Placenta Accreta and Possible Partial Hyster

Hi ladies. I am new to this site. I am currently 14 weeks pregnant. I may, possibly, have a condition called placenta accreta. A sticky uterus. My placenta can grow into my uterus and become a part of it. When the placenta is removed during delivery, a hole is created and I can bleed out. This is my 7th pregnancy and I have had 3 children, with only my 2 daughters with me. This will be my last pregnancy. I am 35. I am due in February. My high risk dr. has said I can be induced, in a controlled environment, and have my tubes tied the next day, have a csection and have tubes tied or have a csection and have uterus (and only uterus) removed if I start to bleed profusely. He has also said that he would take my uterus if I was interested in permanent birth control, which does sound very appealing. But only uterus, no ovaries, no cervix.

So what I would like to know is if anyone out there has had a partial hyster. and how do they feel about it? Any adverse affects on them or their sex life? Do you regret this decision? Would you have done anything differently? I am very confused what to do. I have only give birth vaginally, never had a csection so I am a bit nervous about the section. But I am also nervous about this accreta condition. It does not always present itself or come back. 1 in 4 chance of having it again. We will be monitoring me later in preg. with an MRI to see if we can see any adverse signs but 20% of the time it can be there and not be detected.

Any information or comments any of you ladies may have about a partial hyster. would be appreciated. Thank you. Marsha Salome

Hi,
You may want to post this question on the Post-Op Message board with the heading being in regards to the partial hyst. There are some women on the board who have had that procedure done, and I am sure they would be willing to answer any questions you have.

Marsha, I know you are getting some replies over in Post-op on how women feel about their hysts, so I won't address that part of your question other than to say that the majority of women find that when they have had no other options left to them and chose a hyst as their solution of last resort to miserable or life-threatening conditions, they are the best able to accept with equanimity the problems they might encounter post-op.

In your case, where there are so many unknowns as to whether this really is a life-threatening condition (or, at least, situation), your decision is that much more difficult. I'm going to offer you some thoughts on the middle ground, here, based on my professional experience as a neonatal intensive care nurse who was the night on-call for all distressed deliveries.

Because the delivery process involves two individuals who have, in some cases, competing needs and because the whole situation is one of rapid flux, any addition of an unexpected or unusual element can add to the chaos level and, ultimately, can have its cost in the ultimate health of one or both of those individuals. The more orderly and under control the process, the more likely the outcome is to be the best possible. While most people would prefer to hope for the best and figure they can scramble to deal with the worst, in my experience a more successful outcome comes from planning for the worst and being surprised and relieved at instead getting the best.

In your case, then, going through with a vag delivery and then having a serious bleed adds stresses to your system, weakens you with the delay in treatment while they scramble to prep and begin surgery, and puts doctors under the pressure that can result in errors or hasty technique that causes complications like adhesions later.

In this situation, then, I see the middle ground as the choice of having a section with the option of the hyst if the accreta is present and does cause uterine damage. Here, while you may have an "unnecessary" section (that judgement being at that wonderful vantage of after-the-fact) if all goes well, you are perfectly poised if it does not. You are prepped, there is an anesthesia team present and anesthesia is already in place (either general or, if you prefer to be awake, spinal), there is a team standing by for your baby (who knows where in the process you might bleed, and whether this would also affect your baby, who has a much lower blood volume to play with?) so your doctor isn't worrying about baby-needs to the detriment of his concentration, and all of the equipment and resources are in place for whichever way things might go.

The benefits here are enormous. The costs here are the risks of surgery, the fact of a possibly uneccessary surgery, the effects on the quality of the birth experience (in terms of it being a surgical one rather than a more "natural" and social one), the financial costs, and the increased recovery time.

I cannot, of course, weigh these for you. But I would point to them as worthy of consideration. We have a tendency to see a delivery or a surgery as an endpoint, and forget to look beyond them. Don't neglect what the various outcomes will mean in the weeks following surgery when your ability to be with your new child are so precious.

You have a difficult and complex decision to make, weighing so many what-ifs. I hope that what I've offered you helps you bring in other factors than just the question of the hyst. Please know our thoughts are with you, and do let us know how its going for you. [blue]

Thank you for posting a reply. I also appreciate your opinion, especially with your nursing background.

You are correct in that a controlled environment is best. My due date is 3/2 and my high risk said that I will be picking a date 2 weeks earlier to deliver, whether by vaginal or csection. He also said if the accreta is present, which an MRI can tell 80% of the time, I will be csectioned at 36 weeks, with steroids given at 34 weeks to mature the baby's lungs. I will be getting a MRI, color dopplar, later in pregnancy. While it may show that no accreta is present, there is still a 20% chance it can be wrong.

I am going in the direction of a csection. I agree with you on this also. While yes, it may prove to have been unnecessary, it also will be beneficial if I do have a problem. And if I don't, my tubes will be available to tie, if I choose this over taking out my uterus. Yes, my doc has offered me the chance to have my uterus removed, even if not called for, should I wish. My cervix will be left in tact. My grandmother on my mom's side died of ovarian cancer at 53 and my mom had a total hyster. at 35 due to excessive bleeding for 1.5 years. There is a history of family trouble in this area but this was my first brush with it. He said he would check out my ovaries to make sure they look okay.

I feel this unknown urge to get the csection and have the uterus removed. Why? I wonder if I am swayed by no periods (YEHH) and knowing, for sure, that I will not have any more children. I have experienced a lot in this department.

In short;

93 birth of my daughter, vaginally
95 1st m/c
96 2nd m/c - d&c needed
97 birth of my son at 19.5 weeks due to poor medical diagnosis -he had severe hydrocephalus and was missing his entire cerebellum, 1/3 of his brain. other things wrong but minor compared to these. We decided to proceed with a termination. We held him and named him Sky and baptised him ourselves. He was very much wanted and loved. D&C needed, placenta retained
98 birth of my 2nd daughter, vaginally
99 3rd m/c due to triploid. Baby had extra set of chromosomes due to my egg not dividing so it was maternal triploid - d&c needed and lost 2 liters of blood and that is when the diagnosis of possible accreta made
00 - due 3/02/01

So you can see, I have experienced quite a bit in my pregnancy past. I am tired and look forward to not having to worry about being pregnant. Not that I ever worried before, we have tried for all of our pregnancies and it took 10 months to get preg. with our son, 7 months with our 2nd daughter, 3 months with our 1st daughter. Getting preg. has not come easily and neither has staying pregnant.

I feel I am done with my childbearing and would like to concentrate on other aspects of life. I have lived the last 6 years being pregnant each year and have experienced many disappointments. Knowing that this is my last pregnancy has brought a sense of peace to me. And I feel it because I KNOW this is the last pregnancy. Some sense of control over a situation that lots of times has no sense.

Sorry to ramble. I appreciate your points and hope to continue to speak to you and others about my choice(s). I have months to think and go back and forth but I believe csection is the way I will go.

Look forward to speaking to you again. Thank you. Marsha Salome

My heart goes out to you and all of your pregnacy losses, I truely do understand, as I have been pregnant 6 times and have three children. I lost three, and never was given a reason.....they now think it is part of my long trem endometrosis that no one even suspected. I have had one D&C like you, mine was at 12 weeks for a blighted ovam. I had a severe case of PID after my first child, cause the dingbat nurse midwife ripped out the placenta.....leaving bits inside me, for 10 months until the PID was caught.....didn't need a D&C because I hemmoraged and cleaned myself out. So from that histroy I say I understand 100%, I feel for you, my heart aches for you and I pray that this baby is perfectly fine, happy and healty. As for the possible hyster do to placenta accreta. I would play it by ear. Do the C-section.......don't even consider the vaginal route. Here is why I say that.....first you mentioned that you are done doing the pregnancy thing (hey can't blame you, I quit when I did because it just got too hard emotionally, especially after the last one needed cpr at delievery.......it was all too much and needed to end!) so you want your tubes tied.....good idea. They can do that at delievery with a c-section, but in an additition the doc can go in there and carefully remove the placenta. That way you have the best chance, JMHO to save your uterus. Just in case you ever want to try the baby thing again (yeah I know, slim chance ) and two to advoid a partial hysterectomy if that is NOT what you want. If it turns out that you do want the hyster, then you can get it done in an controled enviroment. In any case doing a c-section just may save your life, because they will be better able to stop hemmoraging (think hemmoraging, vagianial birth, emergancy e-section etc). I wish you the best as you face a tough decision. I pray that this pregnacy gives you a wonderful healthy child. I wish upon you many blessings.

Lisa: Where are you from in Michigan? I am also in Michigan. Thank you for your words of encouragement and your opinion. I am definitely thinking along the lines of you. Csection does seem to be the safest way for me to go, whether we find it is unnecessary or not. Yes, everything will be accessible and viewable. I am nervous about a csection. My doc wants me to donate my own blood, 500 ccs, just in case. Nervous about that too. I get queazy about blood. I get lightheaded just at the thought of it. Hope I don't pass out upon donating. LOL Anyway, it has been helpful to talk with others. I just wish I knew what to choose: tubes being tied or uterus removal. Yes, I know that it could be decided for me if there is hemorrhaging but if there isn't, the option is open to me to just remove the uterus. I know everyone is different. Not having a period anymore is very enticing. Guess I will have to wait until I deliver and what frame of mind I am in and what happens with the csection to decide. Thanks again and let me know where you are from in Michigan. Take care. Marsha

One thing about your whole situation that is super......you have quite a bit of time to weigh the pro's and con's and decide what you are going to do, also you might find out something in an upcomming ultrasound that will make your choice clear.

I am from Grand Rapids (went to high school in Sparta....about a 15 min drive north of the city.....little town) My husband is from the Battle Creek area, a little town called Lacy (well not really a town, a four way stop, 6-7 houses near the corner, and the remenats of a general store from 1870's but not much else :-) When we are finished with the service in December we are coming back, to where we don't know, it all depends on were DH gets a job. Where are you from in michigan??

Lisa: I am in St. Clair Shores, about 20 minutes from downtown Detroit. Have lived here all my life. Don't know much about Grand Rapids except that it is about 2-3 hours from me.

On Wed. Oct 4 I will be getting my 19 week u/s. Am anxious because 1) Want to know if baby is okay; 2) if we see any sign of an accreta; and 3) to determine the sex. I am hoping all is well and no sign of accreta, although that does not mean it is not there. From what I understand, you can only confirm an accreta by actually seeing it and that would mean a csection and the dr. actually lifting your placenta and uterus out. Not many women that I have spoken to have had this happen. We are all "suspected" accreta. But that is enough for me.

Will let all of you know what I find out, if anything, at that ultrasound.

I am also due to have my AFP blood test done next week. That can also indicate a possible accreta if the numbers come back high. I do know the HIGH false positive rate of that test for Downs and/or spina bifida. I am relying more on this test for an accreta result more than anything. I have only had the AFP test for one of my pregnancies, my second daughter who was my 5th pregnancy and only because she followed my son, Sky. It must have been normal because I never heard anything and she was okay and her birth was excellent!!! Arrived at hospital at 3:15 a.m. and was at 10 and ready to push but had to wait for dr. Delivered her at 3:46 a.m. Woke up only 2 hours before feeling slightly crampy and then about 2:45 a.m. it kicked in. I wish all women had labor like I did wher her!!!!

So, we shall see. Will keep all updated and thank you again for your posts!! Marsha

Marsha,

I too, lost several children during my preganacies, without ever having a specific reason. Each time there was a different speculation.

I had a hysterectomy last September, and believe me, when they say the recovery time is a year, they are correct. If I had a choice, I would have opted to keep my uterus, keep having the sporadic, hemmhorage-like periods, and let them end naturally. Unfortunately, the case of grapefruit sized fibroids that I carried in my belly prevailed, damaging all my internal organs. It forced me to trade my damaged uterus and ovaries for major hot flashes, night sweats and big time depression. The instant menopause changed my personality, and not for the better. It was 6 months before I was recovered enough to work, and then, even tho I went back to work full-time, the office staff covered for me so I could leave early most days. They could see I wasn't recovered, even tho I didn't realize it myself.

Think long and hard about giving up your uterus. If it isn't optional, then be glad to let it go, but if it is not damaged, I would vote to keep it!

Cris: Thanks for responding. Unlike your situation I would only have my uterus removed, not my ovaries. So I would not have to deal with hormone therapy or hot flashes. I would only not experience a period or be able to have children. If this info is wrong, someone please correct me, but this is what I have been told. The uterus does eventually absorb back into the body as we age and as we go through menopause. We lose it eventually anyway. I understand that women feel very different after having a TOTAL hyster. but do any of you feel very different than before the surgery for having just your uterus removed? Remember, just the uterus.

As you said, to save my life, remove the uterus for sure. But, now that I have been given the option of removing it, whether a problem or not, I am trying to explore all avenues of opinion and feelings on the subject.

Thanks again. Marsha