Advice from Dr. Weiss

June 05, 2009 12:00 AM

Q: I’m in my second trimester and the doctor suspects I have placenta previa. Will I have to have a C-section? I wish there were some way around it.

A: You might not have to have surgery- if it turns out you don’t have placenta previa. The condition causes the placenta to overlap your cervix, which needs to dilate to allow delivery of the baby. The concern is that as the cervix dilates, the placenta could tear and bleed, which is dangerous for you, the mother. But the relationship of the placenta to the cervix isn’t as clear in your second trimester as it is when you get close to full term.

This is because by the middle trimester, your placenta has already grown large in size, but your uterus will expand a lot more before you deliver. So, it can be difficult to determine by ultrasound where the placenta is actually growing into the uterus or just touching it.

At 27 weeks, there’s still a 51% chance that what your doctor’s seeing isn’t really a previa. There are several types of placenta previa: “Total” means the cervix is completely covered, while “partial,” or “marginal,” and “low-lying” mean the obstruction is less than complete. If your doctor already sees total previa, the odds may not be as sunny that it will resolve itself.

As your uterus enlarges, your ob/gyn should be able to tell if you really have placenta previa. Once you’re at 28 weeks, if yu still have a possible diagnosis, your doctor may put you on pelvic rest, which means no sex or pelvic exams, and possibly limit your exercise. And if it turnsout that you do have placenta previa, a C-section will be the safest way to deliver.

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