Method of conservative management of placenta previa (AIIMS NOV. 2010)
|A||Brandt Andrew method|
|B||MacFee and Johnson|
MacFee and Johnson
a. Brandt Andrew method is the technique of delivering the placenta with the “Controlled cord traction” method.
b. MacFee and Johnson contended that in the absence of vaginal manipulation the first hemorrhage will never be fatal if the patient is carefully followed by this method, both the authors found marked reduction of fetal loss.
c. This revolutionary conception of fetal risk was attained by extreme conservatism:
i. The principle was laid down that no vaginal examination should be made unless and until it could be followed immediately by whatever treatment was required for delivery (e.g., caesarean section).
ii. Thus a patient would be put to bed to wait until the last few weeks of pregnancy, regardless of repeated "warning" haemorrhages so long as there was no undue anaemia; and with increasing experience there was less cause for alarm over any one apparently severe attack of bleeding.
iii. MacFee states significantly that "among these patients there has been nothing to confirm the belief that recurrent haemorrhages tend to lead up to one catastrophic hemorrhage."
iv. Credé’s method…is the act of vigorous massaging and squeezing of the fundus to force the separation of the placenta. This method is not approved since it can cause retention of placental lobes.