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.
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.
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.
Magnesium sulfate
This is the drug of choice for tocolysis in patients with placental abruption.
Corticosteroids
Class Summary
Corticosteroids are given when preterm delivery (less than 37 weeks) is expected. They are associated with a decreased risk of neonatal respiratory distress, necrotizing enterocolitis, and intracranial hemorrhage. The two most used medications are betamethasone and dexamethasone. While they should be considered if the patient is preterm with an abruption, delivery should not be delayed for their administration.
-
Placental abruption seen after delivery.
-
Fetal tracing with placental abruption. Decreased short-term variability, increased baseline uterine tone, uterine hyperstimulation, and worsening variable decelerations.
