Antepartum Expectant Management of Placenta Previa, Inpatient Versus Outpatient

Park, Sun Hui; Kim, Jae Doc; Jeong, Min; Heo, Yun Su; Kim, Jong Hyeon; Jeong, Yong Ju; Cho, Sung Nam; Kim, Jong Duk

Abstract

OBJECTIVE
Our purpose was to determine the outcome of inpatient and outpatient management of placenta previa.
METHODS
Sixty women with the initial diagnosis of placenta previa at 30 to 37 weeks' gestation who required hospitalization for no or minimal vaginal bleeding were stabilized and then randomized to receive either inpatient or outpatient expectant management. Thirty inpatients were treated at bed rest with minimal ambulation, received corticosteroids until 33 weeks of gestation and underwent ultrasonographic examination at 2 week intervals to assess fetal growth and placental location. Thirty outpatients were discharged after 2 or 3 days of hospitalization, and also received corticosteroids every week until 33 weeks of gestation and underwent ultrasonographic examination at 2 weeks intervals. All subjects who reached 37 weeks' gestation with persistent placenta previa underwent cesarean section electively.
RESULTS
There were no differences between inpatients and outpatients for mean age, parity, gestational age at diagnosis, gestational age at first bleeding, and number of prior cesarean sections. There were no significant differences in the maternal and neonatal outcome measures as measured by time pregnancy prolonged, transfusions, cesarean hysterectomy, gestational age at delivery, birth weight, and neonatal morbidity. Significant difference observed only in maternal total hospital stay (p<0.01) as inpatient is 29.5+/-21.4 days and outpatient is 10.1+/-7.5 days.
CONCLUSION
In selected patients, outpatient management of placenta previa can be reduced maternal total hospital stay. There were no apparent differences in the maternal and neonatal outcome of the two groups.