The conservative aggressive management of placenta previa.

One hundred and seventy-three cases of placenta previa managed at the Women's Hospital of Los Angeles County-University of Southern California Medical Center from July, 1975, through June, 1978, were reviewed and compared to a similar series of cases studied in the same institution in 1969. The perinatal mortality of 12.6% was roughly one half of that in the earlier study. The fetal death rate did not change significantly, but the neonatal mortality was markedly less, especially in the 27-to-32-week range. Expectant management was employed in 65.8% of patients, as compared to 42.6% in 1969. The higher rate of expectant management was characterized by the aggressive use of antepartum transfusions in the face of moderate-to-severe bleeding in lieu of delivery, as well as the occasional use of tocolytic agents for inhibition of premature labor in the presence of vaginal bleeding. Elective termination of pregnancy utilizing the lecithin/sphingomyelin (L/S) ratio for determination of pulmonary maturation also resulted in significantly less overall neonatal morbidity and mortality. These multiple factors appear to have contributed to a dramatic reduction in the perinatal mortality associated with placenta previa.