A primigravida at 37 week of gestation reported to labor room with central placenta previa with heavy bleeding per vaginum. The fetal heart rate was normal at the time of examination. The best management option for her is:
Ans. is b, i.e. Cesarean sectionRef. Dutta Obs 7/e, p 249, 250; Fernando Arias 3/e, p 337, 339The patient in the question:1. Has gestational age = 37 weeks i.e. fetus has attained maturity so immediate termination of pregnancy is recommended.2. Has central placenta previa Type IV i.e. vaginal delivery is contraindicated, cesarean section has to be done.3. Patient is having heavy bleeding.According to Fernando Arias 3/e, p 337"In patients with heavy bleeding an efficient management plan including life support measures and immediate operative intervention is the only way to avoid a maternal death."It further says - on p 339"Patients with placenta previa and severe bleeding should be delivered by cesarean section irrespective of the type of placenta previa."So, from the above discussion, it is very much clear that in this patient, immediate cesarean section is the best resort. Friends, here I want to point out that earlier it was said that for minor degrees of placenta previa, vaginal delivery can be tried, but now, irrespective of degree of placenta previa, cesarean section is done and recommended.
Expectant management
Cesarean section
Induction and vaginal delivery
Induction and forceps delivery
Antepartum Haemorrhage