Question
Ideal management of a 37 weeks pregnant elderly primigravida with a condition shown in the picture below and active bleeding is ?
| A. |
Labour induction.
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| B. |
Caesarean section.
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| C. |
Vaginal delivery.
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| D. |
Expectant treatment.
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Show Answer
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Correct Answer � B
Explanation
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The condition shown in the picture above represents placenta praevia.
An initial assessment to determine the status of the mother and fetus is required.
It is now considered safe to treat placenta praevia 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 praevia increases the risk of puerperal sepsis and postpartum haemorrhage because the lower segment to which the placenta was attached contracts less well post-delivery.
