Clinical obstetrics and gynecology
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Clin Obstet Gynecol · Mar 1985
Abruptio placentae with coagulopathy: a rational basis for management.
Abruptio placentae rarely produces severe maternal complications while the fetus is alive in utero. The advent of fetal death (grade III) indicates a severe form of abruptio placentae and a real risk that an overt coagulopathy might develop (grade IIIB). Overt coagulopathy associated with a live fetus is, however, uncommon. ⋯ Following delivery, the physician should be on the lookout for postpartum hemorrhage, which may necessitate immediate transfusion, the administration of oxytocics, and/or uterine manipulation. Surgical intervention is rarely indicated in such cases. The patient should also be carefully observed over the ensuing days and weeks for the evolution and resolution of complications, such as renal failure, pulmonary insufficiency, and panhypopituitarism.
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Septic shock in obstetric patients can be prevented by recognition of patients at risk and aggressive intervention in the warm-hypotensive phase. These patients must be monitored closely. Rarely will an obstetrical floor be capable of providing adequate monitoring of these patients; therefore, the patient should be transferred to an intensive care unit. Individualize therapy, but do not procrastinate in the surgical removal of the nidus of infection.
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In summary, salient points are as follows: The obstetrician must be aware of the normal physiology of pregnancy and the unique response of the pregnant patient to stress and trauma. Maternal stabilization is paramount in the initial management of trauma. With regard to motor vehicle trauma, the three-point restraint system is superior to lap-belt restraint and should be worn by all pregnant women. ⋯ Fetal demise is not an indication for hysterotomy. Postmortem cesarean section is well supported medicolegally. Elapsed time from maternal death and the gestational age of the fetus are the critical factors affecting perinatal outcome.