Kleihauer betke placental abruption first trimester

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What is the status of the fetus at the time of the mother's cardiac arrest? Recognition of gestational age is critically important. Survival is unlikely for the infant born at a gestational age less than approximately 23 to 24 weeks and a birth weight less than g 1 lb, 2 oz. Do not lose sight of the goal of this dramatic event: a live, neurologically intact infant and mother. The potential for reasonable outcome should be carefully considered before pushing the margins of survivability.

Even if the fetus is unlikely to survive gestational age of 20 to 23 weeks , the mother may benefit from emergency hysterotomy. Setting and personnel Are appropriate equipment and supplies available? Are skilled neonatal or pediatric support personnel available to care for the infant, especially if it is not full term? Are obstetric personnel immediately available to support the mother after delivery? In both in-hospital and out-of-hospital settings, is there adequate staff and equipment support?

In out-of-hospital settings, is bystander support available? Equipment should be regularly rechecked. Effective communication is key. The whole team should have periodic drills. Differential diagnosis Consider whether persistent arrest is because of an immediately reversible problem e.

If it is, the problem should be corrected, and there may be no need for hysterotomy. Consider whether persistent arrest is because of a fatal, untreatable problem e. If it is, an immediate hysterotomy may save the fetus. This also raises the problem of quickly reversible issues improperly mixed medication [e. If the cause is reversible or subacute, then timely management of problems may obviate the need for emergency hysterotomy.

In blunt trauma, the most common cause of fetal death is maternal death. The lap belt should be placed as low as possible under the protuberant portion of the abdomen and the shoulder belt positioned off to the side of the uterus, between the breasts and over the midportion of the clavicle Figure 4. Placement of the lap belt over the dome of the uterus significantly increases pressure transmission to the uterus and has been associated with significant uterine and fetal injury.

There should not be excessive slack in either belt, and both the lap and shoulder restraints should be applied as snugly as comfort will allow. Air bag deployment reduces injury to pregnant women and does not increase the risk of adverse pregnancy outcomes. A patient who presents with a vague or inconsistent history of trauma should raise suspicion for battering. Women with a history of cesarean delivery who present with placenta previa or a placenta located at the site of the previous incision should be evaluated for potential placenta accreta with color-flow Doppler by an experienced sonographer 26 Figure 4.

The risks of placenta accreta, increta, and percreta increase with the number of previous cesarean deliveries. The rightsholder did not grant rights to reproduce this item in electronic media. For the missing item, see the original print version of this publication. Placental Abruption Placental abruption is the separation of the placenta from the uterine wall before delivery.

Abruption is the most common cause of serious vaginal bleeding, occurring in 1 percent of pregnancies. Neonatal death occurs in 10 to 30 percent of cases. Preterm labor, growth restriction, and intrauterine fetal death also may occur. Bleeding may be completely or partially concealed or may be bright, dark, or intermixed with amniotic fluid.

Disseminated intravascular coagulation may result from the release of thromboplastin into the maternal circulation with placental separation. A Cochrane review found no randomized controlled trials assessing interventions for placental abruption that met inclusion criteria.

Delay can be fatal to the fetus; 30 percent of perinatal deaths in one case series occurred within two hours of admission.

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