Role of attempted vaginal delivery in the management of placenta previa

Sixty-nine documented cases of placenta previa were managed at The Mount Sinai Medical Center during a five-year period. Vaginal delivery was attempted in six instances of partial placenta previa and was successful in five (83%). For these six cases, intrapartum bleeding was not excessive, blood transfusions were not necessary during or after labor, and all Apgar scores were greater than or equal to 7 at one and five minutes. Anemia in a neonate delivered at 32 weeks of gestation was the only neonatal complication that may have been due to intrapartum fetal hemorrhage. This series suggests that routine cesarean section is not necessary for all cases of partial placenta previa. A protocol is proposed for the intrapartum management of suspected placenta previa at term. Further clinical studies are necessary to evaluate the safety and clinical use of this mode of management.