Placenta praevia

Placenta praevia

Placenta praevia is an obstetric complication in which the placenta implants partially or completely in the lower segment of the uterus. It is an obstetric emergency that should be managed in a facility offering Comprehensive Emergency Obstetric and Newborn Care (CEmONC) services.

Clinical presentation

• Sudden onset of bright red, fresh, painless bleeding after 28 weeks of gestation

Management

Partial placenta praevia and asymptomatic

• Advise bed rest at home

• Follow up every 2 weeks

Complete placenta praevia

• Admit for close monitoring and observation

• Perform ultrasound to localize the placenta

• Perform Full Blood Picture (FBP), coagulation tests, blood grouping, and cross-matching

• Keep at least 2 units of blood available for transfusion in case of acute bleeding

• Consider blood transfusion if indicated

• Avoid vaginal digital examination

• If gestational age is greater than 34 weeks and there is no per vaginal bleeding or uterine contractions, continue expectant management

• Deliver by caesarean section preferably at 37–38 weeks of gestation

• Perform caesarean section at any time if labour begins or severe per vaginal bleeding occurs

• In partial or marginal placenta praevia, carefully perform amniotomy for vaginal delivery if the fetal head is engaged

Pharmacological management

• Dexamethasone (PO) 6 mg every 12 hours for 48 hours if gestational age is less than 34 weeks for fetal lung maturation

• Nifedipine (PO) 20 mg every 8 hours until labour symptoms subside.