Placenta Previa

Question 1

Conservative mgt

Answer 1

 In absence of any of the above indications to deliver the fetus, conservative
management is instituted till an indication comes to picture.
o Conservative management in preterm lady includes:
 Bed rest (in hospital) —–No place for outpatient management
 Dexamethasone 6mg IM Q 12 hours for a total of 4 doses
 Follow: Maternal V/S, vaginal bleeding, uterine contractions, fundal
height, FHB, kick count, BPP, serial HCT.
o Deliver at 37 completed weeks of gestation after maturity is confirmed

Question 2

Route of delivery

Answer 2

depends on the type of placenta previa and presence of
other obstetric indications:
 Low lying & anterior marginal → vaginal delivery
 Partialis, totalis, & posterior marginal → c/d
 Excessive bleeding, NRFS, other indications → c/d

Question 3

Indications for immediate delivery

Answer 3

 Term pregnancy, IUFD, fetal growth restriction, NRFS, excessive
bleeding, gross fetal congenital malformation which may not be
compatible with life, lady in labor.

Question 4

General mgt

Answer 4

 Admit all ladies with APH secondary to placenta previa at time of diagnosis.
 Resuscitation based on clinical condition.
 Vaginal & rectal examinations are absolutely contraindicated.
 Monitor closely maternal & fetal conditions.
 HCT, BG & Rh, cross-match at least two units of blood
 Decide on conservative management versus immediate delivery