Home

Loading...

Table of contents

Placenta previa

Guidelines

Key sources

The following summarized guidelines for the evaluation and management of placenta previa are prepared by our editorial team based on guidelines from the Society of Obstetricians and Gynaecologists of Canada (SOGC 2020) and the Royal College of Obstetricians and Gynaecologists (RCOG 2019). ...
Show more

Screening and diagnosis

Indications for screening: as per RCOG 2019 guidelines, determine placental location during mid-pregnancy routine fetal ultrasound to identify women at risk of persisting placenta previa or a low-lying placenta.
E
Create free account

More topics in this section

  • Diagnosis

Classification and risk stratification

Risk factors
As per RCOG 2019 guidelines:
Recognize that Cesarean delivery is associated with an increased risk of placenta previa in subsequent pregnancies and this risk rises as the number of prior C-sections increases.
B
Recognize that ART and maternal smoking increase the risk of placenta previa.
B

More topics in this section

  • Terminology

  • Risk stratification

Diagnostic investigations

Ultrasound: as per SOGC 2020 guidelines, obtain ultrasound to confirm placental location in patients with a low-lying placenta within 7-14 days before Cesarean delivery.
B
Show 2 more

Medical management

Setting of care
As per SOGC 2020 guidelines:
Offer outpatient management in patients with placenta previa in the absence of risk factors.
B
Consider offering in-hospital management in patients with placenta previa or low-lying placenta in the presence of risk factors or limited access to urgent obstetrical care.
B

More topics in this section

  • Antenatal corticosteroids

  • Tocolytics

  • Management of anemia

Nonpharmacologic interventions

Bed rest: as per SOGC 2020 guidelines, advise patients with placenta previa to avoid bed rest or reduced activity.
B

More topics in this section

  • Pelvic rest

Therapeutic procedures

Cervical cerclage: as per SOGC 2020 guidelines, consider performing cervical cerclage in patients with a short cervical length, particularly in association with antepartum hemorrhage, but not as a prophylactic measure in all patients with placenta previa.
C

More topics in this section

  • Setting of delivery

  • Timing of delivery

  • Mode of delivery

  • Trial of labor

Perioperative care

Regional anesthesia: as per SOGC 2020 guidelines, administer regional anesthesia as first-line anesthetic approach for the peripartum management of patients with placenta previa or low-lying placenta.
B

More topics in this section

  • Intrapartum fluid resuscitation

  • Peripartum blood transfusion

Surgical interventions

C-section, indications
As per SOGC 2020 guidelines:
Offer Cesarean delivery in patients with placenta previa at 36⁰ to 36⁶ weeks of gestation in the presence of risk factors and at 37⁰ to 37⁶ weeks of gestation in the absence of risk factors.
B
Offer Cesarean delivery in patients with a low-lying placenta with the placental edge ≤ 10 mm from the cervical os at 37⁰ to 37⁶ weeks of gestation in the presence of risk factors and at 38⁰ to 38⁶ weeks of gestation in the absence of risk factors.
B

More topics in this section

  • C-section (surgical team)

  • C-section (technical considerations for surgery)

Patient education

General counseling: as per RCOG 2019 guidelines, counsel patients with asymptomatic placenta previa or a low-lying placenta in the third trimester regarding the risks of preterm delivery and obstetric hemorrhage and tailor care to individual needs.
E
Show 2 more

More topics in this section

  • Counseling before delivery