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What is Patient with 37 week AOG, centrally located placenta previa presented with bleeding per vaginum. Management: and explain in detail?
Ans. (a) Caesarean sectionRef : D.C. Dutta 8th ed. / 290-92; William's 23rd ed. Chapter 35.* Placenta previa-placenta located at LUS.* One of the most commoncause of APH.* In case of centrally located placenta previa -mode of delivery is always CS.Management of placenta previa depends on its type- 4 typesIndication for termination(by vaginal/CS)Indication for conservative management* POG-37 weeks or beyond* Pt continuosly bleeding* Fetal distress* Hemodynamically unstable mother* Pt is active labour* IUD* Congenital malformation of baby which are incompatible with lifeDone in patient who do not obey previous 7 ruleTermination by vaginal delivery or CS (depending on type of PPMa caffe's protocol for conservative mxBed restMonitor vitals-mother and babyBlood transfusion (if needed) Type 1(low lying-vaginal deliveryType 2 (marginal vaginal if placenta anterior, CS-if posteriorType 3 (incomplete/partial)- always CSType 4 (complete/central)- always CSIf POG<34 weeks-give betamethsone 12 mg IM 2 dose, 24 hrs apartm, for lung maturityMark CS as management option for placenta previa if any of following points give in Q-* Mother unstable* Fetal distress* Major degree of PP-type3 (incomplete/partial), type4 (complete/central)