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Emergency Medicine

Answer 5
  1.  Stabilize the patient and arrange immediate obstetric consultation. This patient’s vital signs should be stabilized using IV fluids (crystalloid) and, if necessary, blood products (ie, red blood cells, platelets, fresh frozen plasma). Because the patient is at term, the obstetrician also should be notified of the patient’s placental abruption to determine the need for immediate cesarean section. The presentation of placental abruption varies, and management should be individualized based on the gestational age of the fetus, the amount of maternal or fetal compromise, and maternal presentation.6 Continuous fetal and maternal monitoring is necessary for all patients with suspected placental abruption. Laboratory testing should be performed, including hemoglobin/hematocrit, platelet count, fibrin, fibrinogen, fibrin split products, prothrombin time, activated partial thromboplastin time, blood type, and Rh factor. A Foley catheter is placed in patients who are hemodynamically unstable for monitoring urine output to greater than 30 mL/hr. The Kleihauer-Betke test may be positive in patients with severe placental abruption but it is not diagnostic of placental abruption.

    6. Oyelese Y, Ananth CV. Placental abruption. Obstet Gynecol 2006;108:1005–16.

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