Management of PP-1

MANAGEMENT OF
PLACENTA PREVIA
Name - Garima prakash

Chauhan
Roll no- 45
MBBS 2020
CONTENTS
1. PREVENTION
2. MANAGEMENT AT HOME
3. TREATMENT ON ADMISSION
● IMMEDIATE ATTENTION
● FORMULATION OF LINE OF TREATMENT
PREVENTION
To minimize the risk , the following guidelines are useful:

❏ Regular antenatal care to improve the health status of women and
correction of anemia .
❏ Antenatal diagnosis of low lying placenta at 20 weeks with routine
ultrasound needs repeat ultrasound examination at 34 weeks to confirm
diagnosis.
❏ Significance of ‘warning hemorrhage’ should not be ignored .
Cont…..
❏ The women is advised to avoid sexual intercourse or digital vaginal
examination .
❏ Color flow Doppler USG in placenta previous is indicated to detect any
placenta accreta . It is preferably done between 36 and 37 weeks.
❏ MRI is superior to USG because it can diagnose posterior placenta
previa, placenta accreta and with bladder invasion .
Findings : dark intraplacental bands , tenting of bladder and uterine
bulging.
MANAGEMENT
At home
1. The patient is immediately put to bed.
2. To assess the blood loss :
a. Inspection of clothing soaked with blood
b. To note the pulse, blood pressure and degree of anemia
3. Quick but gental abdominal examination to mark height of uterus , to
auscultate FHS and any tenderness on uterus.
4. Vaginal examination must not be done .
TREATMENT ON ADMISSION
IMMEDIATE ATTENTION:
1. Amount of blood loss - by noting the general condition, pallor , pulse
rate and blood pressure.
2. Blood samples are taken for groups , cross matched blood
Transfusion.
3. A large - bore IV cannula is sited and infusion of normal saline is
started .
Cont….
4. Gentle abdominal palpation to ascertain any uterine tenderness and

auscultation to note the fetal heart rate.
5. Inspection of the vulva to note the presence of any active bleeding.
Confirmation of diagnosis is made from the history ,

physical examination and with sonographic examination.
FORMULATION OF THE LINE OF TREATMENT
The definitive treatment depends upon the duration of

pregnancy, fetal and maternal status and extent of
haemorrhage
❏ Expectant management
❏ Active ( definitive) management
Expectant treatment
To improve the fetal salvage without increasing undue maternal hazards.
The aim is to continue pregnancy for fetal maturity without compromising the
maternal health.
● Vital prerequisite:
1. Availability of blood transfusion
2. Facilities for cesarean section should be available throughout 24 hours
● Selection of cases :
1. Mother is hemodynamically stable (hb>10% ; hct >30%)
2. Pregnancy duration less than 37 weeks
3. Active vaginal bleeding is absent
4. Fetal wellbeing is assured
Cont…..
● Conduct of expectant treatment:

1. Bedrest with washroom privileges.
2. Investigation ( hb estimation , blood grouping and urine for protein)
3. Periodic inspection of vulval pads and fetal surveillance with USG at
interval of 2 - 3 weeks
4. Supplementary hematinics (oral / IV) should be given
5. A gentle speculum ( Cusco’s) examination is done to exclude local
cervical and vaginal lesion for bleeding .
6. Use of tocolysis ( magnesium sulfate)
7. Rh immunoglobulin should be given to all Rh -ve (unsensitized)
women.
Active ( definitive) management
Indication:
1. Bleeding occur at or after 37 weeks of pregnancy.
2. Patient is in labor.
3. Bleeding is continuing and of moderate degree.
4. Baby with nonreassuring cardiac status.
Cont….
● A. Cesarean delivery is done for all women with sonographic

evidence of placenta previa where placenta edge is within 2 cm from
internal os.
● Most women with low- lying placenta are also delivered by cesarean
section.
● Wider use of cesarean section to reduce the maternal risk but also to
improve the fetal salvage .
● Cesarean delivery in case of asymptomatic placenta previa is done
preferable between 36 and 37 weeks.
Cont….
B. Vaginal delivery
Done when placenta edge is clearly 2 - 3 cm away
from internal cervical os ( based on sonography) .
Bibliography
DC Dutta’s textbook of obstetrics 10th edition

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MANAGEMENT OF

Name - Garima prakash

To minimize the risk , the following guidelines are useful:

4. Gentle abdominal palpation to ascertain any uterine tenderness and

Confirmation of diagnosis is made from the history ,

The definitive treatment depends upon the duration of

● Conduct of expectant treatment:

● A. Cesarean delivery is done for all women with sonographic

DC Dutta’s textbook of obstetrics 10th edition

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