Management of severe abruptio placentae

The management of severe placental abruption involves:

• admit to hospital by obstetric Flying Squad
• insert Central Venous Pressure line, iv line, urinary catheter
• blood: cross-match 4-6 units, clotting time, FBC, [fibrinogen]
• administer analgesia
• give bloods and fluids as indicated from CVP: try to maintain haematocrit at 30%
• insert indwelling catheter: urine flow should be at least 30ml/hour
• monitor fetal heart sounds with CTG

Most of these cases will either present with a recent IUD and have labour induced, or be delivered by LSCS for fetal distress. When the fetus is obviously dead, vaginal delivery is preferred as the complications of serious coagulation defects are less dangerous than with LSCS. There is a danger that a consumption coagulopathy may develop with hypofibrinogenaemia: if this occurs, give fresh whole blood, FFP or pure fibrinogen. Sometimes excessive fibrinolysis may occur. Also, acute renal failure may occur if there has been extensive haemorrhage.