PA.21 Does all placenta praevia need hospital admission?

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Abstract

Introduction

There are controversies regarding inpatient vs outpatient management of placenta praevia. RCOG1 recommends that the care should be tailored according to the need of individual. This retrospective study aimed to establish whether outpatient management of placenta praevia affected the rates and pace of emergency LSCS, gestation at delivery, neonatal unit admissions, and the incidence of post-partum haemorrhage compared to inpatient group.

Method

Case note review of 100 patients over a 5-year period (July 2008–July 2013) with placenta praevia documented at their 34 weeks scan. Placenta praevia defined as placenta less than 2 cm from internal os.

Results

20% (20/100) of patients were admitted from 34 weeks of pregnancy. The emergency LSCS rate amongst inpatients was 30% (6/20) and amongst those who received outpatient management the LSCS rate was 17.5% (12/80). The time interval between onset of bleeding to delivery time amongst the emergency LSCS group ranged from 35minutes to 96 h96hours, with a median interval of around 4 h. The patient who was delivered the fastest (35 min) was not an inpatient. The rates of SCBU admissions, PPH and blood transfusions were similar for both inpatients and outpatients.

Conclusion

Although the inpatient and outpatient group this study are not matched, there does not appear to be a significant difference in PPH, blood transfusion or neonatal complication rate, although the emergency LSCS was higher amongst inpatients. This could justify outpatient management if the patient is able to access the hospital quickly and has got support at home.

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