Management:
The two major factors have been responsible for the dramatic reduction in both maternal and perinatal mortality rates over the past 40 years: the expectant management approach and the liberal use of cesarean section rather than vaginal delivery. As a result, the maternal mortality rate has fallen from between 25% and 30% to less than 1%. The total perinatal mortality rate has fallen from between 60% and 70% to under 10% in the past 10 years. The goal of management for placenta previa is to obtain the maximum fetal maturation possible while minimizing the risk to both the fetus and the mother. The basis for this approach is that episodes of bleeding are usually self-limited and not fatal to either the fetus or the mother in the absence of inciting trauma (e.g., intercourse, pelvic examination) or labor. Under carefully controlled conditions, delivery of the fetus may be safely delayed to a more advanced stage of maturity in a significant proportion of cases. An additional advantage to this approach is that a small proportion of cases, particularly those discovered early with lesser degrees of placenta previa, will resolve to an extent permitting vaginal delivery at term. It is reasonable to hospitalize women with placenta previa while they are having an acute bleeding episode or uterine contractions. Women who present with bleeding in the second half of pregnancy should have a sonographic examination for placental location prior to any attempt to perform a digital examination. Digital examination with a placenta previa may provoke catastrophic hemorrhage and should not be performed.
Management:
The two major factors have been responsible for the dramatic reduction in both maternal and perinatal mortality rates over the past 40 years: the expectant management approach and the liberal use of cesarean section rather than vaginal delivery. As a result, the maternal mortality rate has fallen from between 25% and 30% to less than 1%. The total perinatal mortality rate has fallen from between 60% and 70% to under 10% in the past 10 years. The goal of management for placenta previa is to obtain the maximum fetal maturation possible while minimizing the risk to both the fetus and the mother. The basis for this approach is that episodes of bleeding are usually self-limited and not fatal to either the fetus or the mother in the absence of inciting trauma (e.g., intercourse, pelvic examination) or labor. Under carefully controlled conditions, delivery of the fetus may be safely delayed to a more advanced stage of maturity in a significant proportion of cases. An additional advantage to this approach is that a small proportion of cases, particularly those discovered early with lesser degrees of placenta previa, will resolve to an extent permitting vaginal delivery at term. It is reasonable to hospitalize women with placenta previa while they are having an acute bleeding episode or uterine contractions. Women who present with bleeding in the second half of pregnancy should have a sonographic examination for placental location prior to any attempt to perform a digital examination. Digital examination with a placenta previa may provoke catastrophic hemorrhage and should not be performed.
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