Marginal Placental Tear: What Kind of Delivery Can I Expect?

Two weeks ago, at 32 weeks, I was hospitalized for a "marginal placental tear." I lost 250 to 400 cc of blood prior to admission. A NST and ultrasound showed baby was fine, but in a complete breech presentation. Since coming home, I have continued to bleed, similar to a light period. If baby presents head first, but I continue to bleed, will I be able to have a vaginal delivery?

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Peg Plumbo CNM

Peg Plumbo has been a certified nurse-midwife (CNM) since 1976. She has assisted at over 1,000 births and currently teaches in the... Read more

Your care provider, because he or she knows much more about your situation, could answer this better, but I can speak in general terms.

A "placental tear" could mean one of two things. An abruption is a process where the placenta releases itself from the wall of the uterus. In an "apparent abruption," the separated portion is at or near the edge of the placenta, and the bleeding is obvious. A "concealed abruption" can occur at a more central location; the bleeding will not be seen, but can build up underneath the placenta. If this type of bleeding continues, eventually, the baby looses the blood supply and the entire placenta may separate.

Another type of "tear" can occur if the placenta is low lying and all or part of it is in contact with the cervix (placenta previa). As long as the cervix has not effaced (thinned) or dilated (opened), no bleeding usually occurs. But in the second or third trimester, when cervical changes begin, the placenta is at risk of partial or total exposure and open vessels can be torn.

Both of these conditions cause spontaneous bleeding, but the bleeding of a previa is usually painless. If an abruption occurs under the placenta, pain and abdominal rigidity can result. Both of these situations can be mild -- and the bleeding may stop and delivery may occur as planned and hoped for. If testing (non-stress tests, contraction-stress tests, biophysical profiles, ultrasounds) all show that the baby is doing fine and the situations are not extensive, then vaginal delivery is indicated. But because both of these conditions are potentially life-threatening to mother and baby, much testing is warranted, and ANY change may indicate the neeed for an emergency cesarean section.

Breech presentation is common in cases of placenta previa. Of course, he or she may turn to vertex at any time, but if the baby stays in a breech presentation, chances of a cesarean are quite high. Even if the baby turns to head down, chances of a cesarean are high because of the risk of placental bleeding during active dilation.

I recommend that you find out what the hospital protocols are for the presence of support people if a cesarean is necessary. Some medical centers or childbirth education programs offer a cesarean birth preparation class. Find out about mandatory separation periods from your baby, typical length of stays and you when can nurse the baby. Discover the name of the unit manager (head nurse) on labor and delivery and ask her lots of questions.

I know this is not the kind of pregnancy that you wished for and thought about. We all have our "fantasy" pregnancy, birth experience and baby. When these are not fulfilled, there is (and should be) some grieving that goes on. Arm yourself with all the support you can get. Ask for names of people who have been through this and go to medical bookstores, if possible, and look things up.

My wish for you is that your baby turns, the bleeding stops and you go on to have a wonderful intervention-free labor and birth. If that does not happen, remember that a cesarean birth is just another way to have a baby. You have made it this far in the pregnancy, and each day your baby gets stronger. If she were born at 34 weeks, she would have an excellent chance.

Another good resource is the nursing staff at a neonatal intensive care unit (NICU) in your area. Your baby may not need to be admitted to one of these, but the nurses in such units are renowned for their knowledge and sensitivity.

My best to you and your family.

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