Critical Care Obstetrics part 33 provides expert clinical guidance throughout on how you can maximize the chances of your patient and her baby surviving trauma. In this stimulating text, internationally recognized experts guide you through the most challenging situations you as an obstetrician are likely to face, enabling you to skillfully:Recognize conditions early-on which might prove life threatening, Implement immediate life-saving treatments in emergency situations, Maximize the survival prospects of both the mother and her fetus | Etiology and Management of Hemorrhage 50 separation 16 . Infants born after abruption have increased rates of cystic periventricular leukomalacia and intraventricular hemorrhage compared to age-matched controls most likely a result of oxygen and nutrient deprivation prior to delivery 17 . The classic signs and symptoms of placental abruption include vaginal bleeding accompanied by uterine tenderness painful tetanic contractions and non-reassuring fetal heart rate patterns. However not all signs may be present simultaneously. Vaginal bleeding may be concealed leading to delays in seeking medical help by the woman as well as in diagnosis by the physician. Abruption can even present as simple unexplained preterm labor. Sonographic evaluation of the placenta will fail to reveal over 50 of abruptions. The appearance of hemorrhage changes over the course of acute hemorrhage to stable hematoma making the diagnosis more challenging 18 . In cases where bleeding is visualized sonographically the likelihood of abruption is very high. A thickened placenta 5cm may also suggest the presence of abruption. Retroplacental hemorrhage confers a worse prognosis for the fetus 18 . The Kleihaur-Betke KB test has not been proven to be clinically useful in the evaluation of abruption. In one study where over 25 placentas with histologic evidence of abruption were analyzed there were no positive maternal KB tests. In the same study there was a 9 false-positive rate 19 . The clinical utility of the KB test is mainly to help formulate the appropriate dosage of Rh immune globulin for the Rh-negative woman. In a major abruption blood extravasates into the myometrium and the uterus becomes woody hard with fetal parts no longer palpable - the Couvelaire uterus. Hemorrhagic shock and coagulopathy may be present. Blood loss may be over 50 of maternal blood volume with abruption severe enough to kill the fetus 20 . Coagulation defects appear to develop rapidly after the occurrence of a severe .
