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[quote=Anonymous][quote=Anonymous]Yes.

I had a similar situation except my accreta was discovered after a stillborn baby (conceived by medicated IUI).  (More specifically, a vaginal birth of a stillborn baby, a placenta that wouldn't deliver and so an immediate D&C, then an infection a week later followed by another D&C, and then imaging that discovered an increta (i.e. the middle level of accreta).  The accreta ultimately "cleared" on its own.)  I was particularly aggressive in seeking out experts about how to have a living child after that experience.  Here's what I did:

1.  Imaging (including MRI and HSG) to confirm no residual tissue or problematic scarring before TTC.  Consulted with MFM (in DC, see below, and also at the Brigham in Boston (they reviewed films, records, and I did a call with the MFM): https://www.brighamandwomens.org/obgyn/maternal-fetal-medicine/meet-our-team)

2.  Conceived via medicated IUI again (this was where we were in our fertility process, so we weren't considering IVF yet).

3.  Once I was pregnant, I was actively treated by an MFM (Dr. Pinckert at GWMFM; I cannot recommend him highly enough.  I also saw Dr Gallagher as backup, then at GWMFM, now at GW, and he was also great.)

4.  Of course my situation was monitoring for both the accreta and the baby's health given my history, but I had ultrasound (the high quality one at the MFM) and doppler every 2 weeks until 24 weeks, and then every week after that.  That included looking for any indication of an accreta (this is a helpful summary:https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Placenta-Accreta)

5.  Did an MRI around 30 weeks.  It was done at Georgetown, and then also sent to the radiologists at the Brigham.

6.  Planned c section at 40 weeks.  A two person MFM team + fellow delivered.  A friend who is a neonatal specialist was the pediatrician at delivery.  The original plan was to have interventional radiologists in the room in case bleeding needed to be controlled, but given the confidence from the imaging, they had those people on call in the hospital but not in the room.

No complications at delivery.  I bled a bit heavily during the c-section and it took a while for them to close during surgery, but not enough to transfuse.  Normal c-section delivery, perfect DC.

I'm now in IVF trying to have another child and have gone through another round of MFM consults.  The consensus at this point is that I am "normal" (though old!)

You're absolutely right that this is more art than science (the story with women's health in general), and the thing I found I relied on was working with the people who had the most accumulated experience of THIS thing.  That's what expertise is in this field.

On the general scarring issue, I have a good friend who had scarring from a loss and infection (not accreta) who struggled with implantation from IVF after that.  She also consulted with the Brigham team and was very happy.

Hope that helps.  All the best to you.    [/quote]

My goodness. Thank you doesn’t cover it. First of all, I am so sorry about your initial experience. That is truly heart-wrenching, and I am just so sorry.

Second, thank you for this wealth of information. I actually have consulted with Dr. Pinckert and plan to stay with him if I’m fortunate enough to get pregnant. If it’s not too much to ask, do you mind telling me if it was Dr. Pinckert who recommended the pre-TTC MRI? He did not recommend that for me despite the accreta. Perhaps it’s because my hysteroscopy looked ok after the delivery (apparently my OB saved my uterus), but a hysteroscopy wouldn’t spot microscopic damage. At the very least, I want to folllow up with him as we are considering a cycle very soon.

Third, and again, if I am bothering you, please ignore me, but I’m intrigued that you got to 40 weeks. Was that because of imaging? In my consultation, Dr. Pinckert suggested 38-39, which isn’t awful, but given that I carried DS to 41, and he was still a small fry, I’m a little nervous. Your story gives me reason, yet again, to follow up.

I am so glad that you’re c-section went well and without transfusion. Mostly I’m glad you got a healthy baby.

I confess I’m a little terrified of what my propensity toward accreta could mean for me, and now for a possible baby. I realize I was ignorant about the latter; no one ever mentioned that before. Yet another thing to follow up on.

Brigham in Boston is phenomenal (I used to live up there); I will look into that as well. Thank you again, truly. [/quote]

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