15. EXPECTANT MANAGEMENT
(Preterm fetus)
AIM
Haemodynamically stable with mild bleeding and
no uterine contractions
Close observation vital signs & vaginal bleeding
Correction of anaemia
Steroids for fetal lung maturation
Counseled and prepared for Caeserian section
To prolong pregnancy till Term
16. IMMEDIATE DELIVERY
Caeserian Section /
Hysterotomy
Haemodynamically unstable.
Profuse vaginal bleeding.
After 37 completed weeks of gestation.
If patients has palpable uterine contractions.
SURGEON / ANAESTHETIST
GENERAL ANAESTHESIA
SENIOR
22. SIGNS & SYMPTOMS
Small separation of
the placenta :
Vaginal bleeding
±
Mild pain or discomfort.
Abdominal pain.
Back pain
Vital signs
Stable
Abdomen
Soft/ Tenderness ±
Foetus
uncompromised
23. Large separation of the placenta:
Heavy vaginal bleeding.
Severe pain in the lower abdomen or back.
Hard, tender abdomen.
Shock (tachycardia, fall in BP rapid breathing, and dizziness).
Fetal distress;
Coagulopathy [DIC]) – Thromboplastine from
fetal heart sounds inaudible.
placenta is
released into the mother's circulation causing blood clotting
defects.
Renal cortical necrosis
----
Anurea
24. EXAMINATIOBN
GPE
depends upon Hemorrhage.
Pallor
Pulse
B.P
ABDOMINAL EXAMINATION
Fundal height larger than dates
Hard and tender
Fetal Part and FHS
PELVIC EXAMINATION
Exclude placenta praevia by USG
P/S examination
P/V examination
28. MANAGEMENT
Expectant :
Mild marginal Abruption with stable mother &
Strict maternal & fetal monitoring.
fetus .
Vaginal Delivery:
If degree of separation is limited ,
revealed hemorrhage
After amniotomy & oxytocin infusion short labour is
expected.
Dead fetus
No complications