From the Guidelines
If you have placenta previa, it is crucial to take precautions to minimize the risk of severe bleeding and ensure the best possible outcome for both you and your baby. When managing placenta previa in a hospital setting, it is essential to prioritize precautions that reduce the risk of morbidity, mortality, and improve quality of life. The key precautions include:
- Avoiding any activities that may trigger bleeding, such as strenuous exercise or heavy lifting 1
- Following pelvic rest guidelines, which means no sexual intercourse, no douching, and nothing inserted into the vagina 1
- Monitoring for signs of worsening condition or onset of labor, such as vaginal bleeding, abdominal pain or cramping, contractions, rupture of membranes, or decreased fetal movement 1
- Regular follow-up appointments to monitor the position of the placenta and the baby's growth 1
- Considering delivery at a level III or IV maternal care facility, with a multidisciplinary team experienced in managing placenta accreta spectrum 1 It is vital to return to the hospital immediately if any warning signs occur, as prompt medical attention can significantly improve outcomes. In addition to these precautions, women with placenta previa should be aware of the potential risks and complications associated with the condition, including severe bleeding, preterm labor, and the need for cesarean delivery. By taking these precautions and being aware of the potential risks, women with placenta previa can minimize their risk of complications and ensure the best possible outcome for both themselves and their babies.
From the Research
Precautions for Hospital Management of Placenta Previa
- Patients with placenta previa are at risk for intra- and postpartum massive blood loss as well as increased risk of placenta accreta, a type of abnormal placental implantation 2
- The risk factors for previa include prior cesarean section, multiparity, advanced maternal age, prior placenta previa history, prior uterine surgery, and smoking 2
- Persistent previa in the third trimester mandates pelvic rest and hospitalization if significant bleeding occurs 3
- Significant vaginal bleeding from any cause is managed with rapid assessment of maternal and fetal status, fluid resuscitation, replacement of blood products when necessary, and an appropriately timed delivery 3
- For patients with placenta previa who must terminate pregnancy, a new procedure using a cervical ripening balloon can reduce the risks during pregnancy termination by quickly reducing bleeding and inducing vaginal delivery 4
Hospitalization and Management
- Women who have asymptomatic previa can continue normal activities, with repeat ultrasonographic evaluation at 28 weeks 3
- For symptomatic placenta previa, both inpatient and outpatient management can be effective, with outpatient management being a cost-effective alternative for selected patients 5
- Patients with symptomatic placenta previa may require hospitalization for vaginal bleeding, and can be stabilized and then randomized to receive either inpatient or outpatient expectant management 5
- The management of placenta previa requires a multidisciplinary approach, including obstetricians, anesthesiologists, and other healthcare professionals 2, 6
Bleeding Management
- Intraoperative anesthetic management and other interventions can be used to control bleeding in patients with previa expected to experience massive hemorrhage and require transfusion 2
- The use of a cervical ripening balloon can help reduce bleeding and induce vaginal delivery in patients with placenta previa who must terminate pregnancy 4
- Fluid resuscitation and replacement of blood products may be necessary to manage significant vaginal bleeding from any cause 3