Deciding when to deliver: 34-36 weeks
Saw a very helpful post on this question yesterday for another case. I'm struggling with my own dilemma, so wanted to open up to the wisdom of this incredible community:
I'm 38 with an IVF pregnancy after several losses, and I'm 32 weeks today. I've been in the hospital on-and-off since 23+1, and permanently since 27+1, with intermittent bleeding from a placenta previa (which now appears to be "just" low-lying). I bleed very frequently--every 1-5 days, more or less--but they are mostly small/medium and resolve within a couple hours.
For now, things are stable, and it's a miracle I've gotten this far. I still haven't had a really big bleed (>100mL) or had a preterm labor scare. My vitals and CTGs have always been great, placental function appears unaffected, baby girl is big (70th percentile), hemoglobin is holding stable with iron supplementation, etc. But placenta previa is unpredictable and the risk of big bleeds/hemorrhage increases with gestational age, so anything could happen. I've also had prior severe hemorrhages after D&Cs, so I can't help but think I'm at higher than baseline risk.
If things remain stable, I'm weighing planned delivery timing (c-section). My team is willing to deliver any time between 34-36 weeks, but don't want to take the risk of going longer. The key trade-off is between the benefits of increased gestation and the risk of severe hemorrhage/fetal distress/emergency c-section, which would be risky for us both.
My original instinct was to deliver early -- basically as soon as we hit 34 weeks -- to try to avoid an emergency scenario and associated catastrophic risks. But now I'm second guessing myself: there seems to be quite a bit of improvement in long-term outcomes between 34 and 36 weeks, and I worry I'm biased by my own hospital fatigue.
Thoughts or feedback? Any insight or experience would be greatly appreciated!
UPDATE:
After talking to my primary consultant and on his strong advice, we've set a tentative c-section date at 34+1. But still quite interested in any supportive or competing perspectives.