Interventions for suspected placenta praevia
RHL practical aspects by Osman NB
The Cochrane review recommends that at the present time clinical practice should not be changed because available evidence is insufficient. The following clinical actions are recommended at different levels of health care by WHO (1).
FIRST CONTACT (PRIMARY CARE) LEVEL
- Advise all pregnant women to seek routine antenatal care and contact a health-care facility immediately if there is bleeding from the vagina – even if the bleeding is very little (with or without contractions).
- When a pregnant woman with vaginal bleeding presents herself at the health-care centre, DO NOT perform a vaginal examination. Start an intravenous infusion and refer the woman to a hospital with facilities for diagnosis of obstetric emergencies and performance of emergency operations.
REFERRAL HOSPITAL (SECONDARY CARE) LEVEL
- Assess the amount of bleeding and restore blood volume by infusing intravenous fluids.
- If the bleeding is heavy, perform a caesarean delivery irrespective of fetal maturity.
- If the bleeding is light or has stopped, consider expectant management, keep the women in hospital until delivery, or keep her in a waiting house close to the hospital so that she can reach the hospital immediately in case bleeding starts again.
AT HOME OR IN THE COMMUNITY
- Increase awareness in community of the importance of regular antenatal care visits for all pregnant women, and the need for pregnant women to go to a health-care centre immediately in case of bleeding during second half of pregnancy.
References
- Managing Complications in Pregnancy and Childbirth: a guide for midwives and doctors. Geneva: World Health Organization; 2000.
This document should be cited as: Osman NB Interventions for suspected placenta praevia: RHL practical aspects (last revised: 28 August 2007). The WHO Reproductive Health Library; Geneva: World Health Organization.