Placenta praevia

management and prognosis

Placenta praevia describes a placenta lying wholly or partly in the lower uterine segment.

If low-lying placenta at the 20-week scan:

• rescan at 32 weeks
• no need to limit activity or intercourse unless they bleed
• if still present at 32 weeks and grade I/II then scan every 2 weeks
• final ultrasound at 36-37 weeks to determine the method of delivery
  • RCOG recommend: elective delivery should be offered between 36+0 and 37+6 weeks of gestation for women with a major placenta praevia to reduce the risk of emergency caesarean section due to bleeding
  • if grade I then a trial of vaginal delivery may be offered
• if a woman with known placenta praevia goes into labour prior to the elective caesarean section an emergency caesarean section should be performed due to the risk of post-partum haemorrhage

Placenta praevia with bleeding

• admit
• ABC approach to stabilise the woman
• if not able to stabilise → emergency caesarean section
• if in labour or term reached → emergency caesarean section

Prognosis

• death is now extremely rare
• major cause of death in women with placenta praevia is now PPH