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. The best management option for her is :
Ans. is b i.e. Cesarean section SCHEME OF MANAGEMENT OF PLACENTA PRE Expectant treatment Indications * No active bleedingdeg * Preg. less than 37 weeksdeg * Patient -- stable hemodynamicailydeg (Hb>10gm% hematocrit >30%) F.H.S -- gooddeg CTG -- reactive Active interference Indications Bleeding continuesa/severe bleeding Preg. 37 weeksdeg Patient in labourdeg Exsanguinateddeg Gross fetal malformation/Dead fetusdeg Fetal distress Till 37 weeks Double setup examination in OT Type I. II (ant) Type II (Post), III&IV Cesarean section A.R.M.+- Oxytocin Satisfactory progress without any bleeding Vaginal delivery Bleeding continues 1 Cesarean section The patient in the question : Has gestational age = 37 weeks i.e. fetus has attained maturity so immediate termination of pregnancy is recommended. Has central placenta pre Type IV i.e. vaginal delivery is contraindicated. cesarean section has to be done. Patient is having heavy bleeding. According to r-ernando Arias "In patients with heavy bleeding an efficient management plan including life suppo measures and immediate operative intervention is the only way to avoid a maternal death." it fuher says- -Patients witn placenta pre and severe bleeding should be delivered by cesarean section irrespective of the type of placenta pre." So from above discussion it is very much clear that in this patient immediate cesarean section is the best reso. Friends here I want to point out, that this patient has central placenta pre so cesarean section has to be done, but even if heavy bleeding with minor degrees of placenta pre i.e. type I, Type II Anterior is there then too the answer would have been cesarean section and not vaginal delivery. Also Know : Type 1 Type 2 Type 3 Type 4 Lateral Marginal Incomplete central Central Browne's classification for placenta pre Placenta dipping into the lower segment but not reaching upto the cis. Placental edge reaches the internal os Placenta covers the internal os when closed, but not when fully dilated Placenta covers the internal os even when fully dilated Type 1 and 2 are called --nor degree' and type 3 and 4 called r7aior degrees of placenta pre. Type 1 and 2 can be anterior or posterior. Type 2 posterior placenta is also called the 'dangerous type' as it is more likely to be compressed producing cord compression. This can cause fetal asphyxia and even death.
Expectant management
Cesarean section
Induction and vaginal delivery
Induction and forceps delivery