Management of preterm labour in
Placenta previa and
It is a condition in which the placenta is located
over or very near the internal os.
Total placenta previa.
Partial placenta previa.
Marginal placenta previa.
Low lying placenta.
Tachycardia or hypotension
Uterus relaxed.Fetal parts easily felt.
-Vaginal examination must not be done.
Management of preterm labour in
Diagnosis should be confirmed.
Admit the patient.
Management depends on,
quantity of bleeding.
overall physical condition of the mother.
Overall fetus condition and fetal maturity.
Active line of
Expectant line of management:
Aim is to continue pregnancy for fetal lungs to
mature without compromising maternal health.
Availability of blood transfusion.
Facilities for caesarean section should be available
Cases suitable for expectant
Mother is in good health: Hb>10 gm%;
Duration of pregnancy <37 weeks.
No active vaginal bleeding.
Fetal wellbeing assured by USG.
Conduct of expectant treatment:
Hb%, blood grouping, Urine protein.
Fetal surveillance with USG.
Blood transfusion to correct anemia.
Tocolytics- Given if vaginal bleeding is associated with
Corticosteroids to improve fetal lung maturity and
reduce respiratory distress.
Rh immunoglobulin given to all Rh negative mothers.
Termination of expectant
It is carried upto 37 weeks of pregnancy and then
the baby becomes sufficiently mature after which
pregnancy is terminated.
Preterm delivery may have to be done in
conditions such as,
Recurrence of brisk haemorrhage which is continuing.
Fetus is dead.
Congenitally malformed fetus found on investigation.
However,there is a risk of IUGR with expectant
When an early delivery is needed fetal
amniocentesis is done to find out whether the fetal
lungs are ready to breathe well.
Active line of management:
LOWER SEGMENT CAESAREAN DELIVERY- done for all
women with sonographic evidence of placenta previa
where placental edge is within 2 cm from internal os.
VAGINAL DELIVERY: when placenta edge is clearly 2-3 cm
away from internal os.
It refers to a condition where antepartum heamorrhage
occurs due to premature seperation of a normally situated
Concealed: Blood is retained within the uterine cavity
and is not visible exernally.Retroplacental clot present.
Revealed: In this the blood collected due to placental
seperation escapes by dissecting under the membranes
and seen externally if memabranes are ruptured.Blood
stained liquor may occur.
Abdominal pain and bleeding PV.
Features of PIH.
Uterine height may or may not correspond to the
period of amenorrhea.
Uterine tenderness and difficulty in palpating fetal
parts in concealed variety.
Fetal heart may be normal,abnormal or absent.
Bleeding is almost always maternal.
Grade 0- No clinical features,diagnosed after delivery
after seeing retroplacental clot.
Grade 1- Slight vaginal bleeding, Uterine tenderness
minimal or absent,BP and fibrinogen level
Grade 3- Mild to moderate vaginal bleeding,uterine
tenderness,maternal pulse increased,BP
maintained,fibrinogen decreased,Fetal distress.
Grade 4-Severe bleeding,tender uterus,Fetal
death,Associated coagulation defect or anuria.
COUVELAIRE UTERUS or uteroplacental apoplexy
includes severe forms of placental seperation with
widespread extravasation of blood into uterine
ACTIVE MANAGEMENT is the main
mode of managing Abruptio placentae.
In Expectant management:
Risk of sudden seperation of
placenta and fetal death.So it is not
Immediate delivery of the fetus is indicated either
by vaginal delivery or ceasarean section.
So, once abruption sets in,it is difficult to prevent
Vaginal delivery indicated when,
Limited placental abruption.
FHR is reassuring.
Continuous electronic fetal monitoring available.
Placental abruption with a dead fetus.
• If patient is not in labour and bleeding continues
Induction of labour by low rupture of membranes.