Retrieval Medicine (Oxford Specialist Handbooks) by Charlotte Evans Anne Creaton Marcus Kennedy and Terry Martin

Author:Charlotte Evans, Anne Creaton, Marcus Kennedy and Terry Martin
Language: eng
Format: azw3
Publisher: OUP Oxford
Published: 2016-11-17T05:00:00+00:00

Subsequent management

• If not already done, administer corticosteroids, and take blood for haemoglobin, and group and crossmatch.

• Resume cardiotocography.

• Ascertain if there is a recent ultrasound report detailing the location of the placenta and, unless the degree of bleeding is such that immediate delivery is required, arrange an urgent ultrasound to localize the placenta, and evaluate fetal growth and well-being.

• A Kleihauer test should be performed to determine the presence and quantity of feto-maternal haemorrhage, as may occur with an abruption.

• Anti-D immunoglobulin should be administered to all Rh-negative women, with the dose modified depending on the result of the Kleihauer test.

• If placenta/vasa praevia and lower genital tract bleeding can be excluded, the presumptive diagnosis is placental abruption, and once the pregnancy reaches 37 weeks, providing there is no other contraindication, delivery will usually be effected.

• In most cases of low-lying placenta, delivery will be by Caesarean section, and consideration should be given preoperatively to the possibility of placenta accreta/percreta especially in women who have had a previous Caesarean birth.

• Delivery is commonly required prior to 37 weeks due to concerns about fetal well-being, or after repeated substantial bleeds associated with a low-lying placenta.

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