Placenta+Previa+and+Low-Lying+Placenta

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** CCRMC OBGYN **** Prenatal Guideline ** Consultation available 24 hours per day from OB on-call at 925-370-5608 or via page/amion, via inbasket to OB dept member or by calling Perinatologist at 510-444-0790 during the day and 510-204-1572 after hours. Consultation appointments or transfer of care to more experienced prenatal clinician available at major clinics sites—see consultation guidelines for more information.

** Placenta Previa and Low Lying Placenta ** Low lying, marginal, partial, or even complete previa seen on early ultrasounds in the first and second trimester will often resolve as the pregnancy progresses.


 * __If placenta previa or low lying placenta on ultrasound:__**
 * Let patient know about previa
 * Instruct patient to let any medical personnel caring for her know about placental position
 * If greater than 20 weeks EGA, to L and D urgently for any bleeding
 * Advise pelvic rest if complete previa or placenta within 1cm of cervical os
 * Advise modified bedrest if bleeding in second or third trimester
 * Make sure she is on adequate iron for maximal Hb before delivery
 * Order follow up ultrasound at 28-32 weeks and again if persisting at 36 weeks EGA to look for resolution


 * __Persistent Previa or Low Lying Placenta—consult with OB Dept physician to review delivery plan__**
 * 1) Complete previa or placenta within 2 cm of cervical os--**schedule cesarean at 37 weeks EGA**
 * 2) Advise to go urgently to labor and delivery NPO if any bleeding prior to delivery
 * 3) If complete previa and prior bleeding consider cesarean prior to 37 weeks EGA
 * 4) If prior cesarean and anterior low lying placenta or previa higher possibility of placental accreta. Consider delivery at ABMC or JMH (options of uterine artery embolization and larger blood banks may improve chances of avoiding hysterectomy) or scheduling in main OR at CCRMC. Discuss plan with an OB Attending.
 * 5) Placenta 1-2 cm from os recommend cesarean. Some OB attendings may consider closely monitored attempt at vaginal delivery if patient very motivated to avoid cesarean and understands risk of bleeding and emergency cesarean in labor.