Ideal management of a 37 weeks pregnant elderly primigravida with placenta prae and active bleeding: September 2007
**Core Concept**
The management of placenta previa in a pregnant woman involves stabilizing the patient, controlling bleeding, and planning for delivery. The key principle is to balance the risks of immediate delivery against the risks of continued bleeding and potential maternal and fetal complications.
**Why the Correct Answer is Right**
In a 37-week pregnant elderly primigravida with placenta previa and active bleeding, the ideal management is to perform a cesarean section under controlled conditions. This approach minimizes the risk of further bleeding and allows for optimal fetal and maternal outcomes. The use of regional anesthesia, such as epidural, is a good option to manage pain and reduce the risk of further bleeding during the procedure. The decision to proceed with an immediate cesarean section is based on the severity of bleeding, maternal stability, and the gestational age of the fetus.
**Why Each Wrong Option is Incorrect**
**Option A:** Immediate vaginal delivery is not recommended as it may exacerbate bleeding and increase the risk of maternal and fetal complications.
**Option B:** Expectant management with bed rest and monitoring may be considered in cases of minor bleeding, but it is not the ideal management for a patient with active bleeding and a history of placenta previa.
**Option C:** Induction of labor is contraindicated in cases of placenta previa, especially with active bleeding, as it may lead to severe maternal hemorrhage and fetal distress.
**Clinical Pearl / High-Yield Fact**
In cases of placenta previa, the risk of bleeding increases with advancing gestational age, and the decision to deliver should be made based on the severity of bleeding and maternal stability.
**Correct Answer:** C. Induction of labor.