Placenta Previa | Complications During Pregnancy

My wife is pregnant with our 2nd baby, and currently at 29 weeks. We've known since the Week 20 scan that she has complete placenta previa -- not marginal, but a total overlap with the cervix. Our OB is pretty confident that the placenta is not going to move away from the cervix before it's time to deliver, based on its current position.
So, we know that we are very likely facing a planned c-section. I'm anxious about the remaining weeks of this pregnancy. If she goes into preterm labour, it can be extremely dangerous for her as well as the baby (with a serious risk of a bleed). Thankfully she has made it into the third trimester without any bleeding so far, and she's really trying to take it easy the next while.
Just wondering if anybody has ever dealt with this and can share stories or advice. Were the final weeks of pregnancy scary? Was the c-section a difficult procedure because of the placenta previa?
Thanks everyone. I know PP is fairly common, but it's unusual to have it still be covering the cervix late into the 3rd trimester and we are nervous about what that means for her safety for the next couple of months.

I’m currently in the hospital, 24wks, admitted for bleeding. The bleeding only starts whenever I get up to go pee, when I’m laying in bed it stops.
I was shopping at michaels when I looked down and saw blood down my leg (was wearing a dress). Pretty scary but everything’s looking good, baby’s good, cervix is still closed. I’m just basically here until the bleeding stops completely.
It’s been about 12 hours for me, I’m wondering how long others were having to wait for bleeding to stop? The nurse told me she’s seen it take about 24 hours.
The bleeding is totally painless. Before they had said I had a low lying placenta, now apparently it’s a complete placenta previa. Baby is still kicking away.

My baby was born nine days ago via emergency c-section due to a major bleed from placenta previa. Due to coronavirus, the hospital has banned anyone but parents from the Special Care Nursery. While I understand why they've done this, it means that I am totally isolated for hours every day except when my husband can attend.
I lost a lot of blood in my c-section and I am still physically recovering. I can't drive and my brother, a doctor, doesn't want me using public transport due to virus risk which means I rely on my husband to take me in and out. I talk to one of the other special care mums a bit but I am incredibly teary and alone. Today the paediatrician told me that they would be aiming for my son's due date as his release date (which is four weeks away) and I'd previously thought he'd get out around 37ish weeks and I burst into tears and sobbed and sobbed. I hate that my son isn't home with me and that none of our family can see or get to know him.
Are there any communities on Reddit or elsewhere for mums with babies in Special Care? The total sense of isolation is really getting to me.

I'm 21 weeks and have been told I have placenta previa, I don't know yet how "complete" it is, my ultrasound is next week to confirm, but based off of what my OB could see, she's put me on pelvic rest and I'm not allowed to lift anything over 15lbs including my toddler, groceries, laundry baskets...
I'm a mom of 3 and this is my first time having this issue, my OB told me to expect a "Big, scary bleed" that while serious, should just be calmly dealt with and should go straight to the hospital. I've also been told that if the placenta doesn't move I'll be sectioned at 37 weeks. I was PLANNING on a section at 39 so that's not a big deal but when I started taking to her about my tubal (hubby and I have decided we're done after this one) Things got weird. She said she was happy to do one for me and totally understood, but didn't want to decide "now" in case I have "an extremely premature baby" and want another one. Implying that the baby doesn't make it, or something??
This whole thing was a bit of a shock, she sent me a voicemail telling my I had PP, after my last ultrasound, but gave no other warnings or instructions, so between the time of her calling me and my in office appt, I did all the lifting and had sex.
So to walk in and be told to "have a bag packed and ready" because I may go that early caused me to ugly cry in the car later.
Has anyone dealt with this???
Thanks.
TLDR: ob doesn't want to decide on a tubal in case baby dies before hand. ((I guess?!))

Hello! Does anybody have experience with this?
My placenta is completely covering my cervical opening.
My OB told me that there's about a 60% chance that it'll resolve in the next eight weeks. Anecdotally, I know a bunch of people who had either marginal or total placenta previa whose placentas migrated.
Reading articles from obstetrics journals makes the condition seem a lot less sunny--big bleeds, placenta accreta, hysterectomies, anemic babies, high incidence of prematurity and fetal death.
I guess I'm wondering whether my placenta's working ok and whether there's any evidence that this condition predetermines adverse outcomes down the road. How much should I be worrying?

Baby girl is wonderfully perfect and doing great. The ultrasound let us discover that I have an extremely rare complication called Vasa Previa along with a “pulsating” cervix that showed signs of wanting to open. Vasa Previa is when the placenta is covering part of the cervix AND fetal blood vessels are part of that overlay. So essentially a more dangerous version of placenta previa. With half way to go, this can absolutely resolve itself and just move up as my uterus grows as long as it doesn’t rupture any blood vessels in doing so. Worst case is CSection which I’m having more peace about as the days go.
The scary part is my throbbing cervix. I don’t feel anything, no pain, no bleeding since my LMP, and no cramps. Cervix is also 7cm long when average is around 4cm, so that’s a good sign.
I’m being transferred to a specialist team which makes me nervous because that just shows how serious it is. Hopeful though that when I go in for that appointment that my cervix will be totally fine and normal and placenta will already show signs of moving up.
I guess I just feel guilty that this is all my body’s fault and feeling like I’m failing my baby.
Does anyone have experience with either of these conditions? Just praying she’s in there long enough to be viable and join our family!

Hi there, BabyBumps. I don't believe I've ever posted in this sub before, but I'm previously an August '17 bumper, and currently expecting my second in March 2020.
I'm 2 days shy of 18 weeks, and late last night (almost midnight) I got home from work, climbed into bed and played some mobile games to wind down, and suddenly felt a gush of what I, in that moment, believed was just a lot of thin vaginal discharge all at once. I went to the bathroom and it was blood. I had never bled at all during my first pregnancy, and not until now during this pregnancy. It was bright red, and enough that it would fill a pantyliner or maybe 2, but not a pad. I wiped and wiped and after a few minutes it had mostly stopped and tapered to spotting. It freaked my husband and I out so bad, but I was able to sleep a few hours with no additional gush of blood.
Early this morning I called my midwife who asked if it was accompanied by any cramping. The answer was no, I felt fine and was totally shocked that I was bleeding. I told her it had stopped and turned mostly to brown discharge. She told me that I may have a low-lying placenta or placenta previa. I have only had one ultrasound so far, which was at about 9 weeks. I did have an appointment last Thursday where the baby's heartbeat was heard on doppler good and strong.
She is getting me into the office tomorrow for an ultrasound, unless I start experiencing more/heavier bright red blood again instead of brownish spotting in which case I'll go to the hospital tonight. All day I've been resting but I'm still having regular spotting that is mostly brown and light but has turned a little bit reddish on occasion. It's like the tail end of a period. I'm trying not to freak out and to wait for the ultrasound tomorrow because an ER visit will surely cost me at least a thousand dollars out of pocket since my deductible isn't even close to being met.
I have a doppler at home and I've been using it to check the baby's heartbeat a couple times today. It's there. But I'm still worried the poor thing may be in distress. And even though I wasn't before, I AM experiencing a little bit of mild cramping now. I'm just very anxious and nervous and looking for support or wisdom from anyone who has gone through something similar, no matter the outcome.
Can anyone share their story of a second trimester bleeding scare? Or offer further advice and support?
. .. ... .... .....
Update: See happy update below! TL;DR, placenta previa as suspected. Baby is A-OK and just beautiful. I'm relieved.

Greetings!
 
I'm excited to finally share my Zanki Step 2 deck with you all. This will be a somewhat lengthy post, so apologies in advance. I will try to give some brief clerkship-specific shelf advice to accompany each anki deck.
 
Design: This anki deck was not designed to be exactly like Zanki step 1. As you have probably seen, or will see, third year doesn't quite afford you as much time! For that reason, the goal of this deck was to be something that is more manageable. The total number of cards is somewhere around ~5200. The formatting of the cards is also slightly different. While Step 1 stuff is quite amenable to the cloze format, Step 2 content often focuses on diagnosis and next step. For this reason, you'll see a mix of cards that are quick cloze cards and some that are a little lengthier. I tried to limit the number of multiple cloze cards to keep the deck concise, but if you feel there’s a particularly difficult card, feel free to add additional cloze deletions.
 
Content: The next thing I’d like to discuss is resources/content. This deck was designed to closely follow Uworld. I believe UW is the greatest resource for every third-year clerkship. With that being said, the idea was to take the core educational materials from each question and break it into digestible anki cards. For example, for a “What is the likely diagnosis?” card, I will put a few of the defining features of that diagnosis. Questions, especially UW questions, will give you a lot more surrounding info, but I tried to isolate the core features. In the “extra” of the card, I often tried to distinguish these features from similar diagnoses where appropriate. UW is always changing so try and just look out for questions with new material. The last day I updated this deck was 04/23/18 (just that day six new questions were added!)

• Side note: I got a new laptop like halfway through making these cards. If some pictures look beautiful and others look like they’re from the 80’s, you know why lol

 
Edit: Because this is based off of UW, I'd recommend doing a UW section first and then doing that anki subdeck after so as not to spoil any questions!
 
Comprehensiveness: I know a frequent question I will get is “How comprehensive is it?”. It’s a tough question to answer, unfortunately. It is nearly as comprehensive as Uworld. However, I think the ability to be comprehensive of all the content of Step 2 is near impossible. The best study strategy (in my opinion) is to do UW, retain the knowledge with anki, and spend other time looking up your patients or reading/watching a different source. I will discuss clerkship-specific sources below.
 
Clerkship-Specific Decks Advice:
 

1. Surgery: There aren’t too many surgery UW questions, which is totally fine because there aren’t too many surgery questions on the surgery shelf lol. If you do happen to have surgery before medicine, I’d definitely recommend trying to get some medicine UW done as well. The most high-yield are probably renal, GI, pulmonary, and cardio. My favorite supplemental source was De Virgilio’s. It’s a looong (600+ pages) textbook, but it’s extremely easy to read. Many people recommend Pestana’s. Personally I didn’t like the brevity of it, but if you’re looking for a short book that can fit in your white-coat pocket, it’s not a bad resource. I didn’t use OnlineMedEd for any clerkships, but I know some people live and die by those videos. Check them out and see if they’re for you. Watch Emma Holliday a day or two before the shelf for a solid review.

 

• 2. Medicine: There are a lot of medicine questions. Furthermore, medicine is such a broad subject that even with all those questions, there’s still tons of other “testable” material. I felt UW was great for many of the subjects, but I definitely missed having some of the details from Step 1. Unfortunately, I didn’t have time to add in “relevant step 1” material to this deck due to time constraints. Overall it wasn’t too much step 1 stuff though, so if step 1 is a distant nightmare, don’t sweat it. As far as book resources, most people will tell you Master the Boards or Step Up to Medicine (I chose to use MTB). Master the Boards was an easy read but definitely lacks on the details. I felt the only strength of it was to review an organ system in an organized way. There aren’t many new details, so it was a good last-minute review. I never read Step Up to Medicine but I’ve heard good things, especially if you’re someone that likes having more detail. Again, there’s OnlineMedEd - I know some people live and die by those videos. Check them out and see if they’re for you. Watch Emma Holliday a day or two before the shelf for a solid review.

 

• 3. Psychiatry: Psychiatry is known for being more of a relaxed rotation, which can be a nice break from some of the other ones with tougher hours. The material is pretty similar to Step 1 psychiatry and there aren’t that many new details to learn. That being said, UW was fantastic and they have really been making a push to update it recently. Some of these anki cards are long because I tried to include DSM-V criteria for the major disorders to help those students who are getting pimped. I personally supplemented with First Aid for Psychiatry. I thought it was a pretty good resource and I’m not really sure what other resources people used besides maybe OnlineMedEd. I also re-watched some of those relevant SketchyPharm videos because this was the only clerkship that I felt pharm was actively tested. I didn’t know Emma Holliday had a video for psych so I never watched it, but if you liked it for past clerkships, check it out.

 

• 4. Neurology: I know this isn’t a universal clerkship for medical students, but my school had it. The neurology questions are under the medicine category but I made them its own clerkship deck. We had an oral exam so I went a little overboard with “relevant step 1” stuff just so I could re-learn the pathways. For those who don’t care to look at the basic neuro stuff, I separated the subdecks so you could more easily suspend/delete them. I think that probably applies to most people, so please feel free to chop down the size of this deck, especially if you don’t have a neurology clerkship. I didn’t supplement neurology with any source, but I know some classmates used Blueprints and CaseFiles. Again, there’s OnlineMedEd - I know some people live and die by those videos. Check them out and see if they’re for you.

 

• 5. Pediatrics: This clerkship is known for having a pretty tough shelf. Mostly because it’s a bit random and has a fair amount of medicine. For that reason, I tried to incorporate relevant step 1 material into deck. I made this deck right after my best friend told me my medicine cards sucked (don’t worry, I edited nearly all of them), so I tried extra hard on these! I personally only did UW and these cards, but I know some people really liked CaseFiles, PreTest, and/or BRS. As before, there’s also OnlineMedEd and Emma Holliday.

 

• 6. OB/Gyn: OB/gyn can be a tough clerkship due to time constraints/stress and finding time to study. Overall, I found UW to be a great resource. I also used Uwise (you can find it as a Quizlet deck) and included a few flashcards from there that I thought were important. Those are the only two sources I used. I know some classmates used Casefiles, but I’m not sure about other textbooks. There’s also OnlineMedEd.

 

• 7. Step 2: Coming off step 2 about a week ago, I will admit it is a tough exam. I personally had a fair amount of material I haven’t seen before, but you just need to do your best and stay sharp-minded throughout. I think the key to a successful step 2 is studying hard throughout your clerkships. Don’t underestimate how much you can learn from your patients. I had about 3.5 weeks of dedicated and that was basically just enough time to re-do UW and take practice tests. I’d say about 1/3 of my test was a mix of NBME 6 & 8 (pretty straightforward with short questions stems), 1/3 was like NBME 7 (short question stems, but vague/confusing), and the final 1/3 was like the UW SAs (long questions, mixed difficulty).

 
Overall Studying Advice:

• I believe these anki cards are great to help retain the details of UW. However, there will often be questions that test materials you haven’t seen. I can’t stress enough how important is to try and seek out patterns. Many questions I’m unsure of, I make a guess based on intuition. If your pattern-recognition is strong, your intuition will rarely lead you astray.
  
• Pay close attention to question stems. There is a big difference between “What is the best next step in management?” and “Which of the following is best test to confirm the diagnosis?”
  
• Don’t let your studying be passive. Actively think about what diagnosis you’re looking at. Are there similar diagnoses? How can you differentiate them? A simple example would be vasa previa (painless 3rd trimester vaginal bleeding, but abnormal fetal heart tracing) vs placenta previa (painless 3rd trimester vaginal bleeding, normal fetal heart tracing) vs abruptio placentae (painful 3rd trimester vaginal bleeding)
  

 
Jaded 3rd year update: I removed all “:)” from the deck, mwahaha
 
Edit: If you have Zanki Step 1 downloaded, you should make a new profile for Step 2 that way the "relevant step 1" cards transfer over correctly.
 
ALRIGHTY! It’s been a great honor to receive so much feedback about Zanki Step 1. I am grateful and humbled by the stories that some of you have shared with me. I appreciate both the positive and negative feedback and I have tried to incorporate that feedback into this deck (except the whole bolding/underlining everything, I’m sorry – bad habit). I also enjoyed reading random comments of people making fun of me for my “:)” cards lol. I wish you all the best of luck, especially throughout 3rd year. This will likely be my last gift to the Meddit community (I pray I do not need to anki anything else in the future). I hope you find this post/anki deck useful.
 
Farewell,
Zanki
 
https://drive.google.com/file/d/1R4h5SMrKqIN-1SxmynyMzpG3QYIrGHG2/view?usp=sharing

Hey MedSchool peeps. So I've had a few MS3 and 4s message me over the past year or two after seeing posts on this subreddit. I made up a mini high yield sheet that I wish I had read before my Obgyn rotations. It's definitely not 100% comprehensive, but it is a good base. The few people who have used it said it helped them a lot, so I figured I'd share the wealth.
I can't guarantee that other well experienced obgyns won't slightly disagree here or there on a point or two below, but generally speaking you can take this as helpful info for your rotation.
1) if you can, read the ACOG practice bulletin titled "The safe prevention of the primary c-section" ... someone somewhere at your institution has access to ACOG, I promise. You might be able to just google it anyhow. This article will give an excellent basis as to wtf is going on while you’re on L&D.
The big take aways from that are we do c-sections too frequently, active labor isn't until 6 cm dilation, if a cervix keeps changing and the baby looks ok then keep going (even if it is 'protracted' labor), women should be induced at 41 weeks as it reduces the risk of a c-section. Don't induce before 39 weeks unless there is a medical indication for mom or baby.
2) Take the time to learn when we do what for our stuff for prenatal care. (see #5)
3) Non invasive prenatal testing is screening that is basically going to fall into 3 categories. You typically only get one of these and if it is abnormal you either choose option C below, OR get amniocentesis. Almost no one does chorionic villious sampling but technically a really early gestational age (like 11-13 weeks) would get it.
a) first trimester screen - checking AFP and PAPP-A (maternal serum) and do a nuchal translucency on the baby. Performed between 11-13 weeks gestational age.
b) quad screen - checking AFP , hCG , Estriol (not estradiol or estrogen!!!!), and Inhibin-A. Performed between 15-21 weeks GA
c) cell free fetal dna- it's actually a misnomer. It's placenta DNA fragments in the maternal blood which is usually, although not always, the same genome as the baby. You can get it any time after 11 weeks although in overweight women you're more likely to get a "equivocal" result if you do it early.
The quick and dirty is that all of these are mostly screening for aneuploidy (in particular 21 and 18) although as quad checks for AFP it also helps screen for spina bifida, anecephaly, and ventral wall defects (omphalocele and gastroschesis).
4) learn how we select a due date - rule of thumb (although not 100% accurate!!!): In the first trimester if the gestational age on ultrasound corresponds within 1 week of what the LMP would correspond to for a due date, then you go with the LMP to set the due date. 2nd trimester 2 week difference, 3rd trimester 3 week difference. Again this is ball park, you can look up the actual strict dating criteria for when there is a discrepancy between LMP and ultrasound if you want. Basically anyone having their due date set after they’re already 20 weeks or later is considered poor dating.
5) Other prenatal care: routine anatomy scan around 20 weeks. Check for anemia and perform glucola (gestational diabetes check) at 24-28 weeks. Tdap is given about 28 weeks. Rhogam is given to rh negative women around 27-28 weeks. Check for vertex fetal presentation and swab for GBS at 36 weeks.
6) Definition of gestational hypertension: systolic of 140 or diastolic of 90, twice, four hours apart withOUT proteinuria. Definition of mild pre-eclampsia: systolic of 140 or diastolic of 90, twice, four hours apart WITH proteinuria (typically people do urine protein to creatinine ratios. so 0.3 or greater is considered proteinuria). Definition of pre-eclampsia with severe features: systolic of 160 or diastolic of 110 twice, four hours apart WITH proteinuria OR other end organ damage such as - severe headache, scotomata, pulmonary edema, thrombocytopenia, elevated creatinine, twice normal LFTs. If they have a seizure it's eclampsia.
We treat "severe range" (160/110) blood pressures. This does not alter the course of the disease, it only reduces the risk of a stroke. We administer IV magnesium in severe preeclamptics (and some milds) to reduce the risk of a seizure. Know that mangesium toxicity can occur from too much magnesium (especially of urine output drops off). First signs are loss of deep tendon reflexes followed by respiratory depression, followed by arrhythmia, followed by death!
Severe preeclampsia diagnosed after 34 weeks is an indication for delivery. Severe pre-E diagnosed before 34 weeks you monitor inpatient until 34 weeks and then deliver... however many preeclamptics will worsen and require earlier induction - if BPs become difficult to treat or labs worsen.
7) betamethasone injection is given to women who are at risk of delivering premature. It primarily reduces neonatal respiratory distress syndrome but also reduces necrotizing enterocolitis and IVH of all grades. These are two injections, 24 hours apart. It can only be done twice (meaning 4 shots total) per pregnancy. Best effects of the shot are seen 48 hrs to 2 weeks after administration. So we don't just give it right away unless it is someone we are worried will deliver. Traditionally after 34 weeks Betamethasone (beta) isn't given however newer evidence says it can be given after 34 if it hasn't already been done. Women who get beta are people whose water broke prematurely, are at high risk of preterm labor (like coming in at 30 weeks with a short cervix and occasionally contracting), or preeclamptic women. I'd say those are the top 3 reasons ppl get beta.
8) Painless bleeding - need to rule out a placenta previa, although in all likelihood, a chronic placental abruption is way more likely to be the cause.
9) First trimester pain should raise suspicion for ectopic pregnancy. Until at least a yolk sac and/or fetal pole is seen in the uterus, it should be considered a pregnancy of unknown location (is it ectopic or not?). bHCG levels of about 1,000 - 2,000 should show a gestational sac on transvaginal ultrasound IF it is an intrauterine pregnancy. Over 48 hours, a bHCG is expected to about double in a viable intrauterine pregnancy (the actual cut off is lower, and depending on the initial value, more like ~40% increase in 48 hours, but this is a new guideline). Just because the bHCG is increasing normally doesn't mean it is in the uterus. Just because it is dropping doesn't mean it was a miscarriage or resolving. You are only certain if ultrasound definitively shows, products of conception are analyzed from a D&C or laparoscopy... if you don't know, you need to track that bHCG to zero. An ectopic can be treated with methotrexate if they have no contraindications (there is a long list for medical absolutely contraindications that typically don't apply to young healthy people). Relative contraindications are a heart beat, ectopic gestational sac > 3.5 cm, or bHCG > 5,000. Obviously if a patient is clinically unstable, they need laparoscopy. If a patient does get methotrexate, you look for a drop in their bHCG levels from day 4 to 7 of 15% or greater. If it is less they get a repeat methotrexate, or do surgery. If the tube is left in place, risk of ectopic recurrence is 15%, and increases with each repeat ectopic pregnancy.
10) Postpartum hemorrhage: by far most common cause is uterine atony. First line drug is pitocin which is given with every delivery. After that rectal misoprostol, IM methergine, or IM hemabate. Important side effects/contraindications: miso can cause a fever, methergine causes elevated BP and so is contraindicated in PreE (my mnemonic was that Meth labs explode), and hemabate will exacerbate asthma (my mnemonic was that hemabate sort of sounds like an inspiratory wheeze... lame I know). If meds don’t work then an intrauterine balloon to tamponade. If that doesn’t work you’re looking at surgical management. This ranges anywhere from tying off the uterine arteries (Oleary stitch) to cinching down the whole uterus with suture (B Lynch). Or the ultimate option, a hysterectomy.
Next most likely is retained placenta. A d&c is done for this. Sometimes it ends up being a placenta accreta and a hysterectomy is generally needed for this as it is impossible to remove all the placenta and the hemorrhage continues.
Lacerations and coagulapathy are important to consider - especially DIC.
Really interesting is that due to hemodynamic and coag changes in pregnancy, a hemorrhage from something like atony can lead to continued hemorrhage as DIC develops. A pregnant pt should always have a fibrinogen above 200, so if it gets near that (or below) DIC is high on the differential.
Peripartum hysterectomy often called a c-hyst (cesarean hysterectomy) is the last ditch effort to stop hemorrhage and has significant morbidity.
Changing topics to Gyn...
11) there are essentially only 2 types of urinary incontinence we see - stress (cough laugh sneeze) and urgency (bladder spasm). Technically neurogenic (like paralyzed) and functional (I can't walk to the bathroom so I piss myself) exist but are obviously rarer.
12) endometrial hyperplasia - pt should get a hysterectomy because they have about a 40% chance of actually having endometrial cancer. Only if pt wants fertility should she keep her uterus but then they need serial endometrial biopsies and need to be on progesterone.
13) endometrial cancer - usually stage 1 (confined to the uterus) and usually adenocarcinoma. Usually treated with hyst alone although people who are old, have deep invasion but still stage 1, or have high grade (histologically) may need brachytherapy which is radiation to the vaginal cuff. The only caveat is endometrial cancer that ISNT adenocarcinoma such as clear cell, papillary serious, etc is treated more like ovarian cancer and gets paclitaxol and carboplatin.
I Guarantee someone will ask you this. Who should have an endometrial biopsy to o hyperplasia or endometrial cancer? Women 35 and older with AUB and risk factors (obesity, PCOS, nulliparity.. there is a long list). Women 45 and older with AUB and without risk factors. You're interested in women who have heavy bleeding or continuous/nearly continuous bleeding.
I Guarantee someone will ask you this. How do you triage postmenopausal bleeding? You can do a transvaginal ultrasound. If the endometrial lining is less than 4 cm then you don't need to biopsy. HOWEVER, this only counts for someone who had one little episode. Anyone who has a lining >= 4cm or is bleeding on and off (even if they have a thin lining) needs an endometrial biopsy.
14) ovarian cancer - most common kind is epithelial - usually stage 3c (every where in the peritoneum). Pt's get primary debulking (meaning hyst, bso, nodes, omentectomy, and if needed bowel resection to remove all tumor bulk) to get all tumors that are >1 cm... or ideally all. But optimal debulking is considered when only tumor left behind is <1cm. THEN like 2 months later they get paclitaxol and carboplatin. Cure rate not so good - like a 5 year 50% recurrence rate. Caveat is that other kinds of ovarian cancer like germ cell tumors get chemo of bleomyocin cisplatin and etoposide and have a really high cure rate.
15) cervical cancer is the only cancer staged clinically! I Guarantee someone will ask you this. It means you can only stage it based on physical exam, a KUB, or a cone biopsy. This is because most cervical caner is diagnosed in the 3rd world and they don't have all the fancy shit we do. You can take findings from a CT to stage but only if it would have been apparent on a KUB (like hydroureter from tumor).
16) PID is intentionally over diagnosed. There are criteria for inpatient IV abx, but generally speaking mildly ill patients who can reliably take PO abx are treated outpatient with IM ceftriaxone followed by two weeks of doxy/flagyl (typically, although flagyl is optional). People who need IV abx first: septic, has high fever, cannot reliably take po (due to n/v or social situations like homeless), pregnancy, uncertain diagnosis, failed outpatient therapy, or who also has a tuboovarian abscess. If you want to know more about this topic, the CDC has a great article. It is very comprehensive and an excellent article on the topic that is reasonably short.
17) vaginal estrogen is great for post menopausal vaginal atrophy and has very little systemic impact
18) Systemic HRT: Rules of thumb: as little as possible for as few years as possible, don't start on someone remote from menopause (such as a woman in her 60s), if no uterus can take estrogen only, if she has a uterus she needs progesterone as well to protect her uterus from developing endometrial cancer from the estrogen. It's more expensive, but patch HRT is safer than oral due to first pass.
19) pap smears: start at age 21. If they come back abnormal then a colposcopy is performed where directed biopsies are done. Rule of thumb: Women with CIN2-3 (high grade dysplasia) should have a LEEP procedure unless they are in their early twenties. Ideally CIN1 (low grade) is watched unless it is persistent. HPV types 16 and 18 cause vast majority of abnormal paps. HPV types 6 and 11 cause the majority of the warts.
Good luck on your rotation. Never mind the haters. Sometimes people are really catty although my med school and my residency generally treated the med students very well. Don't let the stereotypical attitudes get in your way or make you prejudiced from the start. OB is a specialty totally to itself but honestly, its worth knowing about it even if you don't go into it.
For the guys: don't let being a guy prevent you from taking it as a serious consideration. There are lots of great programs and it's actually easier to match as a guy. And you can sub-specialize if you want to do more of one thing over another.
Edit: typos
Edit 2: thanks for the gold!
Edit 3: added some sections

So...no sex, no orgasms! For weeks!
Wtf! lol

It’s coming up on three years that my worst nightmare came true. I am not writing this for anyone to feel sorry or pity for me. I am doing this for me. In hopes that it will help lift this weight off my chest, and to let others know you’re not alone. November of 2015 I found out I was pregnant with my first child. I had been with my husband for 5 years at this point. To be honest we used to joke that one of us if not both of us must be broken because it took so long for us to have a baby. We never tried to prevent it in anyone, yet it took five years. I can’t begin to explain how scared and excited I was. I was 25 when I found out, my husband was 22. My husbands reaction was far from what I expected it to be. I still feel hurt from his reaction, maybe if things would have turned out differently it wouldn’t hurt as badly now. But that’s something I’ll never get to find out, because things did happen the way they did. I officially had it on paperwork December 7 2015 that I was pregnant. But the excitement on my end was short lived. At 10 weeks pregnant, I woke up one morning to find I had starting spotting blood. My mother took my husband an I to the hospital and I found out i had complete placenta previa. Which is common early on in your pregnancy. For the next 10 weeks I would end in the hospital for the same thing 5 more times. Each time I was told to place my feet above my heart and relax. The spotting would either slow down or stop all together, and I would be sent home. Each time making a follow up appointment with my doctor. Each time seeing them I would ask if there was any restrictions for home and work. I’m a caregiver, I lift people for a living. But each time it was always the same, “No there are no restrictions what so ever”. Without a paper stating a weight limit or any restrictions for work, I had to complete my 12 hour a day, 6 days a week, walking back and forth through town between the two woman I took total care of. I found out the gender when I was 18 weeks. A BOY! I can’t even began to explain how excited I was to find out we were having a boy. He was set to be named after my husband and his father William Lee. But the part that really was cool for me was that my step grandfather and uncle both are named William Lee, different last name but it still meant I got to use a family name from both of us. The day I found out I was going to have a little boy was the best day of my life. But that day they did an internal ultrasound as well as the one on the belly. I had been on pelvic rest for the past few weeks. But from that day on for the next week, I never stopped spotting. The day I found out he was a boy was a Tuesday, I had my gender reveal that Sunday. At this point I kept it to myself that I was spotting. I didn’t want to keep going back to the hospital to just be told to go home. March 15,2015 just another day or so I thought. I went with my mom to take my sister to her job interview. Walked around Walmart a little bit and looked at all the boy stuff with my mom talking about nursery rooms and baby shower ideas. That night I ate dinner with the family like any other night. Midway through dinner I got a sharp pain in the left side. Kinda like the sharp pains you get in your side from running to much. Nothing bad enough for me to run to the hospital and being a first time mom I had no clue what the heck it was, so I went on with my night got a shower and went to bed. I woke up about 2:30am to go to the bathroom. Walked the two steps to the door opened it stepped into the hallway, closed the door behind me. That’s when even though I was wide awake my worst nightmare had started. My water broke at 19 weeks and 6 days, with a large mixture of blood in it. I flung the door open woke my husband up in a panic. Ran down the hallway into the living room where my parents were sleeping, screamed for them to wake up. I went into the bathroom to get a better look at what was going on because the house was dark and all I had was the flashlight on my phone, till I got in the bathroom. I’ll save the gory details, and just say I’ve never seen so much blood in all my life on something that was still living. I was panicking big time. I didn’t want my family to see me like that. So I grabbed a rag and hurried to cleaned myself up before anyone got in there. All my mom had to see was the underwear I was wearing that was now sitting in a bucket of water, in the tub. By 3 am my husband an I were in the car on way to the hospital. But it was the same song and dance as the other visits “place your legs above your heart.” Even with me telling them that I thought my water had broke and that their was blood with it, they didn't take it seriously. I laid in that bed from 3 am to 7am bleeding with nothing but a bath towel between my legs, with not one damn person watching how much blood I was loosing. At 7 am they tested finally to see if I was leaking amniotic fluids, which I was. I was then taken down to ultrasound around 8am. I almost passed out while they did the ultrasound, I got light headed and dizzy, so they hurried with what they were doing. I knew that when I got to my room that something was horribly wrong. I didn’t even make it from my wheelchair to my bed before they came rushing in with the papers to transfer me to a better hospital in Pittsburgh. I didn’t even have the papers completed when the paramedics came in with the stretcher. Still this whole time rushing me to another hospital everyone still lied to me and told me everything was fine. I knew deep in my heart that this day March 16, 2016 my life would change one way or the other. When I made it to the other hospital with in a matter of minutes I had easily 8 doctors crammed in the tiny room I was in. They were rushing in with all kinds of machines. Mean while the blood clots that were coming out at this time just kept getting bigger and bigger. The last one that came out before I knew what was going on was as round as a volleyball. Finally I would get some answers. What was going on was natural complete placenta abruption. My placenta had completely torn from my uterus. I was told I needed to make the hardest choice of my life and one that to this day I would be lying if I said I didn’t regret. I needed to choose to either end my pregnancy or bleed to death. My husband started crying worst then I had ever seen up to that point, he begged me not to leave him behind to deal with this by himself. I love my husband don’t get me wrong, but I am still having trouble dealing with the fact that I chose him over being with my son. I was raised that a mother always puts her children first. My whole pregnancy up to that point I told my husband if it comes down to the baby or I that he better choose the baby. Yes, I know logically I had no choice. But the things 2016 put me though, broke me in ways I know will never be fixed. I feel asleep listening to my sons heartbeat, it was 158. I woke up feeling empty, lost, broken, more or less I felt like I had died with my son. It’s going on 3 years, I’m still just as broken as ever. I lost a pint and a half of blood at the second hospital, I lost my son, and I lost myself. All due to the carelessness of the first hospital. I was told in order for me to have had my son I needed to be pregnant for at least 3 more weeks. I’ve lived those three weeks over and over and over again in the past 3 years. I have a daughter now, I found out I was pregnant with her at the end of September 2016. I had absolutely no complications while pregnant with her. She’s what keeps me fighting, she’s my reason to live. I guess if I was to give advice to anyone freshly going though this, would be don’t keep it in find someone to talk to. Scream and cry if you must, but find away though it. I know that’s what I’m trying to do. Thank you if you read this far. Sorry it’s a bit long.

I thought I would post this because I found it so hard to find experiences of having placenta previa.
I had a growth scan at 28 weeks due to GDM and was told afterwards that I had a grade three placenta previa. My placenta was partially covering my cervix by 18mm.
Next scan at 32 weeks showed it had barely moved but that I would still get one at 36 weeks. The doctor I saw after that scan emphasised the importance of taking things easy and getting myself to the hospital ASAP if I bleed. I kind of didn’t take it too seriously as I kept thinking that the bleeding won’t happen to me.
Just after 33 weeks I was at home one evening relaxing with my three year old on the couch when I felt a ‘pop’ and a gush. I thought ‘shit either my water has broken or I’m bleeding and neither of those options are good’. I leapt up and saw a blood stain on the couch. My poor son was freaking out, I raced to wake up my husband who was due to start night shift in a couple of hours and told him we had to get the hospital ASAP. As I went to get my phone to call birth suite to tell them I was coming in,a huge gush came out and blood was streaming out of me so I just called an ambulance.
When I got to the hospital I got checked to make sure I wasn’t dilating (I wasn’t) and was hooked up to the CTG. They discussed the real possibility that I would have to deliver that night but thankfully baby was fine, bleeding stopped and I spent a few nights in hospital before being allowed home. I lost about 250-300mls of blood which doesn’t sound like a lot, but trust me it looks way worse when it’s all over your pale grey tiles!
A few nights after I got home I woke up to another gush. This bleed wasn’t as bad as the first so my husband just drove me to the hospital. I had another speculum examination (ugh) and wasn’t dilated, baby was happy but this time the doctors didn’t want me to go homemade scheduled me for a c section at 36+5. I was mainly totally relieved because I was terrified of it happening again while I was alone with my son, or having a huge bleed and not getting to the hospital in time. But on the other hand I felt terrible being away from my husband and son, leaving my husband to carry the can and then having to get my mum to fly in to help out.
I had another few bleeds over the next week or so but none were very big. Then at 35+5 I started bleeding and it continued on and off for almost 24 hours, when I had a massive one. I soaked a pad within seconds and then a towel and a blanket. When the doctor came in and saw all the blood she told me to call my husband and get him to come immediately. She checked me and I had started to dilate so I basically got rushed immediately to theatre for a category one c section. I was terrified because I had been told how dangerous it can be if you dilate with placenta previa, and also I didn’t think my husband would make it. He did thank goodness, and the c section went well (I did lose 1.2 litres of blood and needed a blood transfusion).
My beautiful daughter was born with a huge cry at 35+6 weighing 2.94 kg which was a great weight for her gestation. She was breathing and feeding on her own and her first blood sugar was great. Unfortunately she had a tough first night with low blood sugar that couldn’t be fixed with expressed colostrum, formula or gel and needed a glucose drip. Her body temp was also very low and needed to stay in the heated incubator for a couple of days.
After bringing her home, she kept losing weight and was extremely sleepy so we had to go back to the paediatric ward for monitored feeding. Finally she started to gain weight and wake up to the world and she has been doing great ever since (three weeks old next Tuesday).
If anyone reads this as they are looking for PP experiences or someone to talk to, please dont hesitate to message me! I had a couple of ladies I could speak to when I was feeling down or scared or just wanted to vent to, and it really helped me stay sane.

Just had a heck of a weekend where I started to experience bleeding (side note: I'm 16 weeks with baby measuring at 17 weeks). The first night I went to ER all they did was an ultrasound. Don't get me wrong was so glad to see baby way ok. However the next day I started to bleed so I had to go back.
I was told I have placenta previa and my cervix is totally covered. I'm still not really sure what this means or how serious it is or my not be. But I'm worried this is going to end up impacting my job as I do custodial work which often requires bending, stooping, and some heavy lifting.
I also haven't even actually met my obgyn Dr. I have been seen by a woman I believe is his nurse. Should I try and demand to see him sooner? The we Dr says I should try and get in sooner rather then later even when I told him my apt is June 5th. I tried calling yesterday but he wasn't there and I don't get the impression the obgyn I spoke with really wanted to tell me more then I was asking...
I'm just not sure what I should do. Any advice or info would be most helpful.

I found out I was pregnant on October 17, just before the 4-week mark (due June 29). I was absolutely devastated. I wasn’t ready for a baby, just started my junior year, I was preparing to write my medical school applications, my wedding was set for November 4, my husband (Marco) and I had just bought a trailer to go camping on weekends and travel the country over the summer, I am also a type 1 diabetic, I lost a baby almost exactly 2 years ago due to its complications. I immediately told my best friend since middle school, she was in a similar situation a few years ago, had her first when she was 17, but her and her boyfriend (who also happens to be my husband’s cousin) have become very successful and have had a second baby too. My husband was away for work and vacation until November 1, and I didn’t want to tell him on the phone, and I knew he’d be over the moon, so I put together a little surprise. I ordered a jersey from his favorite soccer team (Chivas Guadalajara), the number was “88” (his birth year) and the name on the top said “Daddy”. I also bought a baby size one with “18” and “Baby”. I put them in a box, and underneath them I put the pregnancy test. When Marco got back to New York, I gave him the gift, I put his shirt on top so he wouldn’t think much at first. He started crying and hugging me, he was so damn happy. As soon as I saw his face, that’s when I became just as excited, I was finally happy about having this baby!
I experienced morning sickness in the beginning, I was able to prevent vomiting by making sure I don’t get hungry, which meant I had to eat the second I woke up. Otherwise I had a pretty mild first trimester. I had to go to weekly appointments from 6 weeks, which meant I went to an OB twice during my honeymoon, but it also meant I got weekly ultrasound pictures which is so awesome to look back on baby’s development. I got my diabetes fully under control during the pregnancy, I started using new technology which helped with management so much. My blood sugars basically became that of a non-diabetic (most recent HbA1c was 5.0%).
We had our wedding day as planned, it was absolutely magical. Nobody but that best friend and Marco knew anything. We planned an amusement park honeymoon in Queensland, Australia, so I couldn’t enjoy as much as Marco did. We also spent a few days in Townsville which was very relaxing, but also a little boring as we like to be busy. We got home just before Thanksgiving, managed to keep it quiet there too. On Christmas we announced the pregnancy to family, we put a framed photo of my latest ultrasound in with Marco’s parent’s gift. There was a bunch of screaming and crying and hugging and jumping. We told our friend’s over the next week or so.
The second trimester was great physically, but my mental health suffered a lot. I almost rejected being pregnant for over a month, I just wasn’t ready to have a baby, and I didn’t want to give up the life I had planned. I didn’t neglect my health or anything, I just didn’t want the baby anymore. Because of my belly, I didn’t want to be close with my husband anymore, even just hugging him felt strange, so I wasn’t as close to him as I wanted to be, and it caused some issues. By mid-February I was excited about baby again and felt ready (thanks to therapy). At 22 weeks we moved to Utah to be with my husband’s family. I wasn’t happy about moving to Utah, I always pictured living in the suburbs above NYC, but my husband planned his whole life to stay in Utah to raise his family. I absolutely fell in love with Utah once we settled in though, apart from the guy at the DMV who tried to convert me lol (we’re both Catholic).
Over Easter weekend (27 weeks) we went to Mexico to visit Marco’s extended family, it was the first time I felt really fatigued from pregnancy, I spent most of the day in the pool as the resort we were staying at, and it was amazing. Swimming always made me feel better from day one. At 28 weeks we went to Wyoming for a week for a “Babymoon”, there we sorted out all the issues we’d been having the last couple months and we became closer than ever. After Wyoming, I had to start going to three-time weekly appointments, Monday and Wednesday appointments were only 15 or so minutes, and Fridays were the big ones where they did ultrasounds and stuff. Everything continued to be completely healthy, better than we could’ve expected. At the same time, we started slowly buying baby stuff, I didn’t want to go too fast because I was worried that having a baby room set up for months before baby comes would only torture me (I’ll never make that mistake again).
On Saturday, May 19, at nearly midnight, I started getting some cramping. It was similar to period pains, but it was lower (above my pubic bone) and sharper. Marco texted his dad, who’s a pediatrician, and said that it’s probably nothing to worry about, especially because I wasn’t experiencing any other symptoms, and my belly was still super high. We went to sleep, and when I woke up I decided that today was the day that I’d buy all the hospital necessities, a car seat, and a stroller (I didn’t realize at the time but I think it was a part of my subconscious instinct). We spent the day going from store to store, bought everything we’d need for hospital.
That night (Sunday, May 20), at about 7pm, we were eating dinner on the couch and watching the news, I needed to go to the bathroom, when I was walking there I felt something happen “down there”, I completely ignored it, didn’t process it until I saw the dime-sized blood clot on my pantyliner. When I wiped it was absolutely covered in blood, it was pure blood, I’d almost never seen so much blood come out of me. I put on a maternity pad, got up and the toilet was full of blood too, I almost didn’t look diluted by the toilet water. I called to Marco, he starts freaking out, I’m repeating “we’re going to the hospital”. We get in the car, he calls his parents, I call the maternity ward, they told me to go to emergency as they’re busy and it may not me labor. When we were driving I realized I had been getting painless contractions all day long, I don’t believe they were regular, but they happened once or twice an hour.
We arrive at the ER in about 30 minutes (thanks to evening traffic), they admit us straight away as maternity called them to expect us. They do all the normal ER stuff, like vitals. My heartrate was a little high, my blood pressure was 160/110, my blood sugar was over 300. The BP and sugar probably caused the bleeding. They did an ultrasound and confirmed no tears or previa, and an internal exam confirmed I was 2cm dilated and 80% effaced. The maternity pad only seemed to have residual blood on it, so the bleeding only lasted a couple minutes, and they never found the cause of the bleeding. We’re gonna do more investigating soon so it doesn’t happen again.
After a few hours in the ER there was a spot for me in labor and delivery, I went to sleep pretty soon after, and woke up at 8am with painful contractions. I labored all day long, going up a centimeter every few hours, medication-free, alternated between walking the halls, sitting on the ball, and sitting in the birthing pool all day. At 9cm my water broke, and just after 9pm I was 10cm and started pushing in the pool. I pushed for 50 minutes and my baby was born!
Isaiah Morales Cruz 05.21.2018 - 10:07 PM 4lbs 2oz - 16 1/4 inches
He was born screaming and bright red, coughed up everything he needed to, seemed very strong. I got out of the tub almost immediately, I never felt so energized and healthy. They laid me on the bed while they checked his vitals, and his oxygen and heart rate started going down, and his blood sugar was 44. They took him to the NICU, they didn’t let Marco go with at first. I delivered the placenta, and it was all healthy and intact. My blood sugar also started going down. They stopped my insulin but I kept dropping, I got to about 20 an hour later and had a seizure. They gave me glucagon which made me sick, but I went up after that, and they took me to the ICU. They didn’t let Marco come with me either, but at that point Isaiah was stabilized and he was able to be with him. They gave him a CPAP machine, feeding tube, IV, and all the wires and cords to monitor his vitals, as well as hourly blood glucose tests, more if they felt they needed to. He was in a little pod so Marco couldn’t hold him. His blood sugar kept dropping despite the basal dextrose he was receiving, so they kept blousing him every time he went under 50. At 2am he had a seizure from a low of 18, administered glucagon, and upped his dextrose basal.
I was in the ICU for 24 hours, so I wasn’t allowed to see Isaiah, Marco spent the day moving between the two of us. They had to give him another bolus of dextrose at 7am that morning but didn’t need one for the rest of the day. On Wednesday I got moved back to maternity but spent most of the day in NICU with Isaiah, I was able to breastfeed (which he did so well at), change diapers, sponge bath. He also graduated from CPAP to nasal cannula which means he can breathe on his own, his dextrose basal got moved back down to where it was originally (he needed a bolus 7 hours later). His heart rate was fine as long as his oxygen was, and he developed jaundice that evening too, so he has spent some time under the lights. On Thursday afternoon they lowered his dextrose basal even more, to the lowest whole dose, and he tolerated it perfectly. They were also lowering his oxygen when he stayed over 98% for 6 hours. On Thursday night they let him in our room for a few hours, we took photos, watched TV, and had such a good time, it’s when I really bonded with him and fell in love, but we had to take him back when we were going to sleep.
On Friday I got the news that I’m being released, but Isaiah has to stay. He has to meet these certain requirements that I wasn’t totally aware of for some reason: 35 weeks gestation age, birth weight, graduation to crib (temperature regulation), 7 days of consistent, steady breathing and heartrate (on or off oxygen), 48 hours of blood sugar over 70, parent skills, and a “room-in” (Marco and I will stay for 24 hours with Isaiah and they will test how we all go). He reached the 35 weeks that day, parent skills were assessed, but he was still losing weight, at the time 8 ounces so far, a big drop of 5oz between Wednesday and Thursday. We left in the evening, and we decided it’d be a great time to finish his room, I was so devastated when I found out I was in labor because his room wasn’t finished, so that was an upside to getting out before him. We bought preemie clothes and diapers, toys, blankets, sheets, changing table, baby monitor. We had a really good time, it was a good distraction. We stayed up until 3am working on his room and pretty much finished, we just needed to tidy up. We were back at the hospital at 9am, along with Marco’s parents where they met him for the first time (they had no idea what was going on for over a day because everything was so hectic, nobody even knew we had him until Wednesday).
He graduated to a crib on Saturday, managed to get off oxygen and dextrose on Sunday, and on the next Tuesday he reached his birthweight. Tuesday night and Wednesday, we did the room-in, and it went amazingly, it felt so good and right. On Wednesday evening he was discharged with a clean bill of health. I’ve checked his blood sugar a couple times since, and we have a foot brace that monitors his heartrate and oxygen, and we haven’t had a single issue. It’s now Friday night and everything is perfect. He’s sleeping when we want him to be awake and vice versa, but it’s still so fun.
When they were talking about the risks when I was in labor, nobody expected it to go like this. His lungs were just a little too young compared to the rest of him, and my diabetes made his blood sugars suffer. He’s breastfeeding and doing it so well, I never wanted to breastfeed until I tried it in the NICU. So glad he’s out now, I couldn’t be more in love with him. I never thought it’d be possible to love someone as much as I love Marco, but it happened and it makes me want to explode. Sorry this was so long, but it was a long process and I was excited to share because I love reading y’alls birth stories!

I was told my placenta was (maybe?) slightly covering my cervix at my 20 week anatomy scan at the perinatal assessment center where my OB sends her patients for big scans. MFM Doctor told me there wasn't much to worry about as it would most likely move, but to refrain from sex and flying. I told her I had a flight scheduled for a week from then. She had me schedule an appointment for a week later (the day before we were supposed to go - 21 weeks) to check on it again. At that appointment she spent a long time looking. She said the "meat" of the placenta was quite far away but there was a trail of it that she determined was about 1cm away. She said still too low for a vaginal delivery but I was fine to fly.
Now I'm 23 weeks and have another flight (3 hours) in a couple of days. They had me come back again today to check on placenta. Still about where it was at 21 weeks....1-1.5cm from cervix. A different MFM Doctor examined the images this time and was very vague about what he thought. At times he made it sound like it was risky, and other times he made it seem totally fine. He said I have no reason to think I'd go into preterm labor and my cervix is really long. Just not to stress. I kept asking about what his thoughts were about flying and he never really gave an answer. Just told me what I should do if I happened to go into labor while away from home. I feel like he didn't want to give me a straight answer. I much prefer the "yes" or "no" type Doctors! I have no history of bleeding.
I called my regular OB nurse line in hope's she could take a look at the results and see what she thinks. Hoping she returns my call quickly so we can make decisions. Has anyone had this issue while pregnant? From what i've read online it seems very split: some Doctors put no restrictions on you (as long as it's not covering the cervix) while others treat it as a complete previa and you're put on bedrest. I just want a straightforward opinion (like the first Doctor!).

So after bleeding since sunday and being told everything was ok, finally saw a really kick ass OB today.
Placenta Previa and a subchorionic hemorrhage. The bleeding as slowed down a lot and blood work shows my iron levels are ok.
The placenta is VERY close to the cervix, but not totally on it. The tiny bit of space between the cervix and placenta is where the hemorrhage is. He thinks as a the placenta moves it makes the subchorionic hemorrhage worse. Double whammy.
Im not allowed to lift me toddler, drive, grocery shop, NOTHING. The only thing im allowed to lift is a water bottle. The only walking im allowed to do is to the bathroom or kitchen to make food. He said the only time i need to leave the house is for my appointment next week and any emergency.
Grandma is here and changed her work schedule to the weekends, that way my husband will be home to take care of the toddler and house work.
I am a VERY hyper person who use to do 3 mile runs every moring pushing the toddler in a stroller with both my dogs running next to me (large German Shepards.) After the morning run then i would start my day.
I feel horrible but they get walked sometimes and no longer go for their morning run. They spend a lot of time in the back yard with new toys, i just cant have 130 pounds of hyper dogs,a toddler, and a high risk pregnancy in the house. That's just an accident waiting to happen.
I have Grand theft auto and the hubs is going to pick me up some puzzle books and yarn to help me get through all this.
Any ideas are tips to keep myself busy? Or good strong dog toys for my bored puppers?

Anyone out there dealt or dealing with placenta previa? 19 weeks and had some bleeding. Had an ultrasound and everything looks mostly normal but my placenta is very low lying. Dr said could be placenta previa but it was difficult to tell how much of the cervix it was covering, and problem may resolve as baby/placenta/uterus grow. If not, then I should expect more bleeding and a c section. This is my second baby, and my first pregnancy and birth were totally normal and natural, no problems at all. I'm not opposed at all to a surgical delivery if it's necessary, but it is a lot to wrap my head around. Now it's a wait and see game until the next ultrasound. Anyone have experience with this? If so, how did things go for you for the rest of your pregnancy and birth? Thanks!

Trigger warning, I suppose: mentions of bleeding during sex, feelings of sadness, anxiety, and panic about preterm labor and bedrest. Baby is fine, though!
Husband and I had sex around 12:30pm yesterday. We stopped midway because I was bleeding very heavily. This is nothing new to me... especially since I did this with baby #1, too. I know this happens when the cervix gets irritated. OB nurses line has instructed me on keeping an eye on flow, cramping/contractions, baby movement. Regardless, I went through the steps as I've always been instructed. Lots of baby movement, no cramping, but the blood wasn't really tapering off. I refused to bug the nurses line about it because this is part of it, right? Well, I went to tinkle at 5pm...still bleeding, kind of like period flow...and when I wiped there was a clot the at least 2 inches long. I have NEVER had a clot of that size before...even during a period. I panicked and called the nurses line. She gave me the same spiel about what to keep an eye on, but I still felt uneasy after passing that clot and the the bleeding never tapering off. Anytime I've bled after sex, it's only lasted maybe an hour or two...never 5 hours and certainly never passing clots. We loaded up the toddler and went to L&D to be monitored. Baby is fine. I'm having super tiny contractions that I can't even feel because of the post-sex aggravation. Cervix is still completed closed (but soft because this is baby #2...normal). I was put on bedrest today until I talk with my OB tomorrow (Monday) and she instructs me further.
 
I'm still spotting some 19 hours later...still bright red. Everything else is fine, but I'm very anxious and disappointed in my body. Baby #1 we had total pelvic rest because of placenta previa (corrected by 24 weeks) but had to remain on total pelvic rest because I continued bleeding during each sex session. I was admitted to hospital at 34w with #1 for preterm labor..strict bedrest until delivery. Delivered super healthy, no nicu time preemie at 36+2. They still have no idea what caused my preterm labor...no diagnosis of irritable uterus or incompetent cervix.
This pregnancy has felt so different and less complicated so far. I've been on weekly progesterone injections to cut down preterm labor chances by 1/3, my every-two-week ultrasounds of my cervix look PERFECT, no previa, no weird aches/pains. This is the first weird thing...and it's SUPER weird to me. Of course, NONE of the women that I know have had weird pregnancies or complications...so, no one has really been comforting to me or can even begin to understand. My amazing husband has been such a champ, again, about this...but the guilt and disappointment that I feel for having complications and my body not performing the way it needs to is beyond what I want him to comfort me about. I also have so much to take care of...getting toddler ready for Meme's house tomorrow, getting our lunches prepped for the week, and finishing the laundry...all of my weekend chores. Plus, we are showing our house to three different people on Tuesday evening (we're trying to sell our home). I know that husband can carry my load, but again...the guilt I feel is AWFUL.
Bedrest with #1 wasn't so bad compared to this...wanting to run around with my toddler, needing to take care of my home before our work week begins (both work full time), and wanting make love to my husband while not being able to. I'm already grieving things that haven't even been taken away yet. I'm so sad, guilty, and disappointed y'all. I'm sorry!

So my placenta and I have had a very strained relationship basically since conception. I've posted about this a bit here but this is the long story.
I had the baby rabies pretty hard for about a year prior to TTC. I got really into ina may and the business of being born and all that. Once I got a positive test, I found a midwife birth center and planned on a drug-free very granola birth.
12w NT scan-- radiologist review says placenta previa can't be ruled out (I suppose they didn't get a good view or maybe it was just to early to say)
20w anatomy scan-- placenta previa noted. I cried. A lot. The midwives were very upfront that if the previa persists I'd be forced to transfer to an OB and schedule a C Section, which was the exact opposite of my birth plan. But everyone kept telling me "90% of the time the placenta moves! It'll be fine!" But this wasn't just low-lying. This was full coverage of the cervix. I was put on full pelvic rest and told to call immediately if there was any spotting or bleeding.
28w follow-up scan-- we were sooo anxious leading up to this appointment. And yep, still complete previa. By this point I abandoned all hope of the birth center but everyone still tried to give me hope. I was still grieving the birth plan I originally wanted which might sound silly but it had become really important to me since before TTC. I was just ultra bummed. But they scheduled me for yet another follow-up ultrasound. Honestly the feeling of being in limbo was worst of all. I just felt totally out of control and like I couldn't trust my body at all.
32w-- another follow-up and you guessed it, cervix is still fully covered. Oh but the baby is head down and in perfect position for labor...cool. The midwives have been great and already transferred my records to my new ob at the best hospital in my area. I know I'll be in good hands.
I just felt so....cheated. I just kept thinking about all the benefits of vaginal birth over C Section (it's a surprise, you get to go through this experience of labor that has bonded women since the beginning of time, Baby gets important bacteria from the birth canal, quicker recovery time, etc). Unsupportive people who will remain nameless have told me there's no way I could've handled natural childbirth and I just wanted to scream at them two things: 1) I haven't had sex in 3 months and I'm super huge and i feel like shit all the time so get out of my fucking face and 2) I wish I was lucky enough even try to labor naturally!
But then I realized...the best part of me having a C Section? My baby and I are both really really really likely to come home alive! And thank goodness for modern medicine that they were able to identify the previa pre-labor. And also thank goodness that I've had no bleeding (knock on wood). If this were even 100 years ago this could've been bad news bears.
So I've already been told a C Section is recommended for 37 weeks which is only like a month away! SO SOON! I'm starting to freak out about it but at this point I've learned to just roll with the punches and basically have no expectations whatsoever.
My original birth plan just wasn't right for this pregnancy. But I can still be just as granola as I want after the baby's here and there's absolutely nothing I could've done to prevent this.
So for the ladies in limbo out there who don't know if theyll be forced into a C Section or not due to an asshole placenta, yes most of the time it will resolve and you can hopefully have the birth of your dreams. But it might not resolve. And that's ok too.

This is extremely long, I am sorry, but if you have ever experienced any of this, I would love your insight...
So, I am now 18w4d pregnant, and it has been a journey like no other. I never thought I was going to survive this long, yet I have. I have seriously felt like I am the only one that has ever experienced HG, and my OB/GYN has been absolutely no help whatsoever.
Starting at Week 7, I had not been able to get in to see my OB and would not be able to get in until 10 weeks. I had an US at the ER because I had been bleeding for the entire 7 weeks. US showed that I had a small tear in my uterus where the placenta was attached, but was told 'you are probably having a miscarriage, just go home and continue your life like normal'. I was devastated, this is my first pregnancy, and was so excited to become a mamma. I go home and try to continue my life, and morning sickness kicks in over the next week. The nausea and the vomiting continued until my 11wk initial visit to my OB. I have lost about 13 lbs by this time, because the N/V has been 24/7, non-stop. I'd get up several times in the middle of the night to go throw up. I had tried every remedy everyone had thrown at me. Nothing seemed to help. Crackers, pretzels, toast, the BRAT diet, gingerale, ginger tea, ginger this, ginger that, Emetrol, anti-nausea meds from the pharmacy, nothing helped. Water would not stay down. I burst the blood vessels in my eyes from heaving so much.
I get in to see my OB at 11wks, and I had no idea what to expect at a visit. He did the normal initial tests, and I asked about the weight loss over the past 3 and a half weeks. He said "The weight loss is no concern, you were overweight to begin with," granted, I was 220lb, down to 207lbs, and know that I am overweight, but I felt humiliated by this comment (and this comment still hits me hard to this day). I asked about the severe morning sickness I was having. He threw this out saying "this is normal, it will go away by 14wks. I asked for something for the n/v because I told him it was so severe 24/7, he said to take Emetrol, it was over the counter, and worked really well. I asked about the bleeding, because by 11wks, the bleeding had not stopped, and was still at a light flow. "Oh this is normal, it will stop by 14wks also." I don't know any better, so I believe him. The next week, I go to the ER for dehydration and Zofran IV.
I am a nurse on skilled rehab unit (yes I am a nurse, but anything to do OB or babies, I am totally clueless), and it is highly difficult to continue going on with life, let alone life at work, when one suffers from HG. Working my 12hour shifts are no longer possible. I talked to my DON, she, thank god, is very understanding, and agrees to put me down to 8hr shifts, and to put me on an easier unit. This had been well needed, although, still not easy. I have such a severe lack of energy, am so fatigued that I feel like I have forgotten everything, and cannot remember anything, I want nothing more than to sleep, and to stop starving, and I feel I have lost all ability to function properly. It is hard to explain to a patients family that has just died, and needs consoled , that you will be back, and run for dear life to the nearest restroom or trashcan, hoping to make it out of the room, OR to be in the middle of a sterile treatment or wound dressing and have to run for dear life, and come back and apologize to the patient for leaving their 'coccyx' overly exposed, or leaving a patient naked sitting on the toilet awaiting my return to finish dressing.
My 14wk OB visit. My OB comes in, asks me to lie back and expose my tummy, we are going to listen for the heartbeat for the first time. I am all excited, the first time I am going to hear my baby's heart beating! Yay! 5 seconds later, the Dr, says 'heartbeat is 150. you can sit up, we will do an Ultrasound next visit to see if you are having a boy or girl" and he walks out of the room. I'm sitting there waiting on him to return so I could ask him some questions, and the nurse walks in 5 minutes later, "oh, why are you still here, you can go." I state "Uh, I have some questions, can the Dr come back please?" the nurse replied "Oh, he is very busy, ask me and I will call you later and let you know what he says." I reply "No, I want to talk to him. I have questions." reluctantly the Dr comes back in, and I ask "What were my labs? What about my bleeding, why am I still spotting? What of my weight loss? I have lost another couple pounds. What about my nausea and the vomiting? It is still 24/7, not able to eat hardly anything and keep nothing down." Dr replied "Oh, the labs were normal. The bleeding is normal, it will go away by 17wks. the weight loss is normal, you have nothing to worry about, you are still overwieght. The N/V will go away by 17wks, it is normal." I ask for zofran ODT for the N/V, and the Dr replied " I do not know what this Zofran is, I will give you phenergan." and he walked out. The appt ended. I was not happy.
I filled my phenergan suppository prescription and began taking it. The side effects about killed me. I could not walk right, could not focus, could barely get out of bed, and work was out of question, made me dizzy, light-headed and faint and made the n/v worse. I tried it for 3 days, thinking It would pass. It did not. I called my Dr and explained I was having severe side effects to the phenergan. The nurse on the line said, Oh, phenergan does not have any side effects. I still told her I wanted to speak to the Dr. He answered. I explained what was going on, and I wanted switched to the Zofran ODT. "Oh, I never heard of that, what is it?'' I explain it is a dissolving tablet that will dissolve under my tongue, and do not need to drink water with it, so I won't throw it up. He still does not believe me, so I give him my pharmacy number and demand he call and find out what it is, and he needs to give me a prescription for it ASAP since I had not kept anything down for 3 days. I called at noon. I had not recieved a call back by 3pm, so I called back, begging, PLEADING. The nurse said he had been too busy and would do it later. I begged and begged, and this was her answer over and over. Finally, the office closed at 5pm, still no call back. No script sent to the pharmacy. I call back and got ahold of the answering service, stating the Dr was out of the office. I was so sick and so angry. I called my mother to take me to the ER, where I knew they would give me some relief. Just as my mother had gotten to me, it was 7pm. I recieved a call from my Dr office stating he had just sent a script for Zofran ODT to the pharmacy. THANK GOD. So, no ER visit, mom shot me straight to the pharmacy, got the Zofran ODT, and 20 mins later, I was feeling so much better, and could finally eat, and it stayed down. Sweet HEAVEN. The Zofran has helped keep my foods down, with occasional vomiting, and still 24/7 nausea. I can deal with that, it's better than it was.
my 17wk OB visit. The nurse came in first to take a pee sample. I aske her what I am to expect this visit. she rattles off 4 things she says the Dr will do, that he has done at each prior visit, and will do at every visit there after. I stop her and tell her he has not done any of those things, that the only thing he has done is listen 5 seconds with the dopplar to the heartbeat. Nothing else. The nurse reassures me that he did these things last time. My husband speaks up and says No the Dr did none of those things. I then ask if he was still to do an ultrasound this visit. The nurse says there was no US scheduled, and they don't do them in the office, you have to go to the hospital for that, and the Dr does not do them until 18-20 weeks. I asked her why I wasted my time coming in for this visit, if the US was going to be next week instead. She replied because the r still does those 4 things she said he does. OK. Fine. Dr comes in and again, we listen to the heartbeat not even 5 seconds, and he says "the heartbeat is between 150-154" and walks out. I told the nurse to get him back in the room, I have questions. Again, it was a fight to get him to come in and talk to me. I ask him why no US was ordered. He called me a liar and said he never told us that. My husband tells him he did. Dr still denies this. I ask my same questions as before, how were my labs, why am I still bleeding, why am I still having severe N/V 24/7, and I have lost a couple more pounds, equaling a total of 20+lbs lost, and NO weight gain. Again, all of his answers are "This is normal. It will go away by 20 weeks. It never lasts longer than that." I told the Dr, since he did not ask, the N/V has still been bad, but definitely better with the Zofran ODT, can I get a new script with a refill. Dr replies," I did not know you are having bad morning sickness." No crap. why do you think I asked for the Zofran ODT, and you wouldn't give it to me. Dr denied ever saying that he did not know what Zofran ODT was, that I asked for something completely different. I asked about the tear the first US showed in my uterus, is this why I am still bleeding? Dr replied "I did not know you had a tear. where did you here this?'' from the ER US.
I called him an idiot and embarrassed my husband, walked out and told them to release all my records to me, I would not be back. I also demanded that Dr order an ultrasound so I could find out if I still have a tear, or if I have placenta previa, or whatever else might cause me to bleed. reluctantly, he did order it.
I had my ultrasound last Friday, at 18wks. I was highly relieved to find out that there is no longer a tear in my uterus, and the placenta is far enough away from the cervix I have nothing to worry about there. I found out the baby is measuring spot on for 18wks, and currently weighs 7oz. the baby looks healthy, and was moving around being uncooperative. Also, found out, We are having a little Girl! That made my day. All I wanted to know was, is there a tear and is the baby alright, the DR could have humored me sooner. I'm scared shitless and don't know what to expect. But this was all good news to me, and calmed my nerves A LOT.
I now have an Appt scheduled with a new OB, and will not get in to see her until Jan 6,2014. I hope she cares a lot more than this last Dr did.

UPDATE: Had my ultrasound today and there is still a huge clot covering my cervix and the edge of the placenta. I haven't spoken to the doc yet but from what I know this means they will treat it like a previa because they can't see it to know either way. I also was able to get out on a pass today for a couple of hours of dog snuggle time. Leaving him to come back to the hospital was one of the hardest things I've done. We are having him put down on Saturday as he is clearly progressing quickly. Grandpa seems stable but very tired. Oh and to add to the shit we have to kick our housemate out and Hubby's mom, who hates me, is coming for a visit! Yay! Thank you all so very much for your kind words. They mean so much to me and give me something to do to pass the time here in the hospital of boredom.
I haven't posted a whole lot about my situation since the first time I was in the hospital at 27 weeks for bleeding with placenta previa but a whole lot has happened and I thought since I'm awake with nothing to do I would share.
At my 30 week scan we found no more movement from the placenta I was anxiously awaiting my next one at 35 weeks, it was planned for tomorrow. Instead at 33 weeks I had a huge terrifying bleed (think elevator doors opening in The Shining) which left me in the hospital for four days. This caused an irritable uterus and I was having contractions every 2 minutes for 3 hours. They did give me a scan in hospital at this point but the blood clot was in the way and they couldn't tell me if it had migrated or not. Everything settled down and I left the hospital.
This is when life decided I wasn't having enough stress! My husband's grandpa was hospitalized in the cardiac ICU. Then we got to sit around on Easter Sunday as a family and discuss the fact that he was turning off his internal defib as his heart couldn't take anymore shocks. We talked about his end of life care and that he was being placed in palliative care. FYI that is NOT an easy conversation to sit through with hormotions running wild at 34+6!
Then to add to the fun we have been dealing with what we thought was a soft tissue or disc problem in our lovely 4 year old chocolate lab. We were referred to a neurological specialist to do some imaging and find out what was really happening. I was anticipating him sucking us dry financially, having surgery days before baby was here and having to rehab him with a newborn. I was totally game for this as he is our furbaby and still so young. Instead we found out he has a cancerous tumor on his spine which is crazy rare at his age and there is absolutely nothing we can do for him. It cost us $2000.00 to get to this point.
THEN just as we brought him home and were discussing plans for his last couple of days and when we should put him down I felt the all too familiar elevator door bleeding feeling start. I ran to the bathroom and just sat there with it pouring out of me while I cursed a blue streak. My poor husband was terrified and we rushed to the hospital.
So here I sit in the hospital again. My pooch has to be put down so soon and I can't be with him. My grandpa is dying and I can't be with him. They tell me if I have any more significant bleeds they will take baby right away. At best I have until 36-37 weeks but looking more like 36 which is Tuesday.
What in the living hell?! Thanks if you read all the way through this. I really needed to get it all out there.

I haven't posted much, but I want to post an update, since this community has been very supportive, sharing their stories when I went through craziness in my own pregnancy! Also, in my most confusing medical moments, I hunted down posts of people who went through the same thing I was going through and found it empowering, so maybe this story can help someone else some day.
I had a crazy number of issues this pregnancy -- multiples pregnancy after IVF/ICSI. Bleeding from 8 weeks on and off. Hyperemesis gravidarum which was there until I gave birth. A CVS that almost became a miscarriage (I had regular contractions and tons of bleeding a few days after, but they went away). A fibroid that grew to the size of a grapefruit. A hemorrhage event in a public place with a trip to the hospital in an ambulance. Anemia afterwards. I was diagnosed with partial placenta previa. Two hospitalizations. And finally, insufficient cervix that wasn't diagnosed until I was 6 cm dilated at 29 weeks 1 day. Of course the placenta previa had resolved by then. Wheee!
The last time I posted in detail was with the 6 cm dilation, where I was hospitalized indefinitely. I went into L&D triage for a weird eye issue which resolved. I was having regular contractions which I only felt when I was being monitored (Schrodinger's Cat contractions?), which led them to doing an internal exam, which led them to finding that I was 6 cm dilated (I gasped), and that they could see one of the baby's heads (gahhh).
Baby A was acting as a cork. There were no bulging membranes. Just a membrane with a head in it. If he wasn't being a cork, I would have had a c-section that night.
They filled me up with magnesium sulfate (awful!) and steroid shots and another medicine to stop the contractions for long enough to let the steroids take effect. I was shocked that they were not interested in stopping contractions for a longer period of time. The resident explained that their practice was that at 29w, if the contractions started again, they would assume that my body could have an infection or otherwise it needed the babies out, and that they would be better off in the NICU. And that this would happen instantaneously, since I was so far along dilated, Baby A was so small, Baby B was so large and was also breech, that a c-section was the safest course of action for the babies, even though a couple of the doctors were comfortable with doing a breech extraction for Baby B (but not with the estimated size difference).
My goal was to keep the babies in me as long as possible. I held out for a week. Near the end of that week, I was experiencing intense pressure and back pain whenever I shifted my body in certain ways. I tried to suffer through it (I didn't want another false alarm and another night on magnesium sulfate -- I had one mid-week and was so miserable, I thought I was actually dead, because the heart monitoring machine crashed, my heart line stopped, and that seemed the most logical explanation to me). These weird back pains never showed up on the NST, and I kept quiet about them since they were in the realm of normal pregnancy, well, plausible deniability. But finally, after a couple of days with it, the pain was beginning to be so bad, it made me pace around the room as if I was trying to outrun it. I called the nurse.
I expected to be placed on monitoring on my bed, but the doctors were so nervous about my case, the staff rolled in a stretcher, and I was immediately placed on it and sent up to Labor and Delivery. They hooked me up to a monitor (no contractions), but when they checked for dilation, they found I was 8 cm along and had bulging membranes! I had just eaten lunch 15 mins ago, but I was being immediately prepped for c-section. At 30 weeks 2 days.
I find it amazing how quickly things happen in Labor and Delivery -- it's almost an inspiration to me, since I have trouble feeling cool and collected under pressure. I was moved to the operating room, prepped, and in surgery very quickly. They rushed because I was dilating, so they wanted to get both babies out of me before Baby A got too low in to force a vaginal delivery for him, and a c-section for his brother. The OR ran like a well oiled machine. I am so impressed with the staff at the hospital, I almost wish I could restart my life and go into medicine.
I was totally freaked out about having a c-section too, almost had a panic attack when I couldn't feel myself breathe anymore due to the spinal, but the anesthesiologist talked me down, and suddenly I had the courage and embraced where I was -- I was going to birth some babies!
From then on, the c-section was an amazing experience, and although it was so rushed, the experience was much calmer and more spiritual than the last five minutes of "natural childbirth" of our oldest, when my spouse started to bleed, and no one could tell where the blood was coming from or get stats from the baby, and a doctor we never met materialized from nowhere and threatened her with a vacuum to PUSH THAT BABY OUT NOW!
And I heard them cry! Both babies! As they took them from me! Which is something we never heard from our oldest. And I knew they were both okay, and I was so so so deeply happy.
Nurses carried both of them to me as I was being patched together, wrapped up in blankets and on CPAPs, and it was wonderful. And they were so mad to be out, and I loved them.
At the end of the surgery when I was lying in recovery, the resident told me that by the end of the surgery, I was 9 cm dilated. I really had waited to the last possible minute.
When I recovered enough from the c-section that I could move my legs, they wheeled my gurney up to the NICU, and encouraged me to touch each foot -- I was so afraid to, but it was wonderful. The next day, I could hold them -- I had no idea they would allow me given how fragile they were, but I was so thrilled.
Baby A was born at 3 pounds 4 ounces. Baby B was 3 pounds 9 ounces. Baby B was anemic and pale (I so hope it was from delivery, not the chronic anemia I was dealing with in the second half of my pregnancy) and needed a blood transfusion that night, which went well. So far, they've only had the typical issues one might expect for 30 weeks -- jaundice, apnea, needing to bottle feed. Although they were on CPAPs, they were able to avoid a ventilator, and were breathing room air from day 1.
It's been 3 weeks since their delivery. They continue to do great. They are off of CPAPs. They no longer need jaundice lights. They did their first bottle feeding yesterday. They are becoming more interactive, and Baby B is now a full pound heavier! Although everything is going smoothly, NICU life is still stressful. They are probably a month and a half from coming home, and it is a draining experience. My paid maternity leave is likely to run out before they get home from the NICU, but because I had twins, I can take up to 16 weeks of leave, so I will get some time with them when they come home.
The punch line of it all -- they were conceived by IVF/ICSI, but we think they might be identical twins! Either time or a DNA test will tell....