Managing Complications in Pregnancy and Childbirth: - IAWG

S-22 Vaginal bleeding in later pregnancy and labouras cervicitis, trauma, cervical polyps or cervical malignancy. Thepresence of these, however, does not rule out placenta praevia.• Restore blood volume by infusing IV fluids (normal saline orRinger’s lactate).• Assess the amount of bleeding:- If bleeding is heavy and continuous, arrange for caesareandelivery irrespective of fetal maturity (page P-43);- If bleeding is light or if it has stopped and the fetus is alive butpremature, consider expectant management until delivery orheavy bleeding occurs:- Keep the woman in the hospital until delivery;- Correct anaemia with ferrous sulfate or ferrous fumerate 60mg by mouth daily for 6 months;- Ensure that blood is available for transfusion, if required;- If bleeding recurs, decide management after weighingbenefits and risks for the woman and fetus of furtherexpectant management versus delivery.CONFIRMING THE DIAGNOSIS• If a reliable ultrasound examination can be performed, localize theplacenta. If placenta praevia is confirmed and the fetus is mature,plan delivery (page S-23).• If ultrasound is not available or the report is unreliable and thepregnancy is less than 37 weeks, manage as placenta praevia until37 weeks.• If ultrasound is not available or the report is unreliable and thepregnancy is 37 weeks or more, examine under double set-up toexclude placenta praevia. The double set-up prepares for eithervaginal or caesarean delivery, as follows:- IV lines are running and cross-matched blood is available;- The woman is in the operating theatre with the surgical teampresent;- A high-level disinfected vaginal speculum is used to see thecervix.