From the Guidelines
Management of placenta praevia at 24 weeks gestational age should focus on conservative measures to prolong pregnancy until fetal viability improves, with close monitoring and preparation for potential complications. At 24 weeks gestational age, the primary concern is to prevent preterm delivery and its associated risks, while also managing the potential complications of placenta praevia, such as vaginal bleeding.
- Hospitalization is recommended if the patient is experiencing active bleeding, with close monitoring of maternal and fetal status.
- Bed rest is advised, either at home for stable cases or in hospital for those with bleeding episodes, to reduce the risk of bleeding and promote fetal growth.
- Corticosteroids, such as betamethasone 12 mg IM, two doses 24 hours apart, should be administered to accelerate fetal lung maturity in case of preterm delivery, as suggested by general obstetric guidelines, although not specifically mentioned in the study 1.
- Tocolytics may be used for preterm contractions if there is no significant bleeding, to delay delivery and allow for further fetal maturation.
- Iron supplementation is important to prevent or treat anemia, which can exacerbate bleeding complications.
- Regular ultrasound monitoring is essential to assess placental position, as about 90% of previas diagnosed in the second trimester will resolve by term due to differential growth of the lower uterine segment, although the study 1 notes that placenta previa is common in the first half of pregnancy and commonly resolves by 28 weeks.
- The patient should be counseled to avoid sexual intercourse and vaginal examinations, and to seek immediate medical attention for any vaginal bleeding, as these activities can trigger bleeding episodes.
- Blood should be typed and crossmatched, with preparations made for potential transfusion, in case of significant bleeding.
- Delivery timing depends on clinical stability, with planned cesarean section typically scheduled between 36-37 weeks for stable cases, though earlier delivery may be necessary if significant bleeding occurs, as the study 1 highlights the risks of spontaneous labor and bleeding in women with placenta previa after 28 weeks' gestation.
From the Research
Management of Placenta Praevia at 24 Weeks Gestational Age
The management of placenta praevia at 24 weeks gestational age involves several considerations to optimize maternal and fetal outcomes.
- Antenatal Corticosteroids: Administrating a single course of antenatal corticosteroids to women at risk of preterm birth between 24 and 34 weeks of gestation has been shown to decrease neonatal morbidity and mortality 2.
- Tocolytic Therapy: The use of tocolytic therapy in symptomatic placenta praevia has been studied, with some evidence suggesting it may prolong pregnancy and increase birth weight 3, 4. However, other studies have found no significant effect on pregnancy prolongation or other outcomes 5.
- Hospitalization and Monitoring: Women with placenta praevia or low-lying placenta are at increased risk of maternal, fetal, and postnatal adverse outcomes, and optimization of diagnosis and management protocols has the potential to improve these outcomes 6.
- Risk Factors for Delivery: Factors such as complete placenta praevia, severe bleeding at presentation, uterine contractions at presentation, and cervical length <25 mm at presentation are independently associated with delivery within 14 days from admission 2.
Considerations for Management
When managing a patient with placenta praevia at 24 weeks gestational age, it is essential to consider the following:
- The risk of preterm birth and the potential benefits of antenatal corticosteroids 2
- The potential role of tocolytic therapy in prolonging pregnancy and improving outcomes 3, 4
- The need for close monitoring and hospitalization to manage potential complications 6
- The identification of risk factors for delivery within 14 days from admission to optimize management 2