DOUBLE SET UP

EXAMINATION (DSE)
PLACENTA PREVIA

is defined as the implantation of the placenta over the cervical os

DOUBLE SET UP EXAMINATION (DSE)

is performing VE in the OR with all the preparations for an emergency CS are made DSE is performed: on the day of
termination of pregnancy before allowing labor to proceed if the woman is already in labor Procedure in DSE: Take patient
to the OR and make all the preparation for immediate CS which includes draping of the patient, laid trolley, scrapped up nurse
and assistant, x-matched two units of blood, and all preparation for immediate intubation. If placenta previa is more likely or the
anesthetist is not well experienced, general anesthesia can be initiated before the VE. Using two Sims speculum, explore the
vagina and cervix to exclude any local lesion and confirm that bleeding is coming through the cervix if there is active bleeding
Ask an assistant push the presenting part (head), into the pelvic brim First explore the vaginal fornices with your fingers:
Abnormal thickness in the lower segment of the uterus or a feeling of intervening tissue between your finger and the head
indicated presence of placenta previa.
If the thickness all round the vaginal fornices, major placenta previa is entertained while thickening of part of the fornices
indicate lesser degree of placenta previa.
 In case the thickness you feel is not suggestive of a major placenta previa or if there is no
such thickness, put your index finger into very gently through the cervical os, and explore all
round. Sweep it in gently widening circle until you have examined all around as far as you can
reach with your finger. Check for vaginal bleeding while exploring. Stop when you feel any
placenta or bleeding is incited or increased during the examination.
If you feel placenta, manage her as placenta previa
If there is profuse bleeding following the VE, proceed with CS
If you feel no placenta, the bleeding may be due to abruptio or minor degree (low lying) of
placenta. Perform ARM and transfer the woman to the labor ward for close monitoring and
induction with oxytocin