Wednesday, July 18, 2007

Placenta Update

OK, so here's how last Thursday went down.

Nuchal translucency scan: too early to be completely sure, but the word in the ultrasound room seemed to be that the results would probably be fine regarding our risk of a chromosomal trisomy like Down's Syndrome and the like. Full report in 5-10 days after they get the blood work done, etc. And, much to my surprise, it was a transabdominal scan. I got to keep my shorts on. Very civilized.

The fetus is starting to measure rather large for its gestational age. I am concerned that gestational diabetes is looming. This is a minor concern at this point, because of the real "uh oh" moment. The ultrasound technician was very bright and cheerful as she completed her photographs and measurements and said she'd be gone for a few minutes and then the doctor would be coming in.

Doctor? Coming in? My blood pressure shot through the roof. Doctors being fetched during routine ultrasounds has never worked out well for me, and Thursday was no exception. She returned alone, however, and said the doctor wanted her to do a transvaginal ultrasound to see if she could get a better view of the placenta, which looked weird. She still was having issues clearly seeing what she was looking for, so in came another staffer, who then went off to grab the doctor out of a room where he was currently WITH ANOTHER PATIENT. Up went the blood pressure another notch.

Well, to summarize the next few minutes, the placenta looks funky. It's definitely covering the opening to the cervix. This is called placenta previa, and it can be very bad. However, when diagnosed early in pregnancy, it quite often resolves over time as the uterus expands and drags the placenta upwards, away from the baby's potential exit to the world. This would be good. But, this being one of my pregnancies, it isn't that simple. The placenta isn't in one large mass as it should be. A lot of it is on the posterior side (this is good, between my uterus and my backbone) but there appears to be an extra extension crossing the cervical opening and setting up shop for itself on the anterior side. No idea if that will affect the possibility that the placenta may migrate away from the cervix over time. Here's something on wonky placentas.

Interestingly enough, some of the complications during my pregnancy with D were eventually revealed to involve an extra lobe to THAT placenta, which (1) may have been sent out after part of the original placenta peeled away from the inside of the sac after there was a bleed in there (this is called a subchorionic hematoma), and (2) this extra bit of placenta was so deeply dug into the wall of the uterus that it wasn't delivered with the rest of the placenta, and indeed lingered there malevolently until I started hemorrhaging uncontrollably 5 weeks after D was born, and wound up in an ambulance and then had emergency surgery. Placentas that are too deeply attached are called placenta accretia. Also of note: a major risk factor for placenta accretia is placenta previa. Fabulous.

So, best case scenario: this spontaneously resolves itself over the next few months and causes no more trouble than the state of panic that can currently be found in the Problem Uterus Household.

Middling scenario: the placenta previa remains where it is, but my cervix behaves itself until 36 or 37 weeks, thus not causing any vaginal bleeding or loss of blood supply to the baby, which is born via uneventful planned C-section 3 to 4 weeks before my due date. Merry Christmas, everyone.

Other scenarios, of which I am considerably less fond, include:

(a) cervix begins effacing and dilating early, causing attached placenta to pull away in places, causing vaginal bleeding, panic, and likely hospitalization, tocolytic drug therapy, and bed rest. I'm guessing the likelihood of this scenario increases when one considers my history of preterm labor. It this is the case, let's hope it starts as late as possible. They would hold off delivery as long as it seems safe for the baby, and me, but premature delivery seems quite possible.

(b) Part of the placenta is so deeply embedded in uterine wall that upon removal of the placenta, uterine bleeding cannot be controlled, necessitating blood transfusions, and/or a hysterectomy. Possible maternal death.

(c) Cervix misbehavior during pregnancy is rapid and causes unexpected and complete detachment of the placenta (this is placenta abrupta), leading to severe bleeding, loss of blood and oxygen supply to fetus, yadda yadda yadda. Possible maternal and fetal death.

Today I choose to stick my fingers in my ears and loudly sing songs from the new Springsteen release. There's absolutely nothing we can do about this except watch and wait. And, importantly, we have advance knowledge. This is a good thing. We can be as prepared as possible for whatever may be coming.

However, I am mourning the loss of "there's a 70% chance you'll have a completely normal pregnancy." I’m in week 13 and I just used the phrase "maternal and fetal death." I wish we hadn't discovered this so early.

Ignorance is indeed bliss.


Spanglish said...

My God May it's a whole new world of worry. I stopped reading the maternity books and such because I didn't want to know what could go wrong. Ignorance is bliss, but "knowing is half the battle."

Banish the fetal and maternal death thoughts. Flog those thoughts with chains and whips. I'll keep you in my prayers.

By the way -- no worries about the one-up thing... I didn't feel one-upped at all. I would go into panic attacks if my kids showed up to class with starbucks.

Geohde said...

Oh hon, I'm so sorry. But advance warning is valuable, and it *is* an early scan so things may change. Although, having said that, a grade IV praeva with (?a bipartite placenta ?succenturiate lobe) lobes both anterior and posterior to the internal os does not sound like it will nesseccarily migrate away as the lower uterine segment expands.

Nevertheless, with appropriate perparation, your delivery will be as safe as can possibly be achieved, and I would still think that the vast probability is healthy you and baby.

I will cross my fingers.

electriclady said...

Ugh. So sorry you're having to deal with this--I so wanted a totally uncomplicated pregnancy for you. Hoping for a spontaneous resolution.

BTW, do you read Julia at Uncommon Misconception? She has a history of placenta accreta and also recently discovered she has a bilobed placenta on this current pregnancy.

Ann said...

Oh my goodness May, those are some scary possibilities. But I guess the key word is "possibilities." Bad things do not necessarily always repeat themselves. I know that's small comfort, but it's all I got right now.

May said...

I indeed have been reading Julia/Uncommon Misconception for a while. I like her. Very informative. Have you read her congressional testimony on late second trimester terminations? Powerful stuff!

gulptub said...

Just wondering where you are in your journey?? Do you know how rare the succenturiate lobe/placenta previa combo is?? I do, cuz at 22 weeks, (after a second trip to the hospital for a bleed........first bleed at 13 weeks) I was just diagnoed with the same thing. I have searched the internet looking for ANYONE dealing with it and you are all I have found so far! Also, there is very little medical literature. I hope things are going better!

Susan said...

i am 28 weeks and found out i too have succenturiate lobe/complete placenta previa combo. i have a follow up ultrasound friday. doc isnt saying much, except to get to the hospital if bleeding happens, bed rest etc. The good thing is, i have not bled at all throughout my pregnancy and baby is growing normally. i tried to get info on the condition but only found one article in medline but could not access the full text. I am trying not to go crazy thinking about what could happen. good to hear i am not alone. if anyone has more info please advise.

May said...

Hi Susan!

I'd be happy to email you- you can either post an email address here or make your Blogger profile public so you can be emailed that way.