Placenta Previa in Emergency Medicine Treatment & Management

  • Author: Patrick Ko, MD; Chief Editor: Pamela L Dyne, MD   more...
 
Updated: Apr 4, 2011
 

Prehospital Care

  • The key to prehospital care of placenta previa is to ensure hemodynamic stability of the patient and transfer to an appropriate facility.
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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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Consultations

  • Consult an obstetrician.
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Contributor Information and Disclosures
Author

Patrick Ko, MD  Clinical Assistant Professor, Department of Emergency Medicine, New York University Medical School; Assistant Program Director, Department of Emergency Medicine, North Shore University Hospital

Patrick Ko, MD is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Young Yoon, MD  Associate Director, Assistant Professor, Department of Emergency Medicine, Mount Sinai Medical Center

Young Yoon, MD is a member of the following medical societies: Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Joseph J Sachter, MD, FACEP  Consulting Staff, Department of Emergency Medicine, Muhlenberg Regional Medical Center

Joseph J Sachter, MD, FACEP is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Physician Executives, American Medical Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Mark Zwanger, MD, MBA  Assistant Professor, Department of Emergency Medicine, Jefferson Medical College of Thomas Jefferson University

Mark Zwanger, MD, MBA is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and American Medical Association

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Pamela L Dyne, MD  Professor of Clinical Medicine/Emergency Medicine, University of California, Los Angeles, David Geffen School of Medicine; Attending Physician, Department of Emergency Medicine, Olive View-UCLA Medical Center

Pamela L Dyne, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

References

  1. Vergani P, Ornaghi S, Pozzi I, Beretta P, Russo FM, Follesa I, et al. Placenta previa: distance to internal os and mode of delivery. Am J Obstet Gynecol. Jul 23 2009;[Medline].

  2. Milosevic J, Lilic V, Tasic M, Radovic-Janosevic D, Stefanovic M, Antic V. [Placental complications after a previous cesarean section]. Med Pregl. May-Jun 2009;62(5-6):212-6. [Medline].

  3. [Guideline] Royal College of Obstetricians and Gynaecologists (RCOG). Placenta praevia and placenta praevia accreta: diagnosis and management. Oct 2005;[Full Text].

  4. [Guideline] Oppenheimer L. Diagnosis and management of placenta previa. J Obstet Gynaecol Can. Mar 2007;29(3):261-73. [Medline]. [Full Text].

  5. Ananth CV, Smulian JC, Vintzileos AM. The effect of placenta previa on neonatal mortality: a population-based study in the United States, 1989 through 1997. Am J Obstet Gynecol. May 2003;188(5):1299-304. [Medline].

  6. Besinger RE, Moniak CW, Paskiewicz LS, Fisher SG, Tomich PG. The effect of tocolytic use in the management of symptomatic placenta previa. Am J Obstet Gynecol. Jun 1995;172(6):1770-5; discussion 1775-8. [Medline].

  7. Crane S, Chun B, Acker D. Treatment of obstetrical hemorrhagic emergencies. Curr Opin Obstet Gynecol. Oct 1993;5(5):675-82. [Medline].

  8. Dola CP, Garite TJ, Dowling DD, Friend D, Ahdoot D, Asrat T. Placenta previa: does its type affect pregnancy outcome?. Am J Perinatol. Oct 2003;20(7):353-60. [Medline].

  9. Gidiri M, Noble W, Rafique Z, Patil K, Lindow SW. Caesarean section for placenta praevia complicated by postpartum haemorrhage managed successfully with recombinant activated human coagulation Factor VIIa. J Obstet Gynaecol. Nov 2004;24(8):925-6. [Medline].

  10. Glynn JC, Plaat F. Prothrombin complex for massive obstetric haemorrhage. Anaesthesia. Feb 2007;62(2):202-3. [Medline].

  11. Iyasu S, Saftlas AK, Rowley DL, Koonin LM, Lawson HW, Atrash HK. The epidemiology of placenta previa in the United States, 1979 through 1987. Am J Obstet Gynecol. May 1993;168(5):1424-9. [Medline].

  12. Otsubo Y, Shinagawa T, Chihara H, Araki T. Conservative management of a case of placenta praevia percreta. Aust N Z J Obstet Gynaecol. Nov 1999;39(4):518-9. [Medline].

  13. Rani PR, Haritha PH, Gowri R. Comparative study of transperineal and transabdominal sonography in the diagnosis of placenta previa. J Obstet Gynaecol Res. Apr 2007;33(2):134-7. [Medline].

  14. Rathore SS, McMahon MJ. Racial variation in the frequency of intrapartum hemorrhage. Obstet Gynecol. Feb 2001;97(2):178-83. [Medline].

  15. Sharma A, Suri V, Gupta I. Tocolytic therapy in conservative management of symptomatic placenta previa. Int J Gynaecol Obstet. Feb 2004;84(2):109-13. [Medline].

  16. Smith RS, Lauria MR, Comstock CH, Treadwell MC, Kirk JS, Lee W, et al. Transvaginal ultrasonography for all placentas that appear to be low-lying or over the internal cervical os. Ultrasound Obstet Gynecol. Jan 1997;9(1):22-4. [Medline].

  17. Taber. Manual of Gynecologic and Obstetric Emergencies. 2nd ed. Philadelphia, Pa: WB Saunders Co; 1984:313-318.

  18. Taylor VM, Peacock S, Kramer MD, Vaughan TL. Increased risk of placenta previa among women of Asian origin. Obstet Gynecol. Nov 1995;86(5):805-8. [Medline].

  19. Timor-Tritsch IE, Monteagudo A. Diagnosis of placenta previa by transvaginal sonography. Ann Med. Jun 1993;25(3):279-83. [Medline].

  20. Williams, Cunningham, Macdonald. Williams' Obstetrics. 19th ed. Norwalk, Conn: Appleton & Lange; 1993:836-841.

  21. Zhang J, Savitz DA. Maternal age and placenta previa: a population-based, case-control study. Am J Obstet Gynecol. Feb 1993;168(2):641-5. [Medline].

 
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