PLACENTA PREVIA

Question 1

Considerations for the Critical 20 weeks Gestation

Answer 1

Maternal Resuscitation takes precedence

Treat hypotension 1-2 L Crystalloid

Place patient in LATERAL TILT POSITION or manually displace the uterus to the left

Initiate a massive transfusion protocol if hemodynamic stability is not achieved with 2-4 units of packed red blood cells (PRBC)

Assess Fetal Heart Rate

Immediately notify Obstetrics or Neonatology / Pediatrics

Definitive Treatment for the unstable patient is Delivery

Question 2

DDx

Answer 2

Placental Abruption
Placentia Previa
Vasa Previa
Prelabour Rupture of Membranes
Preeclampsia/Eclampsia

Normal Labour with Bloody Show
GU Trauma

Question 3

Clinical Features

Answer 3

Pregnancy > 20 wks

Painless vaginal bleeding

Post coital

Question 4

Investigations

Answer 4

Type and Cross

CBC

Coags

Fibrinogen Level

Assess Fetal Heart Rate

Transabdominal Ultrasound: If the placental edge is visualized at >4 cm from the internal os, placenta previa is unlikely

Question 5

Management

Answer 5

DO NOT do a digital exam or speculum exam

RhoGAM 300 μg as a one-time IM to Rh-negative women

If 23+0 and 36+6 weeks GA give:
Betamethasone 12 mg IM q 24 h x 2 doses
Dexamethasone 6 mg IM q 12 h x 4 doses

If 23-32 weeks GA:
MgSO4 4 g IV x 1 over 30 minutes

Question 6

Disposition

Answer 6

Admission