precautions outlined above by a PP: blood typed and matched ahead of time, a better surgeon assisting, perhaps a higher level hospital than originally planned.