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Placenta previa: aggressive expectant management.

R Silver, R Depp, R E Sabbagha

    American Journal of Obstetrics and Gynecology
    |September 1, 1984
    PubMed
    Summary
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    Aggressive management of placenta previa, including preterm labor interventions and surfactant testing, aims for 37-week delivery. This approach achieved a record low perinatal mortality rate of 4.2%.

    Area of Science:

    • Obstetrics and Gynecology
    • Maternal-Fetal Medicine
    • Neonatology

    Background:

    • Placenta previa diagnosed after 21 weeks' gestation presents risks for both mother and fetus.
    • Hemorrhage and preterm labor are significant complications requiring careful management.
    • Optimizing fetal lung maturity is crucial for infants born prematurely due to placenta previa.

    Purpose of the Study:

    • To report outcomes of expectant management for 95 cases of placenta previa.
    • To present guidelines for outpatient management and delivery preparation.
    • To evaluate the effectiveness of an aggressive management strategy in reducing perinatal mortality.

    Main Methods:

    • Expectant management for 95 placenta previa cases diagnosed after 21 weeks' gestation.

    Related Experiment Videos

  • Aggressive care for high-risk patients: transfusions, volume expansion, tocolysis, amniotic fluid surfactant analysis.
  • Ultrasound for diagnosis and serial placental localization; double setup examination prior to delivery.

    • Main Results:

    • Delivery at 37 weeks' gestation with mature fetal lungs was the goal; hemorrhage determined timing in 50 cases.
    • 86% of 19 infants weighing <2500 gm were managed expectantly.
    • A perinatal mortality rate of 4.2% (4 neonatal deaths, all <2200 gm) was achieved, the lowest reported.

    Conclusions:

    • An aggressive management approach, including interventions to mature fetal lungs, can achieve optimal delivery timing.
    • Guidelines for outpatient management and delivery preparation are essential.
    • This strategy is particularly effective in tertiary care centers for reducing perinatal mortality in placenta previa cases.