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Old 04-18-2012, 10:17 PM   #31
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Originally Posted by daniele_ut
I've had 4 c-sections. The first was a crash c-section at 26 weeks under general anesthesia because of severe fetal distress and DD did not make it. DD had Amniotic Band Syndrome, which is very rare. I had a low transverse incision and healed perfectly.

17 months later I was the perfect VBAC candidate with DS, and was 5cm dilated at 36 weeks but he was frank breech. I went into labor that night and my fluid level dropped too low to safely turn him, so I had a repeat c-section. Everything went perfectly with my recovery again, though DS spent 3 weeks in the NICU for immature lungs and feeding issues.

We waited almost 3 years to have DD2 after that and I almost had a VBA2C, but I chickened out. That 3rd c-section was my easiest recovery and my doc was fine with us trying for one more, but the Maternal Fetal specialists warned me at my ultrasound of the risks of something called placenta increta and the possibility of needed a hysterectomy for hemorrhaging. I filed that away in a very remote place in my mind because I really thought we were done having kids at that point.

3 years later, I found myself pregnant 16 months after having my IUD out. I tried to be really positive about this pregnancy and tell myself that everything was just fine, but in the back of my mind I knew right away that things wouldn't go as we had planned. At my 19 week ultrasound I was diagnosed with complete placenta previa, which combined with my 3 previous c-sections gave me a 70% chance of having placenta accreta. In the 1950s accreta was extremely rare, occurring in something like 1 in 50,000 pregnancies. Fast forward to the present, when c-sections are SO much more common, and it happens in between 1 in 500 and 1 in 2500 pregnancies and it is no joke. It is extremely serious and can be life threatening. Basically, the uterine lining is damaged because of the repeated scarring from multiple c-sections and it allows the placenta to implant too deeply into the uterine wall. During delivery the placenta will not detach well and will lead to major bleeding, usually resulting in a hysterectomy to save the mother's life.

I was put on pelvic rest and restricted activity (no exercise, no heavy lifting) and was told not to travel. We were leaving on a trip to Walt Disney World followed by a cruise the day after my ultrasound and it had to be cancelled because I couldn't be that far from medical care in case I started to hemorrhage. I cried for a solid week and then spent most of the next 4 months wondering if I was going to have a massive hemorrhage. We started getting ready for a planned c-section/hysterectomy that would happen at 36 weeks.

You can tell from reading most of the responses on this thread that very often a 4th or more c-section happens without any complications, but the risk is there and it's very real. I had a whole support group on Babycenter and we were all in the same boat. I know most people focus on uterine rupture as the only risk, but there are others and most people have never heard of placenta accreta/increta/percreta. I had to have a pelvic MRI at 28 weeks to assess the damage my placenta was doing and luckily it hadn't grown through the uterine wall and attached to my bladder. When that happens (called percreta) the surgery becomes even more dangerous.

My delivery happened in the main OR in the hospital and involved 2 OB surgeons, 2 anesthesiologists, a urologist, the NICU team and a startling number of nurses. It was performed under general anesthesia and dh was not allowed in the room. Because the risks of contractions causing major bleeding, I could not be allowed to go into labor. Since I had a previous spontaneous pre term delivery at 36 weeks, they weren't comfortable letting me go past 36 weeks and even though he had steroids, DS2 ended up in the NICU for 3 weeks for tachypnia, then jaundice and feeding issues. They had typed and cross matched 2 units of blood for me, but luckily I didn't need a transfusion. That's extremely uncommon, though. I had adhesions that had attached my uterus to my bladder, so I did end up needing bladder repair and had a catheter for 5 days. The pathology report came back the day I was released from the hospital and it showed placenta increta, which means the placenta was imbedded in the muscle of the uterus.

I don't mean to frighten anyone, but as a mentioned above, the risk is there and anyone contemplating a pregnancy after 3 or more c-sections should be aware. I had totally uncomplicated deliveries and recoveries the first 3 times. I'm completely recovered now and feel like we would have been done after this baby regardless of how my pregnancy went, but sometimes I get pangs when I remember the choice was taken away from me.
Wow mama your story sound very similar to mine. I also had placenta previa and increta. I had to have a bladder repair and a catheter for 2 weeks. I delivered at 33 weeks but required 4 units of blood products. I had a MFM 3 residents, 2 anesthesiologists, a urologist, too many nurses to count, and the NICU team. Also like you I was in the main OR under general anesthesia, and my husband was not allowed in the OR.
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