For a patient with placenta previa at 38 weeks who is bleeding, what is the recommended management step?

For a patient with placenta previa at 38 weeks who is bleeding, what is the recommended management step?

• A. Induce labor immediately
• B. Prepare for surgical intervention or cesarean section
• C. Continue expectant management in bed rest
• D. Perform vaginal delivery with forceps

Answer: (B)

Placenta previa means the placenta is implanted low in the uterus, covering or threatening the cervical os. When bleeding occurs at term, vaginal delivery is unsafe because the placenta can detach as labor begins, leading to life-threatening hemorrhage for the mother and compromised oxygenation for the fetus. Inducing labor or attempting a vaginal delivery (even with forceps) would not reliably avoid catastrophic bleeding in this situation. The safest and most appropriate step is to prepare for surgical delivery, typically a cesarean section, to rapidly deliver the baby and control the bleeding. This involves stabilization of the mother, blood products as needed, fetal monitoring, and ready anesthesia and operative teams.

Placenta previa means the placenta is implanted low in the uterus, covering or threatening the cervical os. When bleeding occurs at term, vaginal delivery is unsafe because the placenta can detach as labor begins, leading to life-threatening hemorrhage for the mother and compromised oxygenation for the fetus. Inducing labor or attempting a vaginal delivery (even with forceps) would not reliably avoid catastrophic bleeding in this situation. The safest and most appropriate step is to prepare for surgical delivery, typically a cesarean section, to rapidly deliver the baby and control the bleeding. This involves stabilization of the mother, blood products as needed, fetal monitoring, and ready anesthesia and operative teams.