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. The advent of an overt coagulopathy should be viewed as ominous. Treatment of
abruptio placentae with overt coagulopathy should be directed toward obtaining a rapid and atraumatic vaginal delivery. Once delivery has occurred, spontaneous reversal of the coagulopathy can be anticipated. In the opinion of one of the authors (G.S.), the advent of severe
consumption coagulopathy and/or
uterine inertia is an indication for intravenous
therapy with
aprotinin. It has been shown that such
therapy will limit
DIC, reverse fibrinolysis, reawaken uterine activity, and lead to rapid vaginal delivery within 6-8 hours.
Aprotinin is not commercially available for clinical use in the United States. Prolongation of the abruption-delivery interval will worsen maternal prognosis. Accordingly, the advent of
uterine inertia prior to complete cervical dilatation is an indication for immediate
cesarean section in circumstances where
aprotinin is not available. 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.