Switching OB for complete placenta previa

[Anonymous]

Hi everyone,

I was diagnosed with complete placenta previa at 23 weeks. My OB delivers at Sibley where they don’t have a higher level ICU. I’m wondering if I should consider switching to Georgetown Washington Hospital center or another center with a level 3 NICU because of the risk of preterm labor and bleeding. If it doesn’t move, are you normally referred to MFM? And can that be at a different hospital? Wondering if anyone has experience with this.

[Anonymous]

Doesn't Sibley work with Georgetown in such cases anyway? I'm not sure you have to move...

[Anonymous]

I had complete placenta previa and delivered at Sibley. If you go into preterm labor you will he sent to Georgetown for the NICU. You will also he sent there if you have any bleeding events—I spent a day or so there at 27 weeks after a bleed. They let me go home but only because I could promise to have someone with my 24-7 and that I could be st a hospital within 20 minutes. And total bed rest.
The placenta does not “move”—it is fixed. The uterus moves as it grows. The question really is where it is affixed. At my 17 week appointment it was clear that the cervix was right not the middle of the placenta so no matter how much the uterus grew, it was always going to be totally covering the cervix.
You goal here should be to avoid any bleeding event, as each bleed is usually worse. The doctors says you get one “sentinel bleed”—like a warning before the problematic bleeds. This means no sex, no exercise (not even yoga), no lifting anything, and start miralax now (constipation will often lead to a bleed from pushing to poop). Also hydrate like mad—even minor dehydration increases uterine irritability which can lead to bleeding. That’s the best way to avoid bed rest.
The stats on complete previa are pretty good nowadays so don’t be too scared—you just need to take it seriously. Also, I guess I should say that a lot of u/s techs and even doctors misdiagnose a partial as a complete, and don’t necessarily know the difference. When I saw the specialist at Georgetown, he sort of scoffed at my OB’s diagnosis until he saw for himself how extreme mine was. They can get a better view if they do a transvaginal u/s instead of just transabdominal.
Good luck! My previa baby is sitting with me playing with our dog right now. We’re so lucky we live in a world of modern medicine, where this is just a minor bump in the road rather than the death sentence it was 100 years ago.

[Anonymous]

Fwiw, I had a complete previa at 24 weeks. It finally moved at 32, yours might as well as your uterus expands. (Apparently most cases resolve, but of course ask your doctor)

[Anonymous]

I had complete placenta précis at 20 weeks, had an ultrasound at 32 weeks and it had resolved itself, delivered at Sibley at 39 weeks. All was fine.

[Anonymous]

*previa

[Anonymous]

I had dr. Malcolm Desouza with the same condition. He delivered me by c section at GW, with no complications.I had to be hospitalized several times during the pregnancy due to bleeding, even though I was on partial bed rest. You have to be careful!

[Anonymous]

I’m pretty sure that the people saying it resolved has partial precise not complete. A lot of non-specialists misdiagnose a partial as a complete. According to what the high-risk specialist told me, a complete can only be diagnosed properly through a transvaginal ultrasound and only after 20-something weeks (can’t remember the cutoff). If you really only have a partial, you probably don’t really need to take as many of the precautions as I outlined above. Partials are very common and generally are not a big deal. Completes are very rare (although the specialist told me they were somewhat more common for IVF patients, in his experience).

[Anonymous]

Sorry for auto-correct typos. Typing on phone and can’t see the auto-corrects well.

[Anonymous]

Yes you need a NiCU.
A complete previa requires a cd at 36 weeks.
Sibley can handle this,

You also need a level 1 trauma center as you are at a higher risk of bleeding, Ask you doctor about their MTP, IR etc.

[Anonymous]

OP here- thank you so much for your replies everyone! It’s good to hear others experiences and that others have delivered at Sibley.

I especially appreciate the post on how to avoid bleeding. Some useful tips. I was diagnosed with two abdominal (one fetal echo) and one transvaginal ultrasound. And yes, it was an IVF pregnancy so that explains the higher risk of the complete previa. Fingers crossed it does move, but trying to be prepared for other scenarios.

[Anonymous]

Anonymous wrote:I’m pretty sure that the people saying it resolved has partial precise not complete. A lot of non-specialists misdiagnose a partial as a complete. According to what the high-risk specialist told me, a complete can only be diagnosed properly through a transvaginal ultrasound and only after 20-something weeks (can’t remember the cutoff). If you really only have a partial, you probably don’t really need to take as many of the precautions as I outlined above. Partials are very common and generally are not a big deal. Completes are very rare (although the specialist told me they were somewhat more common for IVF patients, in his experience).

I’m the poster who had the complete previa at 24 weeks. Yes I had transvaginal ultrasounds and yes it was complete (high risk doctor came in to confirm) and yes it moved.

[Anonymous]

Anonymous wrote:OP here- thank you so much for your replies everyone! It’s good to hear others experiences and that others have delivered at Sibley.

I especially appreciate the post on how to avoid bleeding. Some useful tips. I was diagnosed with two abdominal (one fetal echo) and one transvaginal ultrasound. And yes, it was an IVF pregnancy so that explains the higher risk of the complete previa. Fingers crossed it does move, but trying to be prepared for other scenarios.

If you do have a bleed, don’t blame yourself. All of my bleeds with a partial Previa happened when I was completely inactive (sitting on couch, sleeping, etc).

[Anonymous]

Anonymous wrote:

Anonymous wrote:OP here- thank you so much for your replies everyone! It’s good to hear others experiences and that others have delivered at Sibley.

I especially appreciate the post on how to avoid bleeding. Some useful tips. I was diagnosed with two abdominal (one fetal echo) and one transvaginal ultrasound. And yes, it was an IVF pregnancy so that explains the higher risk of the complete previa. Fingers crossed it does move, but trying to be prepared for other scenarios.

If you do have a bleed, don’t blame yourself. All of my bleeds with a partial Previa happened when I was completely inactive (sitting on couch, sleeping, etc).

NP here. Plus one to not blaming yourself if you experience a bleed. I had multiple bleeds during my previa pregnancy and they often seemed random. As one poster mentioned, uterine irritability seemed to be a factor in bleeding episodes, but you can’t reliably prevent that (although drinking lots of water may help).

[Anonymous]

I had complete previa from an ivf pregnancy, so hugs to you OP, it's really nerve wracking. I saw an mfm pretty often for the second half of pregnancy. I had steroid shots at 32 weeks as a precaution to develop babies lungs in case of an early preterm birth. I was scheduled to have a c-section at 37 weeks (the latest the mfm was comfortable letting me go), but ended up waking up with severe bleeding at 35 weeks, 6 days. Took an ambulance to the hospital as I was told not to walk around once the bleeding started. Had an emergency c-section, but with my regular OB who was in the hospital already. Everything turned out well--no NICU stay for DD, and we all went home after 3 days. Good luck to you!