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Placenta Praevia



It is an obstetric complication in which the placenta embeds itself partially or wholly in the lower segment of the uterus. 


Diagnostic criteria


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



If asymptomatic

  • Bed rest and follow up every 2 weeks


If complete placenta praevia

  • Admit for fetal lung maturation ≥ 24 weeks of gestation 

  • Deliver by Cesarean section at 37–38 weeks of gestation 

  • 30–60mg of elemental iron and 400µg (0.4mg) folic acid supplements 

  • Do FBC and Blood group and cross match, blood coagulation tests 

  • Monitor fetal heart rate 

  • Ultrasound for fetal wellbeing and localization of the placenta


If >34 weeks of gestation and minimal hemorrhage and no uterine contractions:

  • Expectant management

If there is uterine contractions; 

  • Complete placenta praevia or malpresentation: Deliver by Cesarean section. 

  • Partial or marginal placenta praevia: Carefully perform amniotomy for vaginal delivery if the head is engaged.


Major Recommendations

 If <34 weeks of gestation 

Fetal lung maturation give

  • Dexamethasone6 mg IM every 12 hours for 48 hourly 


If there is uterine contractions tocolyse with  

  • Nifedipine short acting (PO) 20mg start, then continue with     

  • Long acting nifedipine 20mg 8 hourly  


If premature rupture of membrane: 

  • Ampicillin 2g start dose, then 

  • Amoxicillin tabs 500mg 8 hourly for 5–7 days, while close monitoring for bleeding 


In case of any hemorrhage, the patient should report to the doctor for immediate action 

  • Avoid vaginal examination 

  • For any risk of premature delivery, the patient must be managed in a center with neonatal care facilities 


Updated on, 3.11.2020


1. STG

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