I need some help/direction about placenta grading

[Burnt Out, ASN, RN]

I have some questions about the grading of placentas on u/s and I guess I need reassurance, advice, words of wisdom...something. :uhoh21:

Is a grade 3 placenta the worst there is? Or is there a grade 4?

The reason I am asking this is because I am 26 weeks pregnant. I was at work tonight (3p-7p) and I felt one contraction at 1730...so I sat down and was having a snack and I kept having them every 5-7 minutes. My co-workers sent me to L&D and I was placed on the monitor and baby looked good (although she didn't want to be monitored) and no ctx via the monitor although they could palpate them. They did a VE and I am dilated a fingertip, but my cervix is still thick and she (the baby) is very ballotable (sp), so they assured me I was not in preterm labor. I went for an U/S and my placenta is a grade 3-my AFI is 19 cm.

Now a little history: my first child was born at 32 weeks due to PIH and my placenta failing (grade 3 the day he was born)-my AFI with him was 4.5 the day he was delivered. Most of you know or may remember that he died at 12 days of age from complications of Tetralogy of Fallot.

So far in this pregnancy, I've had hyperemesis gravidarum and chronic hypertension which has been controlled on meds.

I guess what I am wanting to know is it possible I may have to deliver my daughter soon because of the placenta? Would bedrest help buy us any time? What kind of care should I expect from my ob/gyn-at the very least, I am thinking weekly U/S and NSTs. And if, we do end up having to deliver her soon, she should survive, right? I know she would be in the NICU for a long time and every week she stays inside is better, but if my placenta is this bad now.... it may not be safe for her to remain inside me much longer.

Any words that may help will be appreciated. I want her to come home...I've done lost one child...I can't take losing another.

I sincerely appreciate anything ya'll can tell me.

Very scared, nervous and worried in Alabama,

Ginger

[SmilingBluEyes]

Lord, what you must be going through right now. I don't like saying it, but I am a little concerned by what I am reading here. Have you talked to your OB about all this? Has he/she brought a perinatologist into the situation to oversee your care? I hope so. I can't answer for sure all your questions here and now. But you have made it to 26 weeks. That is good news. They should be watching you VERY closely from this point on and at any point the baby begins to look troubled, be discussing with you the possibility of early delivery.

As you know, "grade 3" means your placenta is likely quite calcified (a condition going with PIH/hypertension often), so at some point, its optimal functioning may be compromised. My bet is knowing this, your doctor will order very frequent testing to see how the baby is doing, biophysical profiles, most likely. At any point when things look troublesome, like I said, expect him or her to discuss immediate delivery. The good news is, the closer to 30 weeks, the better off your baby will be. It's amazing how far we have come, caring for little ones and them going home well and healthy. It's very common for our NICUs to care for 26-28 weekers and send them home at some point, doing rather well. So take heart. If it's in the cards that you will have to deliver early, you have a very good chance at having the baby come home healthy later on.

You mentioned Tetralogy in the first baby, wow I am sorry..........have they done an extensive level 2 scan to be sure THIS baby does not have the same problem? If I missed this information, I am sorry. Hopefullly this is not the case with this baby?

Hugs and please make sure you ask ALL these questions (and more if you think of them) of your OB. Ask about a perinatologist's consult, if appropriate. Hang in there and I wish you the best. You must be petrified. Try to remain calm, for your sake and that of your baby. You have at least passed the point of viability, the point where your baby can be delivered and cared for in the NICU. Grab onto any good news you can, and focus on that, hoping for the best!

[AmyB]

(((?burntout))) I'm so sorry this is happening to you. Deb is a wonderful person to seek advice from - very knowledgable and compassionate. I hope all goes well with this pregnancy and that you will be blessed with a healthy baby when all is said and done. Good luck.

[akcarmean, LPN]

I am sorry I don't have any medically advice I can give you but I do have emotional and support. I had a child born at 28 wks. he is now 12yrs. 145 lbs and 5'3" . I have also had a still born child died 4 days away from due date. When I delivered her dr. figured that she had only been dead about 6 hrs. So I can off mental support. Please feel free to PM or email me. I will add you and the baby to my prayers. Please get a hold of Dr. and start ask ????. Make sure that you feel like you are statisifided and comfortable. Yes I do believe that bed rest would help. I did in the case with my 2nd child who started to come early put on bed rest and then went over due. Please if you need to talk email me.

Angie

[Jolie, BSN]

My very best wishes to you. Deb did an excellent job of outlining your needs. The only thing I would add is to discuss with your OB and/or perinatologist the advisability of receiving antenatal steroids to help mature the baby's organ systems (especially the lungs), should early delivery be required. This, along with surfactant therapy has gone a long way in preventing many of the complications of prematurity.

Please keep us posted!

[Burnt Out, ASN, RN]

We had a f/u u/s today to check on the baby and placenta. The on call ob/gyn wouldn't let me be discharged from L & D last night until I assured him I had an u/s today.

Everything is fine. The tech that does all my ob/gyn's u/s immediately looked at the placenta after I told her about last night's scan at my hospital and the placenta is a grade 0. My ob/gyn looked and said it is not a grade 3-it is definately a grade 0. My AFI is still unchanged at 19 cm. So it looks like I fell into the hands of an incompetent u/s tech last night. :stone :angryfire My ob/gyn and his sonographer informed me that the techs (u/s) at our hospital really do not get a lot of experience with ob patients. I am so grateful my daughter is fine and the placenta is fine, but beyond furious about being terrified that my little girl could come now at 26 weeks and imagining all the worst case scenerios (sp). My ob/gyn is going to talk with the head of radiology at our hospital.

I had in my mind the list of potential treatment: bedrest; at the very least, weekly BPPs and NSTs; a consult with a perinatologist, and I had planned on discussing antenatal steroids with my doctor. I did get one steroid injection before my son was born and he was on o2 for 36 hours after his birth, then weaned-he never had to be vented until the day before his death.

And yes, we had a very extensive level 2 scan and fetal echo with this baby since our son had Tetralogy-he had bilateral cleft lip and palate too. She has been declared "heart healthy" and there is no evidence of cleft lip or palate or other problems :). We also had a consult with a geneticist and both my husband and I were tested to see if we are a carrier for Velocardiofacial (or DiGeorge) Syndrome: the geneticist believes our son had DiGeorge Syndrome, although we will never know 100% as it requires a highly specialized blood test to confirm and neither my hubby or I carry this gene.

Thank you all for your support....it has been a very long day as I didn't sleep well last night. Sending out big (((((((Thank You))))))) hugs. I'm sure there will be more questions down the road.

[SmilingBluEyes]

VERY encouraging. This definately makes the whole scenario better. I am happy for you. Just take it easy and PAY ATTENTION to that blood pressure! Critical!!! Know your "cardinal signs" of trouble and get to a doctor if anything untoward comes up.