Female with 37 weeks of pregnancy comes with grade 3 placenta previa, bleeding per vaginum with uterine contractions. Most appropriate management would be?
ANSWER: (D) Emergency LSCS REF: Fernando arias p. 167-170 , Dutta 6th edp. 252-253 The patient's gestational age is 37 weeks hence the patients should be delivered, however since she has grade III placenta previa, she should be delivered by emergency cesarian section. Indications of cesarian section in placenta previa are: Major degrees of placenta previa II b, III, IV Lesser degrees of placenta previa where amniotomy doesn't relieve fetal distress << Non- engagement of fetal head Severe bleeding Any contraindication of vaginal bleeding. Candidates for expectant management in placenta previa: Mother in good health ,Hb > 10 gm% , Hct >30 % Pregnancy <37weeks Active vaginal bleeding is absent Fetal well being assured by USG and cardiotocography Indications of active treatment: Bleeding occurs at or after 37 weeks Patient in labor Patient exsanguinated on examination Continuous Bleeding or moderate Baby is dead or congenitally deformed Severe degree of bleeding Fetal distress
Dexamethasone and nifedipine
Bed rest & sedation
Wait and watch
Emergency LSCS