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Abruptio Placentae Treatment & Management

  • Author: Shad H Deering, MD; Chief Editor: Carl V Smith, MD  more...
 
Updated: Sep 14, 2015
 

Approach Considerations

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

See 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 the patient is hemodynamically unstable, such as if shock develops, and 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.

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Initial Management of Abruptio Placentae

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.

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Vaginal Delivery

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.

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Cesarean Delivery

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.

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Dietary and Activity

Dietary modification

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

Activity restrictions

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 maternal-fetal medicine (MFM) specialists is advised for conservative management of abruptio placentae.

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Inpatient and Outpatient Medications in 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
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Deterrence and Prevention of Abruptio Placentae

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.

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Consultations

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.

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Contributor Information and Disclosures
Author

Shad H Deering, MD 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, Society for Maternal-Fetal Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

John G Pierce, Jr, MD Associate Professor, Departments of Obstetrics/Gynecology and Internal Medicine, Medical College of Virginia at Virginia Commonwealth University

John G Pierce, Jr, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, Association of Professors of Gynecology and Obstetrics, Christian Medical and Dental Associations, Medical Society of Virginia, Society of Laparoendoscopic Surgeons

Disclosure: Nothing to disclose.

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, Senior Associate Dean for Clinical Affairs, 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, Society for Maternal-Fetal Medicine, Council of University Chairs of Obstetrics and Gynecology, Nebraska Medical Association

Disclosure: Nothing to disclose.

Additional Contributors

Bruce A Meyer, MD, MBA Executive Vice President for Health System Affairs, Executive Director, Faculty Practice Plan, 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: Medical Group Management Association, American College of Obstetricians and Gynecologists, American Association for Physician Leadership, American Institute of Ultrasound in Medicine, Association of Professors of Gynecology and Obstetrics, Massachusetts Medical Society, Society for Maternal-Fetal Medicine

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author Andrew Satin, MD, to the development and writing of the source article.

References
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Placental abruption seen after delivery.
Fetal tracing with placental abruption. Decreased short-term variability, increased baseline uterine tone, uterine hyperstimulation, and worsening variable decelerations.
 
 
 
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