Obstetrics Manual for Merrygold Hospitals - State Innovations in ...

Risks to the mother and fetus:
I. Maternal risks-hypovolaemic shock, acute renal failure , DIC , PPH{because of
atonic uterus and DIC]
II. Fetal risks-premature delivery {spontaneous and iatrogenic}, fetal anaemia, fetal
distress, IUGR, neurological defects in the surviving infants.
Survival rate depends on severity of abruption, the gestation, birth weight, amount of
concealed haemorrhage.
Assessment and Management:
Assessment
• Blood loss should be assessed [concealed +revealed]: -monitor pulse, blood
pressure, urinary output [urinary catheter is required] ,often central venous
pressure.
• Observe for evidence of clinical shock
• Uterine activity, uterine size [may be increasing due to concealed hmg.]
• Coagulation screen , full blood count and cross-matching of a minimum of units
of blood ;urea and electrolytes may also be helpful
• CTG and USG-to confirm viability of the fetus, to exclude pp [pp may be a
coincidental finding in 10% abruptions]. A large retro placental clot may be
identified on USG though it is not a reliable technique.
Management
• Good venous access through 2 large bore intravenous canula for resuscitation
with blood or plasma expanders. [Avoid use of dextran for fear of anaphylactoid
reactions]
• Involve senior obstetricians, hematologists, and anesthetist in the management of
the case.
One hour later the maternal condition was essentially unchanged from admission .she still
had a borderline tachycardia, blood pressure is satisfactory and the uterus continues to
contract at 3/10 min. and remains tender. CTG shows appropriate beat-to-beat variability
with no decelerations in response to contractions. Coagulation screen shows a reduced
haemoglobin-8.4gm/dl, reduced fibrinogen and increased fibrin degradation products,
borderline prolongation of prothrombin time and partial thromboplastin time. Platelet
count was still normal.
Further monitoring is required, as serious haemostatic problems could result with the
worsening of the coagulation screen. The best way to deal with this problem is to effect
delivery to prevent further blood loss and coagulation failure. Blood product therapy,
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