Timing of Delivery and Mode of Delivery:
As gestational age advances, there is an increased risk of significant bleeding, necessitating delivery. It is preferable to perform a cesarean delivery for placenta previa under controlled scheduled conditions rather than as an emergency. In a stable patient, it is reasonable to perform a cesarean delivery at 36-37 weeks of gestation, after documentation of fetal lung maturity by amniocentesis. If the amniocentesis does not demonstrate lung maturity and patient is stable it is reasonable to wait till 38 or 39 weeks of pregnancy or earlier if bleeding occurs or patient goes into labor. There is consensus that a placenta previa which totally or partially overlies the internal cervical os requires delivery by cesarean. However, the mode of delivery when the placenta lies in proximity to the internal os is more controversial. Women with a placenta -- internal os distance of less than 2 cm who undergo a trial of labor almost invariably experience significant bleeding during labor, necessitating cesarean delivery and many centers recommend cesarean delivery in these cases. Women whose placentas are 2 cm or more away from the os can undergo a normal labor. It is important to realize that, in women with a placenta that extends into the non-contractile lower uterine segment who have a vaginal delivery, there is potential for postpartum hemorrhage.
Timing of Delivery and Mode of Delivery:
As gestational age advances, there is an increased risk of significant bleeding, necessitating delivery. It is preferable to perform a cesarean delivery for placenta previa under controlled scheduled conditions rather than as an emergency. In a stable patient, it is reasonable to perform a cesarean delivery at 36-37 weeks of gestation, after documentation of fetal lung maturity by amniocentesis. If the amniocentesis does not demonstrate lung maturity and patient is stable it is reasonable to wait till 38 or 39 weeks of pregnancy or earlier if bleeding occurs or patient goes into labor. There is consensus that a placenta previa which totally or partially overlies the internal cervical os requires delivery by cesarean. However, the mode of delivery when the placenta lies in proximity to the internal os is more controversial. Women with a placenta -- internal os distance of less than 2 cm who undergo a trial of labor almost invariably experience significant bleeding during labor, necessitating cesarean delivery and many centers recommend cesarean delivery in these cases. Women whose placentas are 2 cm or more away from the os can undergo a normal labor. It is important to realize that, in women with a placenta that extends into the non-contractile lower uterine segment who have a vaginal delivery, there is potential for postpartum hemorrhage.
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