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Dr. Andrew Rynne

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Surrogate pregnancy. Scan showed low lying placenta. Blood test and urine test done. Cause of concern?

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Dr. S Patra

OBGYN

Practicing since :2011

Answered : 4047 Questions

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Posted on Thu, 14 Mar 2013 in Women's Health
Question: hi - we are having a surrogate child in India (we are in the U.S.). This morning we received a note from the clinic stating the surrogate (17 weeks) was admitted to the hospital due to bleeding. Could you please tell me what all these medical notes mean and if this is a serious condition with consequences?

17+2 weeks of gestation today admitted on 19/2/13 with threaten preterm labour for Safe confinement.
19/2/13-Hb-11.8 TLC-0000 PC-1.79
Urine routine-pus cells 8-10/hpf.
HIV, HBSAG, HCV- negative.
USG (19/2/13)-SLIUG 17w3d,variable lie,placenta posterior,low lying(1.9x0.8cm sized clot seen along the lower edge of placenta overlying the os.),liquor-adequate,EFW-195gms XXXXXXX os-closed,cervical length -adequate.
Patient is on HPD,CBR,head low,IV antibiotics,Inj Pause,Inj Duvadilan drip to be f/b cap Duvadilan R,inj proluton stat and weekly,Cap Thrive G, B protein powder, ARG 9 XXXXXXX Threptin biscuits, iron , calcium supplements.
doctor
Answered by Dr. S Patra 2 hours later
Hello,

Thanks for writing to us. I am trying to solve your problem.

First of all, I like to congratulate for appreciation of surrogate pregnancy.

Now, we come to test reports. Blood reports & urine test are within normal limit. Her ultrasound report is quite good enough except one thing i.e. low lying placenta and for this, she may face bleeding problem in 2nd- 3rd trimester of gestational age.

I try to discuss it with elaboration for proper understanding the situation. Generally placenta lies on the upper most muscular portion of the uterus. Both anterior & posterior positions of placenta are considered normal for mother and developing baby.

In present situation, she has to give more concern about low lying placenta which reaches towards cervical os. It may develop placenta previa, commonest cause of ante partum hemorrhage (APH) in the 3rd trimester. In such cases, risk of baby is high enough.

Though vaginal bleeding (mild) with low lying placenta is less significant in early weeks of 2nd trimester (17 weeks) but she needs to follow some precautionary measures to avoid future complication. Commonly, placenta moves up to upper part of uterus in most of the cases (90%) around 3rd trimester. Therefore, it is advisable to repeat the ultrasound scan (USG) at the begining of 3rd trimester to get detailed picture on feto placental profile (FPP) if there is no such complication like heavy bleeding etc.

In addition, if placenta still does not fix on the upper portion of the uterus or she get same findings as before even in 3rd trimester, she may get some complication of placenta previa like preterm delivery, excessive bleeding, intrauterine fetal death (IUFD) or still born.

Therefore, she must consult with her obstetrician immediately after getting less fetal movement or mild to moderate bleeding in the later months. Urgent caesarean section is required particularly in 3rd trimester to save the life of the baby and control excessive bleeding.

She must do the following things to avoid future complication:

1) Take healthy protein XXXXXXX diet with extra 350 Kcal/ day and consume more vegetables & fruits. Drink more water/ fluids for better feto-placental circulation. Continue taking Iron/ Calcium tablets with other supplements as prescribed by her doctor till the delivery of the baby and later.
2) Complete avoidance of any type of heavy work/ long journey or traveling/ strenuous activity/ stepping uneven surface/ using high heal shoe etc.
3) Take adequate bed rest, preferably 10-12 hrs in divided schedule and preferably in left lateral position or with foot end elevation by 1-2 pillows.
4) Maintain personal hygiene and do periodic check up of weight gain & BP for healthy pregnancy.

Hope, above information is very much sufficient to you. If you have any further questions I will be happy to help.

Wish her good health with successful journey of pregnancy.

Regards,
Dr Soumen.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. S Patra 53 minutes later
Hi - and thank you very much for the comprehensive reply. I wish they would have been as thorough as you were in your response!

A few questions:

1. Is the size of the blood clot large or small and what will happen to it (reabsorption, spotting, etc.). Will it irritate the fetal wall?

2. does "low lying" equate to placenta praeva or is that something that happens in 3rd trimester? In other words, is it over the os at the current moment?

3. can you tell if she was she admitted to the hospital? is that normal and for how long do they normally stay?

4. The medicine they are giving her - do you agree with? I read that Duvadian is not used in some countries.

5. Would you say she is high risk now for losing pregnancy?

Many thanks XXXXXXX
doctor
Answered by Dr. S Patra 1 hour later
Hello XXXXXXX

Thanks for follow up query. I am trying to give answer according to your query.

1) The size of the clot is very small and it is generally absorbed or expelled out with vaginal bleeding. It does not irritate or causes harmful effect to fetus being small sized.

2) Low lying placenta which reaches towards the XXXXXXX os of cervix and may cover up partially or completely. It is called placenta praevia in medical term. It is the most common cause of ante partum hemorrhage in 3rd trimester with having both maternal & fetal complication. It is an obstetric emergency.
In above ultrasound report, placenta is just over the XXXXXXX os and mostly fixed to upper part of uterus in 3rd trimester with enlargement of uterus.

3) As she took injectable antibiotics and other medication, it is possible for her to get admitted in the hospital.
Hospital staying depends on nature and amount of bleeding. It may extends from one to seven days maximum. As per ultrasound report, 1-2 days are enough and complete bed rest is advisable in home.

4) The prescribed medication and supplements are given for healthy pregnancy so that fetus can grow & develop well enough with low risk.
Duvadilan is an uterine relaxant and it can be used to support pregnancy & avoid miscarriage or preterm delivery. Though it is less valuable in early pregnancy.

5) In present condition, status of pregnancy is not so risky but she should follow all precautionary steps to avoid further complication specially in late 2nd to 3rd trimester.

If you do not have any clarifications, you can close the discussion and rate the answer.

Regards,
Dr Soumen.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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My wife is almost six months pregnant.It started bleeding from 2.5 months onwards.the cause is diagnosed as Placenta Abruptio(low Lying Placenta) ( Eariler there was one spot at the lower end but now the second one has formed at the top) . The bleeding is very severe. It is very random in nature and alongwith the blood some clots have started coming out.Doc has suggested to take injection whenever it bleeds severely.Doc has also told that its ablosultely perfect for the kid as of now.

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