Modern treatment of abruptio placentae.

Abruptio placentae, in its severe form, causes the most hazardous type of third trimester bleeding. The severe grade may be accompanied by systemic effects, some of which are potentially lethal. A knowledge of these, as well as a system of grading the severity in terms of maternal risk, is essential to an understanding of therapy. Cases should be graded in severity from I to III on the basis of clinical factors. A delay in delivery, in Grade III, may result in an increased incidence of serious maternal complications. In Grade II, immediate cesarean section has reduced the fetal mortality rate. IN MANAGING GRADE III PREMATURE SEPARATION OF THE PLACENTA, THE FOLLOWING STEPS SHOULD BE CARRIED OUT: (1) Laboratory study, including blood cross-matching and determination of plasma fibrinogen; (2) vaginal examination to confirm the diagnosis and to rupture of the membranes; (3) indicated therapy of systemic effects with fresh whole blood and fibrinogen, before considering any operative delivery; (4) election of a mode of delivery which will terminate the pregnancy in less than about six hours after onset of separation; this will frequently be cesarean section; (5) careful attention to postpartum care to avoid shock and renal failure. In Grade II, the same principles of therapy obtain. If the fetal heart tones are present, however, and vaginal delivery is not imminent, immediate cesarean section is justified. Complete conservatism, with vaginal delivery, is recommended in Grade I.