21-Week Ultrasound and Placenta Previa: For Me, Never a Dull Pregnancy

This morning, the first day of my 21st week of pregnancy, I had my Level 2 ultrasound, the biggie in which every internal organ and external feature of a fetus is evaluated. 

The great news:  Our baby boy, estimated to be 1 pound 14 ounces, looks perfect in every way—his brain, his heart, his lungs, his stomach, his kidneys, his bladder, his arm and leg bones, and his 10 tiny fingers and toes. 

The doctor said that he saw no sign of chromosomal abnormality, which was reassuring to hear, even though my husband and I utilized pre-implantation genetic diagnosis (PGD) during our in vitro fertilization (IVF) cycles, which would have identified any abnormalities common with parents of advanced maternal and paternal age.  (My husband and I were 43 and 41 at the time of conception.)

Both the ultrasound technician and doctor confirmed that our baby is “still a boy,” so his “plumbing,” as the doctor called it, is normal also.

The bad news:  I am suffering from placenta previa, a condition in which the placenta is completely covering my cervix.

I’ve known that the placenta is blocking my cervix for five weeks now, but I was originally told not to worry because, as a baby grows, the placenta usually moves up as he/she repositions higher in the expanded area of the uterus.  But, today, my doctor said that I need to be resting every day, never lifting a thing, and refraining from having intercourse, for the goal is to protect the placenta so neither bleeding nor pre-term labor begins.

In the pregnancy book given to me by my high-risk practice, You & Your Baby: Pregnancy by Dr. Laura Riley, OB/GYN (Meredith Books, 2006), the placenta is described as “the organ that connects you and your baby.  It develops from the outermost layer of cells on the fertilized egg.  It takes oxygen and nutrients from the mother’s bloodstream and supplies them to the fetus.  It also removes the baby’s waste products, depositing them in the mother’s blood for elimination by the kidneys.  The baby is connected to the placenta by the umbilical cord.”

Regarding placenta previa, Dr. Riley wrote, “An ultrasound at 18-20 weeks may show a low-lying placenta or a placenta previa.  The ultrasound will be repeated in the 3rd trimester, when most low-lying placentas will no longer be low because the uterus has grown larger.  If the placenta still completely covers the cervix at the time of the 3rd trimester ultrasound, most of the time it stays there.  Placenta previa is usually diagnosed during the last 2 months of pregnancy.”

My doctor recommended that I return in three weeks, at 24 weeks of pregnancy, for a basic doctor visit, then again in six weeks, at 27 weeks of pregnancy, for a follow-up ultrasound to check not only the placenta, but also my cervix.

In the five weeks since my 16-week ultrasound, my cervix has shortened from more than 5 cm in length to 4 cm.  Today, the doctor said that any length more than 2.5 cm is considered good.  However, because of my diethylstilbestrol (DES)-induced uterine abnormality and a surgery to remove precancerous tissue from my cervix, I am at risk for incompetent cervix.  When I was pregnant with my 4-year-old son, I was already dilated at 27 weeks of pregnancy, so I was hospitalized, then put on bed rest.

Because of my previous pregnancy history, I wasn’t expecting any restrictions until approximately that same time period, six weeks from now.  So today was a bit of a shock, not only for me, but also for my poor husband.

I already know the treatment for incompetent cervix, which can sometimes be a cerclage, which is literally sewing the cervix shut, and bed rest.  The treatment for placenta previa, according to Dr. Riley, is as follows:

“If placenta previa is diagnosed, but there is no bleeding, your provider will probably tell you to go on bed rest or limit your activities to lessen the danger of bleeding until your baby is big enough to safely deliver by cesarean.  If you start to bleed, you will be admitted to the hospital; how long you will remain depends on several factors.  Cesarean deliveries are almost always necessary because the placenta would be torn from its roots during a vaginal delivery, causing life-threatening bleeding for mom and lack of oxygen for the baby.”

The bottom line is that perhaps the placenta previa will rectify itself, so I’m going to follow my doctor’s recommended restrictions, but I’m not going to worry needlessly.  I know that my high-risk practice is top-notch, so worse-case scenario I will be scheduled for a C-section prior to going into labor.  I have many friends who have survived C-sections with nothing more than a scar.

Regarding my risk for incompetent cervix, I’ve been in that situation already and followed my doctor’s orders so completely that my son was born on his due date, 13 weeks after my cervix had started to dilate. 

But, the first time around, I wasn’t told to give up intercourse.

My husband and I really, really love this little guy…

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