BLEEDING MANAGEMENT IN PLACENTA PREVIA

Introduction: Placenta previa is an abnormal condition during pregnancy that poses risk for ante, intra-, and post-partum blood loss. Massive uncontrolled blood loss can lead to serious obstetric complications, including maternal and neonatal morbidity and mortality. Objective: This study aims to review and understand bleeding management for placenta previa presenting as the ante- and post-partum bleeding. Methods: Literature search was conducted on Google Scholar and Pubmed databases for articles published in 2017 to 2021. Keywords used include ‘bleeding’, ‘hemorrhage’, ‘antepartum’, ‘postpartum’, ‘management’, and ‘placenta previa’. Results: Literature search yielded 142 articles with 14 articles included in the final analysis. The result showed that the main principle of antepartum bleeding management is to maintain maternal hemodynamic stability and determine whether emergency cesarean birth is necessary. A restrictive fluid resuscitation and transfusion protocol should be applied for patients presenting with acute and massive bleeding. For postpartum bleeding management, administration of certain uterotonics (i.e. oxytocin) and tranexamic acid are considered feasible options to prevent massive bleeding. While the most effective postpartum bleeding management is considered to be Bakri balloon tamponade, uterine gauze packing appears as a good alternative in a resource-limited setting. Conclusion: Placenta previa in pregnancy poses a risk for bleeding which can be treated before, during, and after the delivery, in order to improve maternal and neonatal outcome. Accurate diagnosis and close observation during the antenatal period are keys to recognizing the risk of bleeding and planning the proper delivery process.