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.