Placenta previa: The role of conservative management in a controlled study

Abstract

One hundred sixty-six cases of placenta previa in 18,408 deliveries at the U. S. Naval Hospital, Portsmouth, Virginia, are presented and reviewed. The management is discussed in detail. Diagnostic aids, including x-ray and selective filtration techniques, and sterile vaginal examination are appraised for accuracy as well as hazard to the patient. Methods of delivery are discussed, including specific indications for abdominal delivery. Section rates more than 15 per cent above the number of total placenta previas are felt to represent an easy but unwise solution for bleeding problems. Major complications associated with placenta previa and abnormal presentations are mentioned, and the choice of anesthesia for abdominal as well as vaginal delivery, especially in the face of circulatory instability, is discussed.An additional month or more of continued intrauterine gestation for the infants was averaged in 22.3 per cent of cases; 88 per cent of the fetuses in this group were immature or premature by gestational age at the time of admission: 60 per cent of the infants weighed over 2,500 grams at the time of delivery, and an over-all fetal survival rate of 89.1 per cent was credited to this group of patients. Despite there being almost twice the number of total placenta previas in this group, the actual blood needs were 20 per cent less than among patients who were in active labor and bleeding at the time of admission.For an additional 11.5 per cent of the patients temporization permitted more accuracy in the diagnosis of the type of placenta previa present and the selection of a method of delivery which offered the infant and mother the best prognosis in the current pregnancy as well as in future pregnancies.