Expectant management of placenta previa includes all except:
Ans. is b, i.e. Cervical encirclage.Ref. Dutta Obs. 7/e, p 248, 249, Fernando arias 3/e, p 341, 342McAfee and Johnson regime is the name given to the expectant management of placenta previa as it was advocated by McAfee and JohnsonAim of expectant management in case of placenta previa is to continue pregnancy for fetal maturity without compromising the maternal health.Prerequisites for expectant management:Availability of blood for transfusion whenever requiredFacilities for caesarean section should be available throughout 24 hours.Candidates: Suitable for expectant management are:Mother in good health status- Hemoglobin >10gm%Hematocrit >30% and she should be hemodynamically stable.Duration of pregnancy less than 37 weeksActive vaginal bleeding is absentFetal well being is assured by USG and cardiotocographyThe expectant management is carried upto 37 weeks of pregnancy until baby matures.Expectant management includes (i.e. McAfee and Johnson regime includes)Hospitalization till active bleeding stops and then readmission at 34 weeksComplete bed restAnemia corrected with blood transfusion (if necessary), but blood should always to be kept ready as placenta previa is a recurrent condition.Antenatal steroids to promote fetal lung maturityAnti D if patient is Rh negativeIf uterine contractions are present - tocolytics (nifedipine) can be given as it leads to more advanced gestational age at delivery, greater birth weight of fetus, less neonatal complications, and decreased cost of hospitalization. Tocolytics should not be used for more than 48 hours.
Anti-D
Cervical encirclage
Blood transfusion
Steroids
Antepartum Haemorrhage