We report the outcomes of 95 expectantly managed cases of placenta previa; all were diagnosed after 21 weeks' gestation. Patients at risk for preterm delivery because of hemorrhage or preterm labor received aggressive care, including multiple transfusions, volume expansion and tocolytic therapy, and amniotic fluid surfactant determinations, to achieve the goal of delivery at 37 weeks' gestation with mature fetal lung function. We present guidelines for outpatient management and double setup examination prior to delivery. The role of ultrasound in diagnosis (three asymptomatic cases; 13 cases with preterm labor) and serial placental localisation to determine the timing, route, and place of delivery is presented. Eighty-six percent of 19 infants born weighing <2500 gm were managed expectantly. Hemorrhage was the determinant in delivery timing in 50 cases. All four deaths were neonatal with birth weights <2200 gm. This is the lowest perinatal mortality rate (4.2%) published to date. Use of this aggressive approach is particularly suitable for patients cared for in a tertiary center.
ASJC Scopus subject areas
- Obstetrics and Gynecology