PLACENTA PREVIA

Painless – sometimes massive – bleeding in the last trimester of the pregnancy strongly suggests previa.

Same treatment whether fetus is alive or dead:

  • Immediate resuscitation with fluids
  • Transfuse one or two units of fresh blood
  • Perform ultrasound examination
    • Total previa:
      • C/S
    • Marginal previa:  
      • Rupture the bulging membranes
        • Diminishes traction on the placenta
        • Reduces bleeding
      • Deliver vaginally

When ultrasound is not available

  • Bring patient directly to the operating theater
  • Prepare for urgent C/S
  • Perform gentle speculum examination
    • Total previa:
      • C/S
    • Marginal previa:
      • Rupture the bulging membranes
        • Diminishes traction on the placenta
        • Reduces bleeding
      • Deliver vaginally

Watch out for signs of DIC (HELLP Syndrome). Transfuse with fresh blood at the slightest suspicion

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