Expectant management of placenta previa includes all except

Macafee and Johnson regime is the name given to the expectant management of placenta previa as it was advocated by McAfee and Johnson Aim of expectant management in case of placenta previa is to continue pregnancy for fetal maturity without compromising the maternal health. Prerequisites for expectant management: Availability of blood for transfusion whenever required Facilities for caesarean section should be available throughout 24 hours. Candidates: Suitable for expectant management are: Mother in god health status- Hemoglobin > 10 gm% Hematocrit > 30% and she should bev hemodynamically stable. Duration of pregnancy less than 37 weeks Active vaginal bleeding is absent Fetal well being is assured by USG and cardiotocography The expectant management is carried upto 37 weeks of pregnancy until baby matures. Expectant management includes (i.e. MacAfee and Johnson regime includes) Hospitalisation till active bleeding stops and then readmission at 34 weeks Complete bed rest Anaemia corrected with blood transfusion (if necessary), but blood should always to be kept ready as placenta previa is a recurrent condition. Antenatal steroids to promote fetal lung maturity Anti D if patient is Rh negative If uterine contractions are present - tocolytics (magnesium sulphate/nifedipine) can be given as it leads to more advanced gestational age at delivery, greater birth weight of fetus, less neonatal complications, and decreased cost of hospitalization. Tocolytics should not be used for more than 48 hours. Some obstetricians do cervical encirclage in case of placenta previa. The rationale behind the use of cervical cerclage in placenta previa, is that it limits the development of the low uterine segment brought about by advancing gestation and the effect of uterine contraction. But other studies have failed to confirm these findings. Thus, RCOG doesnot recommend the use of cervical cerclage in placenta previa till further data is available