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Initial priorities
Immediate stabilization
If hemodynamic instability, resuscitation bay
Two large-bore IV access
Massive transfusion protocol if ongoing hemorrhage
Maternal vitals and shock index
If shock index > 1, high-risk hemorrhage physiology
If SBP < 90 mmHg or altered mental status, emergent escalation
Fetal assessment if viable gestation
Continuous fetal heart rate monitoring if > 24 weeks and bleeding
If nonreassuring tracing with ongoing bleeding, prepare for delivery
Pelvic exam safety
No digital vaginal examination until placenta location confirmed
Speculum exam only for alternative source if placenta location unknown and unstable bleeding
Immediate imaging
Transvaginal ultrasound for placental edge to internal cervical os distance
If placenta accreta spectrum risk factors, targeted ultrasound with color Doppler
Team activation triggers
If heavy bleeding, obstetrics and anesthesia at bedside
If suspected placenta accreta spectrum, multidisciplinary hemorrhage plan
Hemorrhage framework
Hemorrhage control strategy
If active heavy bleeding, delivery threshold lower than gestational targets
If maternal instability, immediate cesarean regardless of gestational age
If fetal compromise with ongoing bleeding, immediate cesarean if viable
Blood product strategy
Type and crossmatch with anticipated large-volume transfusion
Balanced transfusion strategy during massive hemorrhage
Coagulopathy monitoring
Fibrinogen trend as early marker of consumptive coagulopathy
If fibrinogen low with active bleeding, escalate transfusion and delivery planning
Key concepts
Condition anchors
Placenta previa definition
Placental tissue over or within close proximity to internal cervical os
Painless third-trimester bleeding as classic presentation
Principal safety rule
Digital cervical examination can precipitate catastrophic hemorrhage
Delivery planning anchor
Persistent previa usually requires cesarean delivery
Timing individualized by bleeding history and accreta risk
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.