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Management of Bleeding in Late Preterm Period

Am J Obstet Gynecol; ePub 2017 Oct 25; Gyamfi-Bannerman

The Society for Maternal-Fetal Medicine (SMFM) has issued recommendations on the management of bleeding in the late preterm period. The document is intended to provide guidance on management of late preterm (34 0/7 to 36 6/7 weeks of gestation) vaginal bleeding. Among the recommendations:

  • SMFM recommends delivery at 36-37 6/7 weeks of gestation for stable women with placenta previa without bleeding or other obstetric complications, such as preeclampsia or fetal growth restriction.
  • SMFM does not recommend routine cervical length screening for women with placenta previa in the late preterm period due to lack of data on an appropriate management strategy.
  • SMFM recommended a planned delivery between 34 and 37 weeks of gestation for stable women with placenta accrete.
  • SMFM recommends that in women with active hemorrhage in the late preterm period, delivery should not be delayed for the purpose of administering antenatal corticosteroids (ACS).
  • SMFM recommends that fetal lung maturity testing should not be used to guide management in the late preterm period when an indication for delivery is present.
  • SMFM recommends that ACS should be administered to women who are eligible and are managed expectantly if delivery is likely without 7 days, the gestational age is between 34 0/7 and 36 6/7 weeks of gestation, and if ACS has not previously been administered.

Citation:

Gyamfi-Bannerman. Society for Maternal-Fetal Medicine (SMFM) Consult Series #44: Management of bleeding in the late preterm period. [Published online ahead of print October 25, 2017]. Am J Obstet Gynecol. doi:10.1016/j.ajog.2017.10.019.