Placenta Previa

Treatment Overview

If you have placenta previa, your treatment will depend upon:

• How much you are bleeding (which influences whether you are monitored as an outpatient or in the hospital), whether you need a blood transfusion, and when delivery is necessary.
• Your overall physical condition, such as whether you've lost blood and are anemic.
• Your fetus's overall maturity and physical condition. Whenever possible, delivery is delayed until fetal lungs are mature.
• How much of your cervix is covered by the placenta. Because a vaginal delivery is likely to cause heavy placental bleeding, a caesarean is used for placenta previa deliveries.

If you have placenta previa and are not bleeding, it is important to follow certain precautions:

• Avoid all strenuous activities, such as running or lifting more than approximately 9 kg (20 lb).
• See a doctor immediately if you have any bleeding. Be sure that he or she knows you have placenta previa.
• Have a phone nearby at all times.
• Advise all health professionals who examine you that you must not have pelvic examinations.
• Refrain from sexual intercourse after 28 weeks of pregnancy. Before 28 weeks, ask your health professional about any possible risks.
• Avoid inserting anything, such as tampons or vaginal douches, into the vagina.
• Be close to a hospital that can provide emergency care for both you and a sick or premature infant.

If you have placenta previa and begin to bleed, you may be hospitalized. If your fetus is mature, you will have a caesarean delivery. If your bleeding lessens or stops, delivery can most likely be delayed. This watching and waiting approach is called expectant management. The course of expectant management is based on your and your fetus's condition.

• If your fetus is 24 to 34 weeks' gestation, you may be given corticosteroids to improve fetal lung development and prepare for an early birth. You may have an amniocentesis to see how developed your fetus's lungs are. You may also be given iron supplements to treat or prevent anemia and a high-fibre diet with stool softeners to ease any straining during a bowel movement. If you have Rh-negative blood, you will be given Rh immune globulin in case your fetus has Rh-positive blood. Should you be exposed to your fetus's Rh-positive blood without Rh immune globulin, your immune system will develop antibodies that are dangerous to an Rh-positive fetus (Rh sensitization). For more information, see the topic Rh Sensitization During Pregnancy.
• If your bleeding does not stop, expect to remain hospitalized and closely monitored until your fetus is mature enough to deliver. Moderate blood loss can be replaced with a blood transfusion to prolong your pregnancy until your fetus is mature enough to deliver.⁶
• If you have labour contractions, you may be given tocolytic medication to slow or stop the contractions. But the benefit of tocolytic medications in stopping labour is uncertain. For more information, see the topic Preterm Labour.
• Should bleeding become severe and uncontrollable, an immediate caesarean delivery, possibly with a blood transfusion, is the only treatment available for stopping it.

Delivery

Delivery involving placenta previa is done by caesarean section.

About 25 out of 100 placenta previa deliveries are preterm (before the 37th week of pregnancy).⁶ Infant problems following placenta previa are usually related to prematurity. If your infant is premature, he or she may need care in a neonatal intensive care unit, or NICU. Care in the NICU can last days or weeks, depending on the extent of a baby's problems and the amount of care needed. For more information, see the topic Premature Infant.

Treatment for placenta previa can be done by:

• An obstetrician.
• A perinatologist.

Treatment for a premature infant can be provided by a neonatologist.

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Author:	Douglas Dana Monica Rhodes	Last Updated: April 18, 2008
Medical Review:	Sarah Marshall, MD - Family Medicine William Gilbert, MD - Perinatology Andrew Swan, MD, CCFP, FCFP - Family Medicine
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