Diagnosis and safe management of placenta previa

Close follow-up continues even after surgery

Immediately after surgery, close monitoring of hemodynamic status is required, ideally in a critical care setting. Because women with placenta previa/placenta accreta have often received massive transfusions of blood and blood products along with large volumes of crystalloid fluids, pulmonary edema may develop. Conversely, hypovolemia can result from inadequate replacement of blood or persistent intra-abdominal bleeding. Thus, close attention to urinary output allows early detection of pulmonary edema, acute respiratory distress syndrome, hypovolemia, or persistent intra-abdominal bleeding. Patients who undergo peripartum hysterectomy should also be monitored closely for possible ureteral injury.

Thromboprophylaxis should continue until the patient is ambulatory.

Recommended laboratory tests

Get a complete blood count with platelets and fibrinogen immediately after surgery and at frequent intervals as needed. A chemistry panel with calcium, albumin, electrolytes, and creatinine also is helpful.

Serious morbidity in 3% to 5% of women after emergent hysterectomy

Conditions such as acute respiratory distress syndrome from massive blood transfusion and pulmonary capillary leakage, acute tubular necrosis from renal failure, and pulmonary embolism may complicate 3% to 5% of cases.⁵⁴

Reoperation for persistent intra-abdominal bleeding may be necessary, and 9% of women will have urologic injury. Unfortunately, the maternal mortality rate associated with this procedure is 0.8%, so meticulous postoperative care is mandated.⁵⁵

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