The principle objective of management is to prolong the pregnancy until the fetus is mature. Optimally, this is a gestational age of 37 weeks: the neonatal mortality rate is not improved by further intrauterine development.
Immediate steps include:
If there is a diagnosis of a major placenta praevia then a caesarian section should be undertaken without vaginal examination. If the diagnosis is in doubt or there is minor placenta praevia then there should be vaginal examination under anaesthesia; this should be carried out when the fetus is as mature as possible and only in the setting of the operating theatre with preparations for caesarian section. Rarely, placenta praevia haemorrhage may be so severe as to necessitate evacuation of the uterus despite fetal immaturity.
Caesarian section is often favoured in placenta praevia as the immediate delivery of the fetus and the placenta allows the uterus to contract to stop the bleeding. It also avoids the marginal risk of cervical lacerations which complicate a vaginal delivery.
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