The uterus is usually soft and is not tender to palpation. A pelvic examination is not performed, because of the risk of increasing the hemorrhage by digital disruption of the placenta at the cervical os. The diagnosis is confirmed by ultrasound. If the initial episode of bleeding subsides, hospitalization of the patient with placenta previa is appropriate. Typically the patient will remain at bedrest, in an attempt to delay a repeat bleeding episode.
Cesarean delivery is deferred until the fetus is mature, or until dangerous bleeding develops.
Cross matched blood is maintained in the blood bank for emergency use. Corticosteroids are given to induce fetal lung maturity, and reduce the risk of fetal intraventricular hemorrhage if the pregnancy is less than 34 weeks gestation. Placenta accreta or percreta may be associated with placenta previa especially if the patient has had a previous cesarean section. Your next patient is a 25 year old cocaine addict at 29 weeks who presents with accute onset of severe uterine tenderness and moderate vaginal bleeding.