Placental Abruption 

 

 

Considerations

 

  • Emergency with high maternal & fetal morbidity/mortality

  • Pregnancy considerations (difficult intubation, aspiration, ↓ time to desaturation, aortocaval compression, 2 patients)

  • Need to determine severity of abruption, amount of hemorrhage & degree of maternal/fetal compromise

  • Comorbidities associated with abruption:

    • Hypertension, pregnancy-induced hypertension, smoking, cocaine, EtOH, advanced maternal age, multiparity, multiple gestation, trauma, premature rupture of membranes, polyhydramnios

  • Mobilization of resources & personnel:

    • Multidisciplinary (2nd Anesthesiologist/anesthetic assistant, obstetrician, pediatrician, hematology/blood bank, ICU)

    • Resources (rapid infusers, blood products/massive transfusion protocol, uterotonics/tocolytics, invasive monitoring, tranexamic acid, cell salvage, rFVIIa)

 

 

Management 

 

  • Urgency of delivery depends on severity of abruption 

  • Establish large bore IV access, draw blood work, ensure close maternal & fetal monitoring, cross match & prepare for massive hemorrhage

  • Labor & vaginal delivery with epidural is safe for partial abruption without significant hypovolemia or coagulopathy 

  • Urgent cesarean for more significant abruption with maternal or fetal compromise:

    • GA with RSI (ketamine & succinylcholine) if hemodynamic compromise

    • Aggressive volume resuscitation

    • Invasive monitors 

  • Control & treat hemorrhage:

    • Massive transfusion protocol, rapid infuser, avoid acidosis/hypothermia/coagulopathy

    • Use of uterotonics

    • Blood conservation techniques: tranexamic acid, cell saver, rFVIIa, surgical technique

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