Abruptio Placentae Treatment & Management

Inpatient admission for testing and possible delivery is required if abruptio placentae is considered likely.

Go to Emergent Management of Abruptio Placentae for complete information on this topic.

Transfer considerations

Transfer of the patient to an intensive care unit (ICU) may be necessary, before or after delivery, if shock develops that requires invasive central monitoring or if operative complications are encountered.

Transfer to a facility with a neonatal ICU is needed if the fetus is preterm and appropriate facilities are not available. This should be accomplished after delivery if delivery is required to stabilize the mother.

Begin continuous external fetal monitoring for the fetal heart rate and contractions.

Obtain intravenous access using 2 large-bore intravenous lines.

Institute crystalloid fluid resuscitation for the patient.

Type and crossmatch blood.

Begin a transfusion if the patient is hemodynamically unstable after fluid resuscitation.

Correct coagulopathy, if present.

Administer Rh immune globulin if the patient is Rh-negative.

This is the preferred method of delivery for a fetus that has died secondary to placental abruption.

The ability of the patient to undergo vaginal delivery depends on her remaining hemodynamically stable.

Delivery is usually rapid in these patients secondary to increased uterine tone and contractions.

Cesarean delivery is often necessary for fetal and maternal stabilization.

While cesarean delivery facilitates rapid delivery and direct access to the uterus and its vasculature, it can be complicated by the patient's coagulation status. Because of this, a vertical skin incision, which has been associated with less blood loss, is often used when the patient appears to have DIC.

The type of uterine incision is dictated by the gestational age of the fetus, with a vertical or classic uterine incision often being necessary in the preterm patient.

If hemorrhage cannot be controlled after delivery, a cesarean hysterectomy may be required to save the patient's life.

Before proceeding to hysterectomy, other procedures, including correction of coagulopathy, ligation of the uterine artery, administration of uterotonics (if atony is present), packing of the uterus, and other techniques to control hemorrhage, may be attempted.

If the patient is hemodynamically unstable, either before or after delivery, invasive monitoring in an ICU may be required.

The patient should be restricted to nothing by mouth (NPO) if emergent delivery is a possibility.

Preterm patients diagnosed with a chronic abruption may be started on a modified bedrest regimen and monitored closely for any signs of maternal or fetal distress that could necessitate delivery. Again, consultation with MFM specialists is advised for conservative management of abruptio placentae.

Inpatient and outpatient medications may include the following:

• Prenatal vitamins
• Iron supplements
• Stool softeners if the patient is hemodynamically stable and is kept in an inpatient setting for monitoring

Elimination of correctable risk factors can decrease the risk of recurrence in subsequent pregnancies.

Two of the most notable correctable factors are smoking and cocaine abuse. Education about the risks of these behaviors and about cessation or rehabilitation programs may help to prevent future abruptions.

If a patient has been abused, preventing further abuse is an important consideration.

Because of the potential association with thrombophilias with abruptio placentae, a patient found to have a thrombophilia who had a severe or early abruption, especially with death of the fetus, is usually treated with heparin anticoagulation therapy during the following pregnancy and for 6 weeks' postpartum, although, at present, little evidence has demonstrated that this measure decreases the risk of recurrence.

A maternal-fetal medicine (MFM) specialist should be consulted if a mild abruption is diagnosed or the diagnosis is questionable. In the case of a preterm fetus in which tocolysis is considered likely, consulting an MFM specialist may be prudent.

Pediatricians or neonatal intensive care specialists should be consulted if the fetus is considered viable, usually at 24 weeks' gestation, and delivery is anticipated.