made decision?做出判断？谢谢

MANAGEMENT OF SYMPTOMATIC PLACENTA PREVIA

• Initial assessment for signs of maternal hemodynamic compromise or hemorrhagic shock; large-bore IV access with crystalloid fluid resuscitation. 

• Assess fetal status and gestational age by sonogram and continuous fetal heart rate monitoring. • Cross-matched blood should be made available during bleeding episodes.

• Tocolytic therapy should not be administered in an actively bleeding patients.

• Magnesium sulfate therapy for fetal neuroprotection should be considered in those with symptomatic preterm (less than 32 wks) placenta previa if the decision has been made to likely deliver the patient within 24 hours. Emergent delivery should not be delayed to administer magnesium. 

• Cesarean delivery is indicated for active labor, nonreassuring fetal heart rate tracing, active bleeding with hemodynamic instability, and significant bleeding after 34 wks’ gestation.

Expectant management after a resolved bleed: 

• Antenatal corticosteroid should be administered to symptomatic women between 23+0 and 36+6 wks of gestation to enhance fetal pulmonary maturity. 

• Correct anemia. 

• Administer anti-D immune globulin to D-negative women.

症状性前置胎盘的治疗

l 初步评估产妇血流动力学受损或失血性休克的迹象；大口径静脉输液通道用于晶体液复苏。

l 通过超声波评估胎儿状况和孕周以及持续的胎心率监测。

l 应在出血期间输注交叉配对过的血液。

l 不应对出血活跃的患者进行溶栓治疗。

l 如果判断产妇可能在24小时内分娩，则应考虑对有症状的因前置胎盘而早产（小于32周）的产妇进行硫酸镁治疗，以保护胎儿神经。紧急分娩不应因服用镁而延误。

l 活跃期分娩、胎心率曲线异常、活动性出血伴血流动力学不稳定、妊娠34周后大出血应行剖宫产。

出血缓解后的后续治疗：

l 妊娠23+0周至36+6周有症状的妇女应在产前使用皮质类固醇，以提高胎儿肺成熟度。

l 纠正贫血。

l 给D阴性女性注射抗D免疫球蛋白。

made decision?做出判断？Expectant management后续治疗？还有那些标颜色的麻烦看一下，谢谢