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Step 1
Continue expectant management for uncomplicated pregnancies. If an episode of bleeding or contractions occurs however, the patient should go to the hospital immediately for evaluation.
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Step 2
Conduct an exam in preparation for immediate surgery if bleeding persists. Otherwise, the pregnancy can be continued if the bleeding is minimal and the fetus is not distressed.
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Step 3
Administer tocolytics to arrest the contractions in some cases of minimal bleeding. Magnesium sulfate is a common choice with a loading dose of 6 g given over 20 minutes followed by a continuous infusion of 2 to 4 g/hour. Antenatal corticosteroids also may be given in the event of extreme prematurity.
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Step 4
Hospitalize the patient in some cases where multiple episodes of bleeding occur during a viable pregnancy greater than 24 weeks. These cases have an increased likelihood of an abruption of the placenta and subsequent loss of the fetus.
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Step 5
Perform a cesarean section as the safest method of delivery for cases of placenta previa. A low transverse incision is the most common approach but a vertical incision also may be considered in cases involving an anterior placenta because of the risk of fetal bleeding.
