Materiały źródłowe

• #1 Interventions for treating placental abruption

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8711592/

  Placental abruption is an important cause of maternal and fetal mortality and morbidity. […] To assess the effectiveness and safety of any intervention for the care of women and/or their babies following a diagnosis of placental abruption. […] There is no evidence from trials to show the best way to help pregnant women and babies when there is a placental abruption. […] Additional treatments include pain relief, blood transfusion and monitoring. However, the review found no trials to show which treatments are best. […] The traditional, main principles of clinical care of a woman with placental abruption include: early delivery; adequate blood transfusion; adequate analgesia for pain relief; monitoring of maternal condition; assessment of fetal condition. […] Early delivery is usual. It has been recommended that, if the baby is alive and the gestation not so early as to make fetal survival extremely unlikely, delivery should be by caesarean section.

• #2 Placental abruption – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/placental-abruption/symptoms-causes/syc-20376458

  Placental abruption occurs when the placenta partly or completely separates from the inner wall of the uterus before delivery. This can decrease or block the baby’s supply of oxygen and nutrients and cause heavy bleeding in the mother. […] In some cases, early delivery is needed. […] Left untreated, it endangers both the mother and the baby. […] Seek emergency care if you have signs or symptoms of placental abruption. […] You can’t prevent placental abruption, but you can decrease certain risk factors. For example, don’t smoke or use illegal drugs, such as cocaine. If you have high blood pressure, work with your health care provider to monitor the condition. […] If you’ve had a placental abruption, and you’re planning another pregnancy, talk to your health care provider before you conceive to see if there are ways to reduce the risk of another abruption.

• #3 Treatment of placental abruption following blunt abdominal trauma: a case report

  https://www.jtraumainj.org/journal/view.php?number=1331

  Trauma during pregnancy poses a potentially tragic risk to both the fetus and mother, making its management particularly challenging. […] Although the initial management priorities for injured pregnant women are the same as those for nonpregnant patients, physicians should keep in mind that there are two patients: the fetus and the mother. […] Placental abruption is one of the leading causes of maternal morbidity and perinatal mortality, which occurs in half of major trauma cases. […] Placental abruption is clinically diagnosed and should be suspected when a patient presents with vaginal bleeding or abdominal pain after trauma. […] The optimal length of fetal monitoring following trauma is not clear, though the EAST guidelines recommend a minimum of 6 hours of cardiotocographic monitoring for pregnant women at 20 weeks of gestation. […] Patients with abnormal cardiotocographic monitoring, significant vaginal bleeding, unstable vital signs, and abnormal findings on physical examination, including seat belt signs or abdominal tenderness, should be managed by trauma and obstetric teams with close monitoring.

• #4 Placental abruption – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/placental-abruption/diagnosis-treatment/drc-20376462

  It isn’t possible to reattach a placenta that’s separated from the wall of the uterus. Treatment options for placental abruption depend on the circumstances: […] The baby isn’t close to full term. If the abruption seems mild, your baby’s heart rate is normal and it’s too early for the baby to be born, you might be hospitalized for close monitoring. If the bleeding stops and your baby’s condition is stable, you might be able to rest at home. […] You might be given medication to help your baby’s lungs mature and to protect the baby’s brain, in case early delivery becomes necessary. […] The baby is close to full term. Generally after 34 weeks of pregnancy, if the placental abruption seems minimal, a closely monitored vaginal delivery might be possible. If the abruption worsens or jeopardizes your or your baby’s health, you’ll need an immediate delivery usually by C-section. […] For severe bleeding, you might need a blood transfusion.

• #5 Placental Abruption: Causes, Symptoms, & Treatment

  https://my.clevelandclinic.org/health/diseases/9435-placental-abruption

  Once the placenta has separated from the uterus, it cant be reconnected or repaired. A healthcare provider will recommend treatment based on: […] Generally, the severity of the abruption and gestational age of the fetus are the two most important factors in determining treatment. […] If the fetus isnt close to term: […] If the abruption is severe and the health of you or the fetus is at risk, immediate delivery may be necessary even if the fetus isnt close to term (37 weeks of pregnancy). […] If the fetus is near term: […] If the abruption is severe, delivery may need to happen immediately. If you or the fetus is in danger at any time, the baby will be delivered (typically via emergency C-section). […] A severe abruption is usually a medical emergency because both the fetus and mother are at risk for life-threatening complications. Delivery typically occurs immediately.

• #6 Placental Abruption | Cedars-Sinai

  https://www.cedars-sinai.org/health-library/diseases-and-conditions/p/placental-abruption.html

  There is no treatment to stop placental abruption or reattach the placenta. Your care depends on how much bleeding you have, how far along your pregnancy is, and how healthy your developing baby is. You may be able to have a vaginal delivery. Or you may need a cesarean section delivery if you have severe bleeding or if you or your baby are in danger. You may need a blood transfusion if you lose a lot of blood. […] If you have placental abruption, you may need to deliver your baby early and may need a cesarean section delivery.

• #7 Interventions for treating placental abruption

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8711592/

  Prompt treatment and monitoring of the mother is seen as vital. Much of the blood loss from placental abruption is not revealed, and traditional teaching advises that an abruption of sufficient severity to produce fetal death merits a minimum transfusion of two units of blood to the mother. […] If there is evidence of coagulopathy, expert haematological input may be required. […] The clinical management of placental abruption has to rely on knowledge other than that obtained through randomised clinical trials. […] All aspects of care of women with placental abruption require further study.

• #8 Placental Abruption | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/17041

  The onset of placental abruption is often unexpected, sudden, and intense and requires immediate treatment. […] Upon arrival at the hospital, most women receive intravenous (IV) fluids, supplemental oxygen, and continuous maternal and fetal monitoring while the history and physical are completed. […] Women classified with a class 1 or mild placental abruption, no signs of maternal or fetal distress, and pregnancy less than 37 weeks gestation may be managed conservatively. […] Delivery is necessary if the collected data results in class 2 (moderate) or class 3 (severe) classification and the fetus is viable and alive. […] Careful management of fluids and circulatory volume is important during the surgical procedure. […] Placental abruption is a serious pregnancy complication and is best managed by an interprofessional team of healthcare professionals, including an obstetrician, radiologist, hematologist, obstetric nurse, and intensivist. […] While the condition cannot be prevented, the patient must be encouraged to stop smoking to lower the risk. […] Placental abruption is a life-threatening disorder for both the mother and the fetus. If the bleeding is not arrested, then the lives of the mother and fetus are in jeopardy.

• #9 Abruptio Placentae Treatment & Management: Approach Considerations, Initial Management of Abruptio Placentae, Vaginal Delivery

  https://emedicine.medscape.com/article/252810-treatment

  Inpatient admission for testing and possible delivery is required if abruptio placentae is considered likely. […] 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. […] Begin continuous external fetal monitoring for the fetal heart rate and contractions. The optimal duration of monitoring after trauma has not been established; however, most placental abruptions occur within 6-9 hours of the event. […] 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.

• #10 Placental abruption | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/healthyliving/placental-abruption

  All cases of suspected placental abruption, regardless of severity, should be closely monitored to protect the health and safety of the mother and child. This monitoring is usually done in hospital and should include regular checks of the vital signs of both mother and baby. Treatment depends on the severity of the condition but may include: […] Mild cases, earlier in pregnancy if the baby isnt distressed and if the vaginal bleeding stops, you may be allowed to go home and rest. See your doctor for regular check-ups and if your condition changes. […] Moderate cases, earlier in pregnancy you may need to stay in hospital until the baby is old enough for the doctor to safely induce labour. The doctor may recommend medicines to help the babys lungs mature more quickly prior to birth. […] Mild to moderate cases, later in pregnancy at 36 weeks gestation or more, the doctor may recommend delivery. A vaginal birth may be possible. However, if the placenta separates further from the wall of the uterus during labour, the doctor may switch to immediate delivery via caesarean section. […] Severe cases immediate delivery is the safest treatment. The mother may require supportive care. Heavy maternal bleeding may be treated with a blood transfusion or emergency hysterectomy or both.

• #11

  https://step2.medbullets.com/obstetrics/120370/abruptio-placentae

  Medical […] expectant management with continuous fetal monitoring […] indications […] when both the mother and fetus are stable and the fetus is […] fluid replacement […] indications […] all patients with signs of bleeding […] modalities […] placement of 1-2 large-bore intravenous lines […] administer lactated ringers (LR) to maintain urine output 30 mL/hr […] serum studies […] indications […] all patients with suspected placental abruption […] modalities […] complete blood count (CBC) […] blood type and screen […] with crossmatch if transfusion is likely […] coagulation studies […] liver chemistries […] in patients with suspected preeclampsia or HELLP syndrome […] RhoGAM […] indications […] all Rh(D)-negative mothers with vaginal bleeding if father is Rh(D)-positive or unknown

• #12 Acute placental abruption: Management and long-term prognosis – UpToDate

  https://www.uptodate.com/contents/acute-placental-abruption-management-and-long-term-prognosis

  Acute placental abruption is a significant cause of both maternal morbidity and neonatal morbidity and mortality, particularly when it occurs preterm. Prompt intervention can reduce these risks. This topic will discuss the management of pregnancies complicated by acute abruption. […] Pregnant people 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. Even those with an apparently small abruption who are initially stable may deteriorate rapidly if placental separation progresses or they develop sequelae from potential comorbidities, such as preeclampsia, trauma, or cocaine use. […] The following actions are reasonable initial interventions: Maternal and fetal monitoring […] Initiate continuous fetal heart rate monitoring, since the fetus is at risk of becoming hypoxemic and developing acidosis.

• #13 EM@3AM: Placental Abruption – emDocs

  https://www.emdocs.net/em3am-placental-abruption/

  Placental abruption is defined as the premature separation of the placenta from the uterine wall usually after 20 weeks and prior to delivery. […] The key in managing placental abruption is maternal stabilization, cardiotocographic fetal monitoring, and emergent OB consultation. Continuous maternal/fetal monitoring. Secure IV access with 2 large bore IVs, as these patients may be at risk for hemorrhagic shock, so they may need blood transfusions. RhoGAM administration should be considered if mother is Rh negative. Repletion of coagulation factors should be initiated if labs indicate DIC. Severe abruption should be managed by immediate delivery. […] Consult OBGYN. Observation with fetal monitoring in L&D vs Delivery. In cases of blunt/minor trauma and unclear diagnostics, observation is recommended with electronic fetal monitoring. Optimal duration is unclear, but recommendations include: Women with viable pregnancies after trauma without contractions: 6 hours with cardiotocography after trauma. Women with viable pregnancies after trauma with contractions: 24 hours with cardiotocography. […] Keys in management include maternal stabilization, cardiotocographic fetal monitoring, and emergent OB consultation.

• #14 Treatment of placental abruption following blunt abdominal trauma: a case report

  https://jtraumainj.org/journal/view.php?number=1331

  The optimal length of fetal monitoring following trauma is not clear, though the EAST guidelines recommend a minimum of 6 hours of cardiotocographic monitoring for pregnant women at 20 weeks of gestation. […] Patients with abnormal cardiotocographic monitoring, significant vaginal bleeding, unstable vital signs, and abnormal findings on physical examination, including seat belt signs or abdominal tenderness, should be managed by trauma and obstetric teams with close monitoring.

• #15 Placental Abruption (Abruptio Placentae) – Gynecology and Obstetrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/gynecology-and-obstetrics/antenatal-complications/placental-abruption-abruptio-placentae

  Hospitalization and observation are advised if all of the following are present: Bleeding does not threaten the life of the mother or fetus, The fetal heart rate pattern is reassuring, The pregnancy is preterm. […] This approach ensures that mother and fetus can be closely monitored and, if needed, rapidly treated. Women should be advised to refrain from sexual intercourse. […] Corticosteroids should be considered (to accelerate fetal lung maturity) if gestational age is 34 weeks. Corticosteroids may also be given if all of the following are present: The pregnancy is late preterm (34 to 36 weeks), The mother has not previously received corticosteroids during this pregnancy and has no contraindications, Risk of delivery in the late preterm period is high. […] If bleeding resolves and maternal and fetal status remains stable, ambulation and usually hospital discharge are allowed. If bleeding continues or if status deteriorates, prompt cesarean delivery may be indicated. […] Complications of placental abruption (eg, shock, DIC) are managed with aggressive replacement of blood and blood products.

• #16 Placental Abruption Causes, Symptoms, and Treatments

  https://www.upmc.com/services/womens-health/conditions/placental-abruption

  How Do You Treat Placental Abruption? […] Placental abruption requires immediate treatment. It tends to occur suddenly and intensely, sometimes without much warning. […] Your doctor will consider several factors when determining treatment options, such as your condition, the amount of bleeding, your baby’s heart rate, and your baby’s gestational age. […] Your treatment also may depend on how severe the abruption is, how it affects your baby, and how close your due date is. No treatment prevents the placenta from detaching, and there is no way to reattach it. […] Your doctor may suggest: […] Bed rest Limited activity to reduce bleeding and likelihood of further detachment. […] Blood transfusion If you have lost a lot of blood, you may need a blood transfusion. […] Close monitoring If your doctor considers it safe enough to continue with your pregnancy, you and your baby will be checked often, and you may be able to attempt a vaginal delivery.

• #17 Placenta abruption | Pregnancy Birth and Baby

  https://www.pregnancybirthbaby.org.au/placental-abruption

  Placental abruption is a medical emergency that requires urgent assessment and treatment. […] If your placenta has completely separated, there is nothing your doctor can do to reattach it. It is a medical emergency that is life-threatening to your baby if it is not treated immediately. In most cases, you will need an emergency caesarean to birth your baby safely. Complete placental abruption can also cause severe bleeding that may be life-threatening for you without urgent medical treatment. […] In cases where the placenta has only partially separated from your uterus and you have mild symptoms only, your doctor may recommend close monitoring in hospital. This is especially true if you are less than 37 weeks pregnant. In these cases, the bleeding may resolve on its own. If it worsens, you will be in the safest place for urgent treatment. […] Your doctor will discuss with you the safest course of action depending on your situation.

• #18 Placental abruption | March of Dimes

  https://www.marchofdimes.org/find-support/topics/pregnancy/placental-abruption

  If you need to give birth right away and if there is time, your provider may give you medicines called corticosteroids. These medicines help speed up the development of your baby’s lungs and other organs. […] Treatment depends on how serious the abruption is and how far along you are in your pregnancy. […] If you have a mild abruption at 24 to 34 weeks of pregnancy, you need careful monitoring in the hospital. If tests show that you and your baby are doing well, your provider may give you treatment to try to keep you pregnant for as long as possible. Your provider may want you to stay in the hospital until you give birth. If the bleeding stops, you may be able to go home. […] If you have a moderate to severe abruption, you are in a medical emergency and usually need to give birth right away. Needing to give birth quickly may increase your chances of having a c-section.

• #19 Abruptio Placentae Medication: Tocolytics, Corticosteroids

  https://emedicine.medscape.com/article/252810-medication

  This is the drug of choice for tocolysis in patients with placental abruption. […] 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.

• #20 Abruptio Placentae Medication: Tocolytics, Corticosteroids

  https://emedicine.medscape.com/article/252810-medication

  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 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.

• #21 Take a look at the Recent articles

  https://www.oatext.com/Preterm-placental-abruption-Tocolytic-therapy-regarded-as-a-poor-neonatal-prognostic-factor.php

  A multicenter retrospective study was conducted. […] The number of subjects who received tocolytic therapy was significantly higher in the VPT group as compared with the LPT group. […] Administration of tocolytic agents is a possible factor in a poor neonatal prognosis in preterm placental abruption. […] The most important finding from this investigation is that tocolytic therapy is a factor involved in exacerbation of the neonatal prognosis in preterm placental abruption. […] Based on the results of this investigation, we inferred that the use of the tocolytic agents exacerbated the prognosis of placental abruption, but we could not determine whether repression of labor pain was the cause or the drug was the cause. […] In conclusion, the present study showed that use of tocolytic agents is a possible factor that causes poor neonatal outcomes in preterm placental abruption.

• #22 Placental Abruption (Abruptio Placentae) – Gynecology and Obstetrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/gynecology-and-obstetrics/antenatal-complications/placental-abruption-abruptio-placentae

  Treatment of Placental Abruption […] Sometimes prompt delivery and aggressive hemodynamic supportive measures (eg, in a term pregnancy or for maternal or possible fetal instability) […] […] Prompt cesarean delivery is usually indicated if placental abruption plus any of the following is present: Maternal hemodynamic instability, Nonreassuring fetal heart rate pattern, Term pregnancy (37 weeks); preterm delivery possibly necessary if the mother or fetus is at risk of severe morbidity or mortality. […] Once delivery is deemed necessary, vaginal delivery may be attempted if all of the following are present: The mother is hemodynamically stable, The fetal heart rate pattern is reassuring, Vaginal delivery is not contraindicated (eg, by placenta previa or vasa previa). […] Labor may be carefully induced or augmented (eg, using oxytocin and/or amniotomy). Preparations for postpartum hemorrhage should be made.

• #23 Abruptio Placentae Treatment & Management: Approach Considerations, Initial Management of Abruptio Placentae, Vaginal Delivery

  https://emedicine.medscape.com/article/252810-treatment

  Correct coagulopathy, if present. […] Administer Rh immune globulin if the patient is Rh-negative. […] Begin course of corticosteroids for fetal lung maturity (if the patient is less than 37 weeks gestation and they have not been previously given during pregnancy). […] This is the preferred method of delivery for a fetus that has died secondary to placental abruption. […] 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. […] 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.

• #24

  https://step2.medbullets.com/obstetrics/120370/abruptio-placentae

  modalities […] single intramuscular or intravenous dose […] vaginal delivery […] indications […] fetus is 36 weeks gestation […] no other indications for cesarean delivery […] if the patient is not in active labor […] amniotomy and oxytocin administration […] administer standard delivery medications […] group B streptococcus prophylaxis according to guidelines […] magnesium sulfate for neuroprotection if […] Surgical […] immediate delivery with cesarean delivery […] indications […] non-reassuring fetal status […] hemodynamic instability in the mother […] if fetus is 34-36 weeks gestation […] due to risk of progressive placental separation and maternal/fetal compromise

• #25

• #26 Placenta Problems (Accreta and Abruption) | Doctor

  https://patient.info/doctor/placenta-and-placental-problems

  Placental abruption treatment […] The mother should be resuscitated and stabilised before any decision is made regarding delivery of the baby, regardless of the gestation. Surprisingly, a Cochrane review has found no trials to inform management. Guidance from the Royal College of Obstetricians and Gynaecologists for moderate or severe placental abruption is to follow ABCD of resuscitation: Assess Airway and Breathing: high-flow oxygen. Evaluate Circulation: Intravenous access, FBC, coagulation screen, UE, Kleihauer test, crossmatch four units. Position in the left lateral position tilted and keep the woman warm. Until blood is available, infuse up to 2 litres of warmed crystalloid Hartmann’s solution and/or 1-2 litres of colloid as rapidly as required. With continuing massive haemorrhage and whilst awaiting coagulation studies and haematology advice, up to 4 units of fresh frozen plasma (FFP) and 10 units of cryoprecipitate may be given empirically. Ideally, measure central venous pressure (CVP) and adjust transfusion accordingly. Assess fetus and Decide on Delivery: If the fetus is alive, perform either caesarean section or artificial rupture of the amniotic membranes. Monitor the fetus and switch to caesarean if fetal distress develops. Vaginal delivery is the treatment of choice in the presence of a dead fetus, although if the abruption is massive, caesarean may occasionally be indicated to control haemorrhage. If bleeding has settled and delivery is not imminent, maternal steroids may be indicated in order to promote fetal lung development and reduce the risk of respiratory distress syndrome and intraventricular haemorrhage.

• #27 Management of Fetal Demise Caused by Abruption at Term

  https://exxcellence.org/pearls-of-exxcellence/list-of-pearls/management-of-fetal-demise-caused-by-abruption-at-term/

  In the presence of placental abruption, cesarean delivery has a significant risk of intraoperative hemorrhage due to atony or coagulopathy potentially leading to peripartum hysterectomy. If surgical delivery is necessary, marked thrombocytopenia (platelets less than 50,000/L) or hypofibrinogenemia (fibrinogen less than 100 mg/dL) should be corrected with platelet or cryoprecipitate infusion to mitigate the risk of intraoperative hemorrhage. […] Couvelaire uterus, defined as widespread extravasation of blood into the myometrium and beneath the serosa, may be encountered but is not necessarily an indication for hysterectomy.

• #28 Placental abruption – Wikipedia

  https://en.wikipedia.org/wiki/Placental_abruption

  For small abruption, bed rest may be recommended, while for more significant abruptions or those that occur near term, delivery may be recommended. […] If everything is stable, vaginal delivery may be tried, otherwise cesarean section is recommended. […] In those less than 36 weeks pregnant, corticosteroids may be given to speed development of the baby’s lungs. […] Treatment may require blood transfusion or emergency hysterectomy. […] Treatment depends on the amount of blood loss and the status of the fetus. […] Immediate delivery of the fetus may be indicated if the fetus is mature or if the fetus or mother is in distress. […] Blood volume replacement to maintain blood pressure and blood plasma replacement to maintain fibrinogen levels may be needed. […] Vaginal birth is usually preferred over Caesarean section unless there is fetal distress. […] The mother should be monitored for 7 days for postpartum hemorrhage. […] Excessive bleeding from uterus may necessitate hysterectomy. […] The mother may be given Rhogam if she is Rh negative.

• #29 Placental Abruption: Symptoms, Causes, Treatment, Types, Ultrasound Diagnosis, vs Previa Definition — EZmed

  https://www.ezmedlearning.com/blog/placental-abruption-symptoms-causes-treatment-types

  Provide appropriate analgesia. […] Input from an ICU specialist may be required in very severe cases. […] A vaginal delivery is preferable for a fetus that has demised secondary to placental abruption. […] Cesarean delivery may be required to save both mother and child. […] The type of uterine incision is dependent on the gestational age of the fetus. […] A classical cesarean section (C-section) may be required if the fetus is less than 28 weeks gestation. […] The patient must be closely monitored post-delivery as postpartum hemorrhage may result from uterine atony following intravasation of blood into the myometrium or from an uncorrected coagulopathy.

• #30 Placental abruption (abruptio placentae) | Healthengine Blog

  https://healthinfo.healthengine.com.au/placental-abruption-abruptio-placentae

  Parents will be counseled by a neonatologist about the potential outcomes and treatments. Delivery will need to take place in a centre with adequate neonatal facilities. The decision for conservative management should weigh up the perceived risks for delaying delivery against the risks of premature delivery. […] Management in subsequent pregnancy The risk of placental abruption occurring again in a subsequent pregnancy is increased approximately ten fold. These women are also at increased risk of other adverse pregnancy outcomes including preeclampsia and preterm birth. […] Women in this situation are encouraged to minimise exposure to those predisposing factors that are within our control, particularly cocaine and tobacco use. Prior to the next pregnancy it is also important to have good blood pressure control in those with hypertension. […] It would be reasonable in subsequent pregnancies to increase the frequency of ultrasounds in the second half of the pregnancy to monitor foetal growth. If a mother has a history of two or more prior abruptions, amniocentesis for lung maturity and delivery at 37 weeks gestation may be carried out.

• #31 Can Aspirin Decrease Risk of Placental Abruption and Antepartum Hemorrhage? – The ObG Project

  https://www.obgproject.com/2018/01/19/can-aspirin-decrease-risk-placental-abruption-antepartum-hemorrhage/

  A daily dose of aspirin of greater than 100 mg, initiated at less than 16 weeks of gestation may decrease risk of placental abruption or antepartum hemorrhage […] Based on previous studies and this current meta-analysis, initiating aspirin after 16 weeks will not only have no impact on preeclampsia but may increase risk of abruption or antepartum hemorrhage.

• #32 Comprehensive management of placental abruption: An interprofessional approach

  https://wjarr.com/content/comprehensive-management-placental-abruption-interprofessional-approach

  Placental abruption (PA) is a major obstetric complication characterized by the premature separation of the placenta from the uterine wall, typically occurring between 20 weeks of gestation and delivery. […] Effective management of PA necessitates prompt medical intervention, with treatment strategies tailored to the severity of maternal and fetal distress. […] An interprofessional healthcare team approach is critical, involving obstetricians, anesthesiologists, midwives, radiologists, hematologists, intensivists, and neonatologists to ensure optimal outcomes. […] The prognosis is heavily influenced by the timing of hospital admission, with early recognition and immediate intervention being paramount to reduce the morbidity and mortality associated with this condition.

• #33 What Is Placental Abruption?: Leonardo A. Longoria K., MD: Obstetrician & Gynecologist

  https://www.longoriaobgyn.com/blog/what-is-placental-abruption

  Placental abruption, medically known as abruptio placentae, is a serious complication that can cause heavy bleeding in the mother and endangers the babys life. […] If you have symptoms of placental abruption, seek emergency medical care right away. Medical treatment is essential for getting mother and baby through a placental abruption. […] After a placental abruption, it isnt possible to reattach the placenta to your uterine wall. If your baby isnt near full term, you may need to be hospitalized for monitoring and may be given medications to help your babys lungs and brain in case of early delivery. […] If your pregnancy has progressed to at least 34 weeks, early delivery, possibly by C-section, might be the best treatment for you and your baby.

• #34 Epidemiology, Risk Factors, and Perinatal Outcomes of Placental Abruption—Detailed Annual Data and Clinical Perspectives from Polish Tertiary Center

  https://www.mdpi.com/1660-4601/19/9/5148

  Another direction is implementing the best possible organizational preparation of maternity centers for the quick admission and appropriate treatment of such patients. […] One of the most important matters in this case is time. A prolonged decision-to-delivery interval increases perinatal morbidity and mortality. […] Therefore, there is a substantial need for medical staff training and performing simulations of such challenging situations. […] This provides faster decision-making, brings knowledge and skills up to date, improves teamwork, and builds self-confidence.

• #35 Late Pregnancy Bleeding | AAFP

  https://www.aafp.org/pubs/afp/issues/2007/0415/p1199.html

  Placental abruption is the most common cause of serious vaginal bleeding, occurring in 1 percent of pregnancies. […] Management of abruption may require rapid operative delivery to prevent neonatal morbidity and mortality. […] The initial management of significant bleeding in late pregnancy is similar regardless of the etiology. […] Delay can be fatal to the fetus; 30 percent of perinatal deaths in one case series occurred within two hours of admission. […] Definitive management should never be delayed for ultrasound confirmation because ultrasonography is not reliable in diagnosing abruption. […] A nonreassuring fetal heart tracing necessitates rapid, usually cesarean, delivery. […] A decision-to-delivery interval of 20 minutes or less resulted in improved neonatal outcomes in a case-control study of severe abruption.

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