Placenta Previa: Should We Opt for Early Delivery?

Placenta previa

My wife has been diagnosed with placenta previa by her obstetrician, who has recommended a cesarean section.
We are currently at 36 weeks, but the fetus weighs only 2300g.
The doctor advised that we should definitely have the cesarean at 38 weeks to avoid the risk of significant bleeding.
However, we are concerned that at 38 weeks, the fetus may only weigh around 2500g, which seems a bit low.
Therefore, we hope to delay the delivery until 40 weeks.
We would like to ask the doctor: should we follow the doctor's advice and deliver early? If we decide to postpone, what precautions should we take? Thank you.

A Tian, 30~39 year old female. Ask Date: 2000/11/17

Dr. Li Guanghan reply Obstetrics and Gynecology

Placenta previa occurs when the placenta implants in an abnormal position, leading to reduced nutrient supply to the fetus.
By 36 weeks, a fetus may weigh approximately 2300 grams, which is about 400 grams less than expected.
If the due date is accurate, this condition is classified as intrauterine growth restriction (IUGR).
Therefore, the fetal weight at 38 or 40 weeks should not differ significantly.
However, there is a risk of severe bleeding during labor, so it is still recommended to follow the physician's advice.

Reply Date: 2000/11/17

More Info

Placenta previa is a condition where the placenta is abnormally positioned in the lower part of the uterus, covering or being very close to the cervix. This can lead to significant complications during labor, including severe bleeding, which can be life-threatening for both the mother and the baby. Given your wife's diagnosis and the recommendation for a cesarean section at 38 weeks, it is crucial to weigh the risks and benefits carefully.

Your wife's current gestational age of 36 weeks and the estimated fetal weight of 2300 grams indicate that while the baby is nearing term, it is still on the lower side of the expected weight for this stage of pregnancy. The concern about the baby's weight is valid, as a weight of 2500 grams at 38 weeks is still considered low, but it is essential to consider the risks associated with placenta previa.

The primary reason for recommending an early cesarean delivery in cases of placenta previa is to prevent the risk of hemorrhage. If labor were to start naturally, the placenta could detach or bleed significantly, leading to a medical emergency. The recommendation for delivery at 38 weeks is based on the balance of risks: the risk of the baby being born slightly underweight versus the risk of severe maternal bleeding.

If you are considering delaying the delivery to 40 weeks, several factors should be taken into account:
1. Monitoring: Continuous monitoring of both the mother and the fetus is essential. This includes regular ultrasounds to assess the placenta's position and the baby's growth. If there are any signs of distress or complications, immediate action may be necessary.

2. Signs of Labor: Be vigilant for any signs of labor or bleeding. If your wife experiences any contractions, bleeding, or unusual pain, it is crucial to seek medical attention immediately.

3. Hospital Preparedness: If you choose to delay delivery, ensure that you are prepared for a quick trip to the hospital. It might be wise to have a plan in place for transportation, especially if labor starts unexpectedly.

4. Consultation with Healthcare Providers: Maintain open communication with your healthcare team. Discuss your concerns about the baby's weight and the risks associated with placenta previa. They may provide additional insights or adjust their recommendations based on your wife's specific situation.

5. Consider the Risks: Ultimately, the decision should be made based on a thorough understanding of the risks involved. While it is natural to want the baby to reach a certain weight before delivery, the risks associated with waiting longer in the context of placenta previa may outweigh the benefits.

In conclusion, while the desire to wait for a higher fetal weight is understandable, the recommendation for early delivery is primarily to safeguard against the potentially life-threatening complications of placenta previa. It is essential to follow your healthcare provider's advice, as they are best equipped to assess the risks and benefits in your wife's specific case. Always prioritize safety for both the mother and the baby in making your decision.

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