A primigravida at 37 week of gestation repoed to labour room with central placenta pre with heavy bleeding per vaginum. The fetal hea rate was normal at the time of examination. Which of the following is the best management option for her?
Since this patient in labour is having central type placenta pre with heavy vaginal bleeding, the most appropriate step in management is to conduct caesarean section. Indications for caesarean section in placenta prae are: Severe degree placenta pre (type-II (marginal), type-III (incomplete or paial central), type-4 (central or total). Lesser degree of placenta pre where amniotomy fails to stop bleeding or fetal distress appears. Complicating factors associated with lesser degrees of placenta pre where vaginal delivery is unsafe. Vaginal delivery usually is reserved for patients with a marginal implantation and a cephalic presentation. If vaginal delivery is elected, the membranes should be aificially ruptured prior to any attempt to stimulate labor (oxytocin given before amniotomy is likely will cause fuher bleeding). Ref: Textbook of Obstetrics By D.C. Dutta, 6th Edition, Pages 251-252 ; Scearce J., Uzelac P.S. (2007). Chapter 20. Third-Trimester Vaginal Bleeding. In A.H. DeCherney, L. Nathan (Eds), CURRENT Diagnosis & Treatment Obstetrics & Gynecology, 10e.
Caesarean section
Expectant management
Induction and vaginal delivery
Induction and forceps delivery