How should I counsel a patient with placenta praevia regarding the risks of vaginal delivery versus cesarean section?

Counseling a patient with placenta praevia about delivery options should emphasize that caesarean birth is the recommended mode of delivery when the placenta partly or completely covers the internal cervical os (minor or major placenta praevia). This is because vaginal delivery in placenta praevia carries significant risks of severe maternal bleeding and fetal compromise.

Explain that vaginal delivery is generally not advised due to these risks, and caesarean section is offered to reduce the risk of hemorrhage and improve safety for both mother and baby.

Discuss the benefits of caesarean section in this context, including controlled delivery, reduced risk of severe bleeding, and better preparedness for potential complications. However, also inform the patient about the general risks associated with caesarean birth, such as surgical risks, longer recovery, and implications for future pregnancies.

Ensure the patient understands that while both vaginal and caesarean births have benefits and risks, in the case of placenta praevia, caesarean birth is the safer and standard recommendation. The discussion should take into account the patient's individual circumstances, concerns, and preferences.

Offer referral to specialist care if there is suspicion of placenta accreta spectrum, especially if there is a previous uterine scar, as this requires multidisciplinary management.