Conservative management is contraindicated in a case of Placenta pre under the following situations, except :
Ans. is c i.e. Hemodynamically unstable condition The aim of expectant management in case of placenta pre is to continue pregnancy for fetal maturity without compromising the maternal health. Prerequisites for expectant management Availability of blood for transfusion whenever required Facilities for cesarean section should be available throughout 24 hours. Candidates : Suitable for expectant management are : Mother in good health status -- Hemoglobin > 10 gm% -- Hematocrit > 30% Duration of pregnancy less than 37 weeks Active vaginal bleeding is absent Fetal well being is assured by USG and cardiotocography. The expectant management is carried upto 37 weeks of pregnancy until baby matures, Indications for active treatment I contraindications for putting the patient to expectant management. Bleeding occurs at or after 37 weeks Patient is in Tabour-' Patient is in exsanguinated state on admission Bleeding is continuing and is of moderate degree Baby is dead or known to be congenitally deformed Severe degree of bleeding Fetal distress." Coming to option "c"i.e. hemodynamic unstable condition of mother -- Hemodynamic unstable condition means there is a change in vital signs of the patient due to blood loss and approximate blood loss is 15-30% of the blood volume (Moderate blood loss). Remember : Mild bleeding blood loss <15% No charge in vital signs/ urinary output Moderate bleeding blood loss between 15-30% Pulse rate 'I/ B/P / cold clammy extremities Severe bleeding blood loss >30% Patient in shock with decreased or unrecordable BP, Oliguria or anuria So initial hemodynamic instability is not a contraindication for expectant management but if the condition remains unstable for 24 - 48 hours despite resuscitative measures, it is a contraindication for expectant management. Note: Since in this question there is no other correct option, therefore, we are saying hemodynamic unstability of mother is not a contraindication for conservative management and finding out ways to suppo it but if there was a better option then I would have included hemodynamic unstability in the contraindication for conservative management
Evidence of fetal distress
Fetal malformations
Mother in a hemodynamically unstable condition
Women in labour