The regimen used for expectant management of placenta previa is –
Correct Answer: Macafee & Johnson regimen
Description: Ans. is 'a' i.e., MacAfee and Johnson regimen It has long been taught that placenta previa cannot be managed expectantly.It was believed that a patient with major degree of placenta previa would in the absence of intervention frequently bleed to death and that fatal hemorrhage may ensue without warning.But evidence is accumulating that more morbidity is produced by overtreatment rather than observation.In their overenthusiasm to manage the placenta previa patients actively, by L.S.C.S., most of the obstetricians end up delivering premature baby.It has been a major conclusion in several studies that most important cause of fetal morbidity in placenta previa is i fetal prematurity" which in many cases occur due to "over active" intervention.Macafee's and Jhonson 's great contribution lav in their advocacy of expectant treatment there by reducing the prematurity.The aim of expectant management is to prolong pregnancy till the fetus is reasonably mature and if possible till term. Sometimes cases of minor previa presenting early in pregnancy may resolve spontaneously with expectant management.As a rule, the first hemorrhage is not lethal either to the mother or child particularly in case of a primigravida and it soon ceases in practically every case.The separated area of the placenta becomes infarcted and the maternal vessels supplying the exposed portion of the placental site thrombose.If more than l/3rd area of the placenta is not detached, the fetus, also develops some compensatory mechanism to meet its oxygen requirement.Johnson and MacAfee's regimen includesIn hospital management till delivery which includesRestMonitoring of mother and fetusCorrecting anemia with blood transfusionsUltrasound localisation of placentaPer speculum examination, once active bleeding ceasesDigital examination is avoided in all casesBlood transfusion (maternal hematocrit 30%)
Category:
Gynaecology & Obstetrics
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