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Earlier had delivery through c section. Now have marginal placenta previa. What are the risks?

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Practicing since : 1999
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can i ask some questions about my third pregnancy?
i had my first at 36 weeks emerg csection - placenta not feeding baby, had calcified, grading III
i had my 2nd at 34 1/2 emerg csection - right pain, cramping, placental abruption had occured by 20%
i am now 19 weeks with third pregnancy...
i will be visitng a few high risk specialists to have a look at history and way ahead...
Do you think this baby should be taken out earlier?
To keep on safe side...?
Right now placnetal grade is I and placental location is anterior, 1.3cm away from XXXXXXX OS
Posted Fri, 15 Feb 2013 in Pregnancy
Answered by Dr. Timothy Raichle 1 hour later
Hello, I would be happy to help you with your question.

So to summarize (I will make a couple of assumptions):

1. 36 weeks urgent C/S for placental insufficiency and probably IUGR (intra-uterine fetal growth restriction)
2. 34+ weeks urgent C/S for placental abruption
3. You are 19 weeks pregnant
4. You have a low-lying / marginal placenta previa

Here is what I think:
1. You obviously have a higher risk for problems in pregnancy
2. Sometimes these different problems point to a common underlying cause. Patients with a history of IUGR and placental abruption commonly have underlying blood pressure issues (chronic HTN or preeclampsia) or a predisposition to blood-clotting (called a thrombophilia)
3. The low-lying placenta is a problem if it is towards the front, or anterior, as there will be an increased risk for something called placenta accreta - someone needs to review the scans with you to say if this is a concern at all.

Here is what should happen:
1. Review of the prior pregnancies to determine if BP was ever an issue
2. You need labs related to thrombophilia - these indicate whether you have an increased risk for blood clotting (and also an increased risk for IUGR and placental abruption). These problems are all tied together by common causes.
3. If you smoke then you MUST stop, because this can cause all of these problems too.
4. Someone needs to tell you where the placenta is and you need to ask "are you concerned about placenta accreta?"

In answer to your question:
No, the baby does not need to be taken early. You need a targeted scan of the baby at about 20 weeks, followup growth scans every month (24/28/32 and 36 wks) and weekly testing of the baby at 32 weeks. If the baby falls below the 10%ile, then it needs to be followed even closer with delivery by 37 weeks at the latest

This is a generic answer, but hopefully helpful. Please ask if you have additional questions or need clarification.
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Follow-up: Earlier had delivery through c section. Now have marginal placenta previa. What are the risks? 28 minutes later
Thank you very much
I will be meeting with a team of Doctors next week so i will follow up re: the accreta as my placenta is currently anterior and lowlying and yes i have always had low bp
i also had endometriosis stage 3 - diagonosed in 2001 with a laporascopy and a uterine suspension
Answered by Dr. Timothy Raichle 1 hour later
Make a list of questions - hopefully my answer will guide you in this way. The endometriosis is only an issue if they think there will be significant adhesions at the time of delivery and in this case, you should request that at least two Attending OB's are present for the C/S.

Good luck and let me know if you have any more questions.

Please take time to leave feedback!
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