Placenta Previa in Emergency Medicine Treatment & Management
- Author: Patrick Ko, MD; Chief Editor: Pamela L Dyne, MD more...
Prehospital Care
- The key to prehospital care of placenta previa is to ensure hemodynamic stability of the patient and transfer to an appropriate facility.
Emergency Department Care
- Because of the potential morbidity and mortality secondary to profuse bleeding, obtain immediate gynecologic consultation, if available. Before gynecologic consultation or transfer, the hemodynamic stability of the patient should be addressed. This includes the establishment of 2 large-bore intravenous access lines with intravenous crystalloids or blood products, as necessary.
- Obtain continuous fetal monitoring, if available.
- If the fetus is preterm and immediate delivery is unnecessary (eg, fetus < 37 weeks' gestation and hemorrhage not present), the patient may be treated expectantly on an outpatient basis.
- If the fetus is reasonably mature (ie, >37 weeks' gestation) and the patient is in labor or if severe hemorrhage is present, therapy is directed at the delivery of the fetus. The patient should receive crystalloids and/or blood, and the patient should be transferred to the operating room with double set-up conditions.
- A trial of labor may be considered for anterior marginal previa, including oxytocin (Pitocin) augmentation.
- Guidelines for the diagnosis and management of placenta previa have been established.[3, 4]
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