Female with 37 weeks of pregnancy comes with grade 3 placenta previa, bleeding per vaginum with uterine contractions. Most appropriate management would be?
**Core Concept**
Placenta previa is a condition in pregnancy where the placenta partially or completely covers the internal cervical os. In a grade 3 placenta previa, the placenta covers the entire cervical os, posing a significant risk of severe maternal bleeding during delivery. Immediate management is crucial to prevent maternal and fetal morbidity.
**Why the Correct Answer is Right**
In a patient with grade 3 placenta previa and active bleeding, the primary goal is to stop the bleeding and stabilize the patient. This is typically achieved through a procedure called **arterial embolization** or **balloon tamponade**. However, in the context of active labor and uterine contractions, the most appropriate management is **immediate delivery by cesarean section**. This approach allows for the rapid evacuation of the uterus, which helps to control bleeding and prevent further complications. The surgical team should be prepared for a possible blood transfusion and careful post-operative monitoring.
**Why Each Wrong Option is Incorrect**
**Option A:** Immediate delivery by vaginal delivery is contraindicated in grade 3 placenta previa due to the high risk of severe maternal bleeding.
**Option B:** Expectant management, which involves waiting for spontaneous resolution of the bleeding, is not appropriate in this scenario due to the active labor and uterine contractions.
**Option C:** Medical management with uterotonics, such as oxytocin, is not effective in controlling bleeding in grade 3 placenta previa and may even exacerbate the situation.
**Clinical Pearl / High-Yield Fact**
In cases of grade 3 placenta previa, a **"rule of 10s"** can be used to guide management: 10% of patients will have significant bleeding, 10% will require blood transfusion, and 10% will require cesarean section.
**Correct Answer: C. Immediate delivery by cesarean section.**