Ideal management of a 37 weeks pregnant elderly primigravida with placenta prae and active bleeding: September 2007

Ans. B: Caesarean Section An initial assessment to determine the status of the mother and fetus is required. It is now considered safe to treat placenta prae on an outpatient basis if the fetus is at less than 30 weeks of gestation, and neither the mother nor the fetus are in distress. Immediate delivery of the fetus may be indicated if the fetus is mature or if the fetus or mother are in distress. Blood volume replacement (to maintain blood pressure) and blood plasma replacement (to maintain fibrinogen levels) may be necessary. In cases of fetal distress, associated complicating factors like malpresentation, elderly primigravidae, pregnancy with a previous caesarean section and contracted pelvis, a caesarean section is indicated. Caesarean section is contraindicated in cases of disseminated intravascular coagulation. Placenta prae increases the risk of puerperal sepsis and postpaum haemorrhage because the lower segment to which the placenta was attached contracts less well post-delivery