Managing Complications in Pregnancy and Childbirth: - IAWG

Vaginal bleeding in later pregnancy and labourS-23• If the cervix is partly dilated and placental tissue is visible, confirmplacenta praevia and plan delivery (page S-23).• If the cervix is not dilated, cautiously palpate the vaginal fornices:- If spongy tissue is felt, confirm placenta praevia and plandelivery (page S-23);- If a firm fetal head is felt, rule out major placenta praevia andproceed to deliver by induction (page P-18).• If a diagnosis of placenta praevia is still in doubt, perform acautious digital examination:- If soft tissue is felt within the cervix, confirm placenta praeviaand plan delivery (below);- If membranes and fetal parts are felt both centrally andmarginally, rule out placenta praevia and proceed to deliver byinduction (page P-17).DELIVERY• Plan delivery if:- the fetus is mature;- the fetus is dead or has an anomaly not compatible with life(e.g. anencephaly);- the woman’s life is at risk because of excessive blood loss.• If there is low placental implantation (Fig S-3 A) and bleeding islight, vaginal delivery may be possible. Otherwise, deliver bycaesarean section (page P-43).Note: Women with placenta praevia are at high risk for postpartumhaemorrhage and placenta accreta/increta, a common finding at thesite of a previous caesarean scar.• If delivered by caesarean section and there is bleeding from theplacental site:- Under-run the bleeding sites with sutures;- Infuse oxytocin 20 units in 1 L IV fluids (normal saline orRinger’s lactate) at 60 drops per minute.