Undiagnosed placenta previa?

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I have a question for you experienced nurses:

Does it make sense that a woman would not be diagnosed with previa until they showed up at full term in labor bleeding profusely? I just had never heard of this happening before and don't understand why it wouldn't have been seen on u/s.

Shannon

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

Sure, I suppose, if no u/s were done that would have diagnosed it! Are you sure she had u/s at any point where previa could be seen?

(or if she had no prenatal care til she showed up in your ED door)

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Yeah, what she said. :p

Was there an US done?

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Sorry, should have given more info. This was actually a friend who had all of her pre-natal care, including a 20-week u/s. I just couldn't believe that it had been missed. Aside from the fact that it was dangerous that she wasn't aware of it, she went all the way to term thinking she would be able to have an unmedicated natural birth...of course things can change at the last minute, but if she were aware of the previa ahead of time it wouldn't have been such a shockingly scary situation. We live on a barrier island and there are only 2 OBs, and I have serious doubts about one of them. Anyway, just wanted to get some other opinions!

Thanks!

Shannon

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It could have been a low lying placenta; they can bleed too... I'd be interested in who did the scan; location of the placenta is very important and at 20 weeks if a low lying or previa is diagnosed follow up should be scheduled.

I have had some patients who had an early dating ultrasound and that was all they wanted. Also the occasional mom who doesn't want any type of ultrasound, not even doppler (had to get my fetoscope out)...

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kinda off topic but how is the mom and baby? (I was a placenta previa baby born by c-section 6 weeks early.)

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Specializes in Education, FP, LNC, Forensics, ED, OB.

Sometimes US done early in pregnancy will not always be indicative of what happens at term. The placenta could be low lying as previously stated and cause major bleeding.

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But if it was a low-lying placenta shouldn't that have been followed? My friend is a very well-informed and intelligent woman with a medical background (well with animals anyway, she is a vet.) and if she had been told that it was low-lying I know she would have educated herself about what could happen.

Oh, thank God, literally, Mom and baby are doing great now. The baby is just beautiful. But they almost lost mom, the dr. told her it was as close as he'd come to losing a pt. and having a good outcome. It was a crash c-section under general, so very scary for the whole family.

Thanks for sharing your ideas!

Shannon

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Specializes in Education, FP, LNC, Forensics, ED, OB.
But if it was a low-lying placenta shouldn't that have been followed? My friend is a very well-informed and intelligent woman with a medical background (well with animals anyway, she is a vet.) and if she had been told that it was low-lying I know she would have educated herself about what could happen.

Oh, thank God, literally, Mom and baby are doing great now. The baby is just beautiful. But they almost lost mom, the dr. told her it was as close as he'd come to losing a pt. and having a good outcome. It was a crash c-section under general, so very scary for the whole family.

Thanks for sharing your ideas!

Shannon

The placenta can be low lying in early pregnancy and "self correct" as the pregnancy progresses. If she was informed about a low lying one, yes, she should have had another US nearer term. But, just because a praevia was not found on a 20 week gestation, does not mean it could not be one later on and without another US, this would not have been discovered.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

If it was an u/s done early and a "low-lying" placenta was observed, a follow up U/S was absolutely indicated!

anyhow I am just armchair quarterbacking here....I don't know the specifics, and I can speculate til the cows come home. The question is, how are mom and baby? (like the poster above asked)

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The placenta can be low lying in early pregnancy and "self correct" as the pregnancy progresses. If she was informed about a low lying one, yes, she should have had another US nearer term. But, just because a praevia was not found on a 20 week gestation, does not mean it could not be one later on and without another US, this would not have been discovered.

OK, so here is my question--it is possible then, that at 20 weeks it wouldn't have been a previa, but later on the placenta can move down? I had never heard of that, only thought it would sometimes move up! Great, something else to worry about if I am ever crazy enough to try for a 3rd, LOL!

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

I have not heard of a placenta migrating "downward"......

it really defies physics/physiology, if you think about it.

It implants thru the villi network very early in gestation. As the uterus grows, it "pulls" the placenta away from the cervical os upward---the placenta firmly attached to the uterus by this time.

To migrate down (if possible) would be a bad thing...it would have to have detached to do so.

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