Treatment :

Prehospital Care :

Provide emergency care at the advanced life support (ALS) level to all patients with suspected placental abruption. This care includes the following:

• Continuous monitoring of vital signs
• Continuous high-flow supplemental oxygen
• One or 2 large-bore IV lines with normal saline (NS) or lactated Ringer (LR) solution
• Monitoring amount of vaginal bleeding
• Monitoring of fetal heart
• Treatment of hemorrhagic shock, if needed

Emergency Department Care :

ED care depends on stage of gestation and severity of symptoms.

• Closely observe the patient.
• Administer supplemental oxygen.
• Continuous fetal monitoring.
• Administer IV fluids.
• Perform aggressive fluid resuscitation to maintain adequate perfusion, if needed.
• Monitor vital signs and urine output.
• Crossmatch 4 units of packed red blood cells. Transfuse, if necessary.
• Perform amniotomy to decrease intrauterine pressure, extravasation of blood into the myometrium, and entry of thromboplastic substances into the circulation.
• Immediately deliver the fetus by cesarean delivery if the mother or fetus becomes unstable.
• Treatment of coagulopathy or disseminated intravascular coagulation (DIC) may be necessary. Some degree of coagulopathy occurs in about 30% of severe cases of placental abruption. The best treatment for DIC as a complication of placental abruption is immediate delivery.

Consultations :

Consult an obstetrician as soon as possible.