Management of placenta previa
- Charles J Lockwood, MD, MHCM
Charles J Lockwood, MD, MHCM
- Section Editor — Obstetrics
- Senior Vice President, USF Health
- Dean, Morsani College of Medicine
- Professor, Obstetrics and Gynecology
- University of South Florida
- Karen Russo-Stieglitz, MD
Karen Russo-Stieglitz, MD
- Consulting Perinatologist
- Morristown Medical Center
- Section Editors
- Deborah Levine, MD
Deborah Levine, MD
- Section Editor — Imaging
- Professor of Radiology
- Director of Ob/Gyn Ultrasound
- Department of Radiology
- Beth Israel Deaconess Medical Center
- Susan M Ramin, MD
Susan M Ramin, MD
- Section Editor — Obstetrics
- The American Board of Obstetrics and Gynecology (ABOG)
The management of pregnancies complicated by placenta previa is best addressed in terms of the clinical setting: asymptomatic women, women who are actively bleeding, and women who are stable after one or more episodes of active bleeding.
ASYMPTOMATIC PLACENTA PREVIA
The management goals in women with asymptomatic placenta previa are to:
●Determine whether the previa resolves with increasing gestational age
●Reduce the risk of bleeding
●Reduce the risk of preterm birth
- Reddy UM, Abuhamad AZ, Levine D, et al. Fetal imaging: executive summary of a joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, American Institute of Ultrasound in Medicine, American College of Obstetricians and Gynecologists, American College of Radiology, Society for Pediatric Radiology, and Society of Radiologists in Ultrasound Fetal Imaging workshop. Obstet Gynecol 2014; 123:1070.
- Lam CM, Wong SF, Chow KM, Ho LC. Women with placenta praevia and antepartum haemorrhage have a worse outcome than those who do not bleed before delivery. J Obstet Gynaecol 2000; 20:27.
- Love CD, Fernando KJ, Sargent L, Hughes RG. Major placenta praevia should not preclude out-patient management. Eur J Obstet Gynecol Reprod Biol 2004; 117:24.
- Rosen DM, Peek MJ. Do women with placenta praevia without antepartum haemorrhage require hospitalization? Aust N Z J Obstet Gynaecol 1994; 34:130.
- Ononeze BO, Ononeze VN, Holohan M. Management of women with major placenta praevia without haemorrhage: a questionnaire-based survey of Irish obstetricians. J Obstet Gynaecol 2006; 26:620.
- Spong CY, Mercer BM, D'alton M, et al. Timing of indicated late-preterm and early-term birth. Obstet Gynecol 2011; 118:323.
- American College of Obstetricians and Gynecologists. ACOG committee opinion no. 560: Medically indicated late-preterm and early-term deliveries. Obstet Gynecol 2013; 121:908.
- Yoong W, Karavolos S, Damodaram M, et al. Observer accuracy and reproducibility of visual estimation of blood loss in obstetrics: how accurate and consistent are health-care professionals? Arch Gynecol Obstet 2010; 281:207.
- Bose P, Regan F, Paterson-Brown S. Improving the accuracy of estimated blood loss at obstetric haemorrhage using clinical reconstructions. BJOG 2006; 113:919.
- Lyndon A, Miller S, Huwe V, Rosen M, et al. Blood loss: Clinical techniques for ongoing quantitative measurement. California Maternal Quality Care Collaborative. CMQCC Obstetric Hemorrhage Toolkit; 1/6/2010.
- Goodnough LT, Daniels K, Wong AE, et al. How we treat: transfusion medicine support of obstetric services. Transfusion 2011; 51:2540.
- American Society of Anesthesiologists Task Force on Obstetric Anesthesia. Practice guidelines for obstetric anesthesia: an updated report by the American Society of Anesthesiologists Task Force on Obstetric Anesthesia. Anesthesiology 2007; 106:843.
- Miller S, Martin HB, Morris JL. Anti-shock garment in postpartum haemorrhage. Best Pract Res Clin Obstet Gynaecol 2008; 22:1057.
- Miller S, Ojengbede O, Turan JM, et al. A comparative study of the non-pneumatic anti-shock garment for the treatment of obstetric hemorrhage in Nigeria. Int J Gynaecol Obstet 2009; 107:121.
- Miller S, Fathalla MM, Youssif MM, et al. A comparative study of the non-pneumatic anti-shock garment for the treatment of obstetric hemorrhage in Egypt. Int J Gynaecol Obstet 2010; 109:20.
- Besinger RE, Moniak CW, Paskiewicz LS, et al. The effect of tocolytic use in the management of symptomatic placenta previa. Am J Obstet Gynecol 1995; 172:1770.
- Sharma A, Suri V, Gupta I. Tocolytic therapy in conservative management of symptomatic placenta previa. Int J Gynaecol Obstet 2004; 84:109.
- Frederiksen MC, Glassenberg R, Stika CS. Placenta previa: a 22-year analysis. Am J Obstet Gynecol 1999; 180:1432.
- Hong JY, Jee YS, Yoon HJ, Kim SM. Comparison of general and epidural anesthesia in elective cesarean section for placenta previa totalis: maternal hemodynamics, blood loss and neonatal outcome. Int J Obstet Anesth 2003; 12:12.
- Parekh N, Husaini SW, Russell IF. Caesarean section for placenta praevia: a retrospective study of anaesthetic management. Br J Anaesth 2000; 84:725.
- Cotton DB, Read JA, Paul RH, Quilligan EJ. The conservative aggressive management of placenta previa. Am J Obstet Gynecol 1980; 137:687.
- Silver R, Depp R, Sabbagha RE, et al. Placenta previa: aggressive expectant management. Am J Obstet Gynecol 1984; 150:15.
- Farine D, Peisner DB, Timor-Tritsch IE. Placenta previa--is the traditional diagnostic approach satisfactory? J Clin Ultrasound 1990; 18:328.
- Wing DA, Paul RH, Millar LK. Management of the symptomatic placenta previa: a randomized, controlled trial of inpatient versus outpatient expectant management. Am J Obstet Gynecol 1996; 175:806.
- Placenta Accreta, ACOG Committee Opinion 2002; 266:169.
- Neilson JP. Interventions for suspected placenta praevia. Cochrane Database Syst Rev 2003; :CD001998.
- Mouer JR. Placenta previa: antepartum conservative management, inpatient versus outpatient. Am J Obstet Gynecol 1994; 170:1683.
- Droste S, Keil K. Expectant management of placenta previa: cost-benefit analysis of outpatient treatment. Am J Obstet Gynecol 1994; 170:1254.
- D'Angelo LJ, Irwin LF. Conservative management of placenta previa: a cost-benefit analysis. Am J Obstet Gynecol 1984; 149:320.
- Ravelli AC, Jager KJ, de Groot MH, et al. Travel time from home to hospital and adverse perinatal outcomes in women at term in the Netherlands. BJOG 2011; 118:457.
- Yamada T, Mori H, Ueki M. Autologous blood transfusion in patients with placenta previa. Acta Obstet Gynecol Scand 2005; 84:255.
- Dinsmoor MJ, Hogg BB. Autologous blood donation with placenta previa: is it feasible? Am J Perinatol 1995; 12:382.
- Toedt ME. Feasibility of autologous blood donation in patients with placenta previa. J Fam Pract 1999; 48:219.
- Watanabe N, Suzuki T, Ogawa K, et al. Five-year study assessing the feasibility and safety of autologous blood transfusion in pregnant Japanese women. J Obstet Gynaecol Res 2011; 37:1773.
- Yamamoto Y, Yamashita T, Tsuno NH, et al. Safety and efficacy of preoperative autologous blood donation for high-risk pregnant women: experience of a large university hospital in Japan. J Obstet Gynaecol Res 2014; 40:1308.
- Fung Kee Fung K, Eason E, Crane J, et al. Prevention of Rh alloimmunization. J Obstet Gynaecol Can 2003; 25:765.
- ACOG practice bulletin. Prevention of Rh D alloimmunization. Number 4, May 1999 (replaces educational bulletin Number 147, October 1990). Clinical management guidelines for obstetrician-gynecologists. American College of Obstetrics and Gynecology. Int J Gynaecol Obstet 1999; 66:63.
- Arias F. Cervical cerclage for the temporary treatment of patients with placenta previa. Obstet Gynecol 1988; 71:545.
- Cobo E, Conde-Agudelo A, Delgado J, et al. Cervical cerclage: an alternative for the management of placenta previa? Am J Obstet Gynecol 1998; 179:122.
- Bhide A, Prefumo F, Moore J, et al. Placental edge to internal os distance in the late third trimester and mode of delivery in placenta praevia. BJOG 2003; 110:860.
- Oppenheimer LW, Farine D, Ritchie JW, et al. What is a low-lying placenta? Am J Obstet Gynecol 1991; 165:1036.
- Dawson WB, Dumas MD, Romano WM, et al. Translabial ultrasonography and placenta previa: does measurement of the os-placenta distance predict outcome? J Ultrasound Med 1996; 15:441.
- Oyelese Y, Smulian JC. Placenta previa, placenta accreta, and vasa previa. Obstet Gynecol 2006; 107:927.
- Predanic M, Perni SC, Baergen RN, et al. A sonographic assessment of different patterns of placenta previa "migration" in the third trimester of pregnancy. J Ultrasound Med 2005; 24:773.
- Bronsteen R, Valice R, Lee W, et al. Effect of a low-lying placenta on delivery outcome. Ultrasound Obstet Gynecol 2009; 33:204.
- Vergani P, Ornaghi S, Pozzi I, et al. Placenta previa: distance to internal os and mode of delivery. Am J Obstet Gynecol 2009; 201:266.e1.
- Kayem G, Davy C, Goffinet F, et al. Conservative versus extirpative management in cases of placenta accreta. Obstet Gynecol 2004; 104:531.
- Kotsuji F, Nishijima K, Kurokawa T, et al. Transverse uterine fundal incision for placenta praevia with accreta, involving the entire anterior uterine wall: a case series. BJOG 2013; 120:1144.
- Fan D, Xia Q, Liu L, et al. The Incidence of Postpartum Hemorrhage in Pregnant Women with Placenta Previa: A Systematic Review and Meta-Analysis. PLoS One 2017; 12:e0170194.
- Yoong W, Ridout A, Memtsa M, et al. Application of uterine compression suture in association with intrauterine balloon tamponade ('uterine sandwich') for postpartum hemorrhage. Acta Obstet Gynecol Scand 2012; 91:147.
- Matsubara S, Kuwata T, Baba Y, et al. A novel 'uterine sandwich' for haemorrhage at caesarean section for placenta praevia. Aust N Z J Obstet Gynaecol 2014; 54:283.
- Kavak SB, Atilgan R, Demirel I, et al. Endouterine hemostatic square suture vs. Bakri balloon tamponade for intractable hemorrhage due to complete placenta previa. J Perinat Med 2013; 41:705.
- Maher MA, Abdelaziz A. Comparison between two management protocols for postpartum hemorrhage during cesarean section in placenta previa: Balloon protocol versus non-balloon protocol. J Obstet Gynaecol Res 2017; 43:447.
- Zaki ZM, Bahar AM. Massive haemorrhage due to placenta praevia accreta: a useful role for vasopressin. J Obstet Gynaecol 1997; 17:486.
- Kato S, Tanabe A, Kanki K, et al. Local injection of vasopressin reduces the blood loss during cesarean section in placenta previa. J Obstet Gynaecol Res 2014.
- Kato S, Tanabe A, Kanki K, et al. Local injection of vasopressin reduces the blood loss during cesarean section in placenta previa. J Obstet Gynaecol Res 2014; 40:1249.
- Thomas AG, Alvarez M, Friedman F Jr, et al. The effect of placenta previa on blood loss in second-trimester pregnancy termination. Obstet Gynecol 1994; 84:58.
- Halperin R, Vaknin Z, Langer R, et al. Late midtrimester pregnancy termination in the presence of placenta previa. J Reprod Med 2003; 48:175.
- Ruano R, Dumez Y, Cabrol D, Dommergues M. Second- and third-trimester therapeutic terminations of pregnancy in cases with complete placenta previa--does feticide decrease postdelivery maternal hemorrhage? Fetal Diagn Ther 2004; 19:475.
- Nakayama D, Masuzaki H, Miura K, et al. Effect of placenta previa on blood loss in second-trimester abortion by labor induction using gemeprost. Contraception 2007; 75:238.
- ASYMPTOMATIC PLACENTA PREVIA
- Follow-up transvaginal ultrasound examination
- Prediction of and reduction of risk of bleeding
- ACUTE CARE OF BLEEDING PLACENTA PREVIA
- - Maternal
- - Fetal
- - Laboratory
- Anti-shock garments
- Intravenous access and crystalloid
- Magnesium sulfate
- Antenatal corticosteroids
- Indications for delivery
- CONSERVATIVE MANAGEMENT AFTER AN ACUTE BLEED
- Inpatient versus outpatient management
- Correction of anemia
- Autologous blood donation
- Anti-D immune globulin
- Fetal assessment
- Preterm premature rupture of membranes
- - Timing
- - Route
- Low placenta
- - Cesarean procedure
- Management of hemorrhage
- - Vasopressin
- PREGNANCY TERMINATION IN WOMEN WITH PLACENTA PREVIA
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS
- Asymptomatic previa
- Acute management of bleeding previa
- Conservative management after an acute bleed