Managing Complications in Pregnancy and Childbirth: - IAWG

Vaginal bleeding in later pregnancy and labourS-21• Restore blood volume by infusing IV fluids (normal saline orRinger’s lactate) before surgery.• When stable, immediately perform caesarean section and deliverbaby and placenta (page P-43).• If the uterus can be repaired with less operative risk thanhysterectomy would entail and the edges of the tear are notnecrotic, repair the uterus (page P-95). This involves less time andblood loss than hysterectomy.Because there is an increased risk of rupture with subsequentpregnancies, the option of permanent contraception needs to bediscussed with the woman after the emergency is over.• If the uterus cannot be repaired, perform subtotal hysterectomy(page P-103). If the tear extends through the cervix and vagina,total hysterectomy may be required.PLACENTA PRAEVIAPlacenta praevia is implantation of the placenta at or near the cervix (FigS-3).FIGURE S-3Implantation of the placenta at or near the cervix.Warning: Do not perform a vaginal examination unless preparationshave been made for immediate caesarean section. A careful speculumexamination may be performed to rule out other causes of bleeding such