A 29-year-old at 30 weeks presents with sudden onset painless vaginal bleeding of 200 mL. Ultrasound shows complete placenta previa. She is hemodynamically stable and the fetus is not in distress. What is the most appropriate management?

• A Hospitalization, corticosteroids for fetal lung maturity, tocolysis if contracting, transfusion if needed, and planned cesarean at 36–37 weeks ✓
• B Emergency cesarean section immediately to prevent further hemorrhage
• C Amniocentesis to assess fetal lung maturity followed by delivery
• D Expectant management at home with pelvic rest and repeat ultrasound at 36 weeks

Explanation

For hemodynamically stable antepartum hemorrhage from placenta previa at 30 weeks, expectant management in hospital is appropriate. This includes bedrest, continuous fetal monitoring, betamethasone 12 mg IM x2 doses 24h apart for fetal lung maturity, tocolysis if uterine contractions are present, and blood transfusion if hemoglobin falls significantly. Planned cesarean section is performed at 36–37 weeks electively for complete previa. Immediate cesarean is reserved for uncontrolled hemorrhage, maternal instability, or fetal distress. Home management is unsafe given the risk of recurrent bleeding. Amniocentesis adds risk without changing management at 30 weeks.

Reference: Williams Obstetrics, 26th ed.

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Written and medically reviewed by the StethoPrep medical team.