Abruptio Placentae Medication

  • Author: Shad H Deering, MD; Chief Editor: Carl V Smith, MD   more...
 
Updated: May 16, 2011
 

Medication Summary

Tocolysis is considered controversial in the management of placental abruption and is considered only in patients (1) who are hemodynamically stable, (2) in whom no evidence of fetal jeopardy exists, and (3) in whom a preterm fetus may benefit from corticosteroids or delay of delivery.

Even in patients meeting these criteria, consultation with an MFM specialist is important. Tocolysis must be undertaken with caution, because maternal or fetal distress can develop rapidly. In general, either magnesium sulfate or nifedipine (but not both) is used for tocolysis and beta-sympathomimetic agents are avoided, as the latter may cause significant undesirable cardiovascular effects, such as tachycardia, which may mask clinical signs of blood loss in these patients.

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Tocolytics

Class Summary

Tocolytics may allow for the effective administration of glucocorticoids to the preterm fetus to accelerate fetal lung maturation. In chronic abruption, these drugs may also help to delay delivery to a gestational age when complications of prematurity are less severe.

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Nifedipine (Adalat, Procardia, Nifediac CC, Nifedical XL)

 

Nifedipine is a calcium channel blocker. The theory behind its use as a tocolytic is that by blocking an influx of calcium into uterine muscle cells, it will decrease contractions, which are dependent on calcium.

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Magnesium sulfate

 

This is the drug of choice for tocolysis in patients with placental abruption.

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Contributor Information and Disclosures
Author

Shad H Deering, MD  Clinical Assistant Professor, Department of Obstetrics and Gynecology, University of Washington School of Medicine; Medical Director, Andersen Simulation Center, Madigan Army Medical Center

Shad H Deering, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, Association of Professors of Gynecology and Obstetrics, and Society for Maternal-Fetal Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Bruce A Meyer, MD, MBA  Executive Vice President for Health System Affairs, Chief Clinical Officer, Interim CEO, University Hospitals; Professor, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical School

Bruce A Meyer, MD, MBA is a member of the following medical societies: American College of Obstetricians and Gynecologists, American College of Physician Executives, American Institute of Ultrasound in Medicine, Association of Professors of Gynecology and Obstetrics, Massachusetts Medical Society, Medical Group Management Association, and Society for Maternal-Fetal Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Chief Editor

Carl V Smith, MD  The Distinguished Chris J and Marie A Olson Chair of Obstetrics and Gynecology, Professor, Department of Obstetrics and Gynecology, University of Nebraska Medical Center

Carl V Smith, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Institute of Ultrasound in Medicine, Association of Professors of Gynecology and Obstetrics, Central Association of Obstetricians and Gynecologists, Council of University Chairs of Obstetrics and Gynecology, Nebraska Medical Association, and Society for Maternal-Fetal Medicine

Disclosure: Nothing to disclose.

References

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  2. Oyelese Y, Ananth CV. Placental abruption. Obstet Gynecol. Oct 2006;108(4):1005-16.

  3. Ananth CV, Oyelese Y, Yeo L, Pradhan A, Vintzileos AM. Placental abruption in the United States, 1979 through 2001: temporal trends and potential determinants. Am J Obstet Gynecol. Jan 2005;192(1):191-8. [Medline].

  4. Rana A, Sawhney H, Gopalan S. Abruptio placentae and chorioamnionitis-microbiological and histologic correlation. Acta Obstet Gynecol Scand. May 1999;78(5):363-6. [Medline].

  5. Tuuli MG, Norman SM, Odibo AO, Macones GA, Cahill AG. Perinatal outcomes in women with subchorionic hematoma: a systematic review and meta-analysis. Obstet Gynecol. May 2011;117(5):1205-12. [Medline].

  6. Ananth CV, Smulian JC, Vintzileos AM. Incidence of placental abruption in relation to cigarette smoking and hypertensive disorders during pregnancy: a meta-analysis of observational studies. Obstet Gynecol. Apr 1999;93(4):622-8. [Medline].

  7. Ananth CV, Savitz DA, Luther ER. Maternal cigarette smoking as a risk factor for placental abruption, placenta previa, and uterine bleeding in pregnancy. Am J Epidemiol. Nov 1 1996;144(9):881-9. [Medline].

  8. Ananth CV, Savitz DA, Bowes WA Jr, Luther ER. Influence of hypertensive disorders and cigarette smoking on placental abruption and uterine bleeding during pregnancy. Br J Obstet Gynaecol. May 1997;104(5):572-8. [Medline].

  9. Hoskins IA, Friedman DM, Frieden FJ. Relationship between antepartum cocaine abuse, abnormal umbilical artery Doppler velocimetry, and placental abruption. Obstet Gynecol. Aug 1991;78(2):279-82. [Medline].

  10. Tikkanen M, Nuutila M, Hiilesmaa V, Paavonen J, Ylikorkala O. Clinical presentation and risk factors of placental abruption. Acta Obstet Gynecol Scand. 2006;85(6):700-5. [Medline].

  11. Ananth CV, Wilcox AJ. Placental abruption and perinatal mortality in the United States. Am J Epidemiol. Feb 15 2001;153(4):332-7. [Medline].

  12. Raymond EG, Mills JL. Placental abruption. Maternal risk factors and associated fetal conditions. Acta Obstet Gynecol Scand. Nov 1993;72(8):633-9. [Medline].

  13. Clark SL. Placentae previa and abruptio placentae. In: Creasy RK, Resnik R, eds. Maternal Fetal Medicine. 5th ed. Philadelphia, Pa: WB Saunders; 2004:715.

  14. Glantz C, Purnell L. Clinical utility of sonography in the diagnosis and treatment of placental abruption. J Ultrasound Med. Aug 2002;21(8):837-40. [Medline].

  15. Kramer MS, Usher RH, Pollack R. Etiologic determinants of abruptio placentae. Obstet Gynecol. Feb 1997;89(2):221-6. [Medline].

 
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