From the Guidelines
Expectant Management of Placenta Previa
Expectant management of placenta previa involves close monitoring and supportive care to minimize the risk of bleeding and optimize fetal outcomes, with women diagnosed with placenta previa after 28 weeks’ gestation being advised to avoid moderate to vigorous physical activity (MVPA) 1.
- Key aspects of management include:
- Re-evaluation at 28 weeks’ gestation to assess if the placenta previa has resolved, allowing for continued exercise within current guidelines if resolved 1
- Maintenance of activities of daily living and low-intensity activity, such as walking, for women with persistent placenta previa after 28 weeks 1
- Consideration of corticosteroids for fetal lung maturity if preterm delivery is anticipated, although specific details on this are not provided in the given evidence
- It is crucial to balance activity levels to prevent spontaneous labor while maintaining the patient's overall health and well-being, with the understanding that not all women with placenta previa experience vaginal bleeding, and management should be tailored accordingly 1.
From the Research
Expectant Management of Placenta Previa
The expectant management of placenta previa involves careful monitoring and treatment to minimize complications and improve outcomes for both the mother and the fetus. Key aspects of this management include:
- Aggressive care, including multiple transfusions, volume expansion, and tocolytic therapy, to achieve the goal of delivery at 37 weeks' gestation with mature fetal lung function 2
- Use of ultrasound in diagnosis and serial placental localization to determine the timing, route, and place of delivery 2
- Outpatient management for selected patients, which can be a cost-effective and safe alternative to traditional inpatient management 3, 4
- Weekly corticosteroids until 32 weeks of gestation and ultrasonographic evaluations to assess fetal growth and placental location 3
Comparison of Inpatient and Outpatient Management
Studies have compared the outcomes of inpatient and outpatient management of placenta previa, including:
- No significant differences in maternal morbidity, fetal mortality, or neonatal morbidity between inpatient and outpatient management 3, 4
- Reduced maternal hospital days and hospital costs with outpatient management 3, 4
- Similar outcomes for women with major and minor placenta previa, although major placenta previa is associated with higher complication rates 5
Special Considerations
In certain situations, such as pregnancy termination in the second trimester, a cervical ripening balloon can be used to reduce bleeding and induce vaginal delivery 6
- This method has been shown to be effective in reducing bleeding and minimizing complications in patients with placenta previa who require pregnancy termination 6