Placenta praevia Mx and prognosis

Question 1

If low-lying placenta at the 20-week scan:

Answer 1

rescan at 32 weeks

no need to limit activity or intercourse unless they bleed

if still present at 32 weeks and grade I/II then scan every 2 weeks

final ultrasound at 36-37 weeks to determine the method of delivery

elective caesarean section for grades III/IV between 37-38 weeks

if grade I then a trial of vaginal delivery may be offered

if a woman with known placenta praevia goes into labour prior to the elective caesarean section an emergency caesarean section should be performed due to the risk of post-partum haemorrhage

Question 2

Placenta praevia with bleeding mx

Answer 2

admit
ABC approach to stabilise the woman
if not able to stabilise → emergency caesarean section
if in labour or term reached → emergency caesarean section

Question 3

prognosis

Answer 3

death is now extremely rare

major cause of death in women with placenta praevia is now PPH