Abruptio Placenta

Question 1

General mgt

Answer 1

!All cases should be admitted!
1. Establish iv line
2. Asses and monitor fetal well being
3. HCT, BGP &Rh, platelets, fibrinogen, PT aPTT

Question 2

Grade 1 AP

Answer 2

Conservative management
●Steroid in < 34 weeks of gestation
●Keep in ward till bleeding subsides
●Tocolysis in < 33 weeks of gestation
●Follow maternal V/S, bleeding, uterine contraction & tenderness, FHB, kick
count, BPP, fetal growth
■Indications for delivery:
Term, IUFD, malformed fetus, NRFHR, advanced labor, excessive bleeding

Question 3

Grade 2-3

Answer 3

1. Asses maternal hemodynamic status, then stabilize the mother
2. Maintain U.O.P> 30 ml/hr & HCT > 30%
3. Platelets (6U) transfusion if thrombocytopenia
4. FFP if fibrinogen < 100mg/dl
   ■ Delivery
   ● Vaginal: Amniotomy & induction with oxytocin
   ● C/d for uncontrolled hemorrhage & other obstetric indications
   ● Hysterectomy; if uncontrolled hemorrhage occurs
   ●Couvelaire uterus—Uterotonic agents, hysterectomy if unresponsive