Placental abruption: Management
- Yinka Oyelese, MD
Yinka Oyelese, MD
- Atlantic Health System
- Morristown, NJ
- Cande V Ananth, PhD, MPH
Cande V Ananth, PhD, MPH
- Virgil G Damon Professor
- Department of Obstetrics and Gynecology
- College of Physicians and Surgeons
- Columbia University
This topic will discuss the management of pregnancies complicated by placental abruption. The clinical features, diagnosis, and potential consequences of abruption are reviewed separately. (See "Placental abruption: Clinical features and diagnosis".)
INITIAL APPROACH FOR ALL PATIENTS
Pregnant women with symptoms of abruption should be evaluated promptly on a labor and delivery unit to establish the diagnosis, assess maternal and fetal status, and initiate appropriate management. Patients who have an apparently small abruption and are initially stable may deteriorate rapidly if placental separation progresses. They may also deteriorate from sequelae of potential comorbidities, such as preeclampsia, cocaine use, or trauma.
The following actions are reasonable initial interventions:
●Initiate continuous fetal heart rate monitoring, since the fetus is at risk of becoming hypoxemic and developing acidosis.
●Secure intravenous access. Place one wide-bore intravenous line; two if the patient presents with signs of moderate or severe abruption, such as moderate to heavy bleeding, hypotension, tachysystole, uterine hypertonicity and tenderness, coagulopathy, or an abnormal fetal heart rate. Administer crystalloid, preferably Lactated Ringer's, to maintain urine output above 30 mL/hour.
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- INITIAL APPROACH FOR ALL PATIENTS
- SUBSEQUENT MANAGEMENT BASED ON THE CLINICAL SETTING
- Dead fetus
- - Unstable mother
- - Stable mother
- Live fetus
- - Nonreassuring fetal status
- - Reassuring fetal status
- Unstable mother
- Stable mother
- - Less than 34 weeks of gestation
- - 34 to 36 weeks of gestation
- - 36 weeks to term gestation
- COUVELAIRE UTERUS
- POSTPARTUM CARE
- MANAGEMENT OF FUTURE PREGNANCIES
- Recurrence risk
- Other risks
- Antenatal fetal surveillance
- Timing of delivery
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS