Major placenta praevia should not preclude out-patient management

To review current management of women with major and minor placenta praevia in view of the recommendations made in the RCOG guideline 2001. To assess whether out-patient care was detrimental to pregnancy outcome.

Retrospective observational study at the Simpson Memorial Maternity Pavilion, Edinburgh (a tertiary referral centre). One hundred and sixty-one women with major and minor placenta praevia between 1994 and 2000 were separated into those who experienced bleeding (antepartum haemorrhage (APH)) and those who had no bleeding during pregnancy (non-APH). Statistical analysis was carried out using SPSS.

There were 129 women (80%) in the APH group. Forty-three were out-patients at the time of delivery and 63% had a major degree of praevia. Thirty-two women were in the non-APH group. Sixty-eight were managed as out-patients and 50% had a major degree of praevia. Women with a major degree of praevia were not significantly more likely to experience bleeding. Women with APH were significantly more likely to be delivered early, by emergency caesarean section (C/S), of lower birthweight babies who required neonatal admission than the non-APH group.

There is a place for out-patient management of women with placenta praevia. Caution is required with increasing number of bleeds but not degree of praevia.