How to treat placenta praevia

  The incidence of anterior placenta varies, with some reporting that the percentage of placenta edges reaching or covering the internal cervical os is 42% at 11-14 weeks of gestation on ultrasound, 3.9% at 20-24 weeks, and further decreasing to 1.9% at term. Therefore, the low placenta position found during early pregnancy ultrasound is not a cause for concern, as most placentas will gradually move upward as the uterus increases in size. However, if the placenta covers more than 15 mm of the internal os at mid-pregnancy, the probability of placenta praevia at term increases significantly, and the greater the distance covering the internal os of the cervix, the higher the probability of cesarean delivery. Whether or not vaginal delivery is possible also requires an ultrasound at 35-36 weeks. Please note that the gold standard for placenta praevia diagnosis is transvaginal ultrasound, as the false positive rate is higher with transabdominal ultrasound (TAS). If the edge of the placenta is >20 mm from the internal cervical os, vaginal delivery can be attempted and the success rate of vaginal delivery is high. If the distance of the placental margin from the internal cervical os is between 0-20 mm, the probability of cesarean delivery is higher, but there is still a chance of vaginal delivery, depending on whether the patient has vaginal bleeding or other conditions before or during labor.  As we enter the mid to late stages of pregnancy, some patients with complete placenta praevia or partial placenta praevia will have bleeding. For small amounts of bleeding, hospitalization for observation may be temporarily unnecessary, as one study found no significant difference in clinical outcomes between hospitalization and observation at home. However, for patients with moderate or heavy bleeding, it is safer to be hospitalized for observation. Even with hospitalization, absolute bed rest is not required. In patients with immature placenta praevia, cervical cerclage has been attempted to reduce bleeding and prolong gestational weeks, but the current evidence does not yet support this.  Of the placenta praevia, the more risky is a history of a previous cesarean section with the placenta implanted in the uterine scar, a condition that is prone to placental implantation and can easily lead to hemorrhage and hysterectomy during delivery. In this case, it is important to go to a large hospital with resuscitation facilities.