Management of Abruptio Placenta After Trauma in the 2nd Trimester

Immediate Stabilization and Assessment

The American College of Obstetricians and Gynecologists recommends establishing large-bore intravenous access immediately upon presentation, with activation of massive transfusion protocol early if significant bleeding is present, and maintaining maternal temperature above 36°C, as clotting factors function poorly below this threshold 1, 2
Baseline laboratory studies, including complete blood count, type and crossmatch for at least 4 units, coagulation panel, fibrinogen level, and platelet count, should be obtained 1

The American College of Obstetricians and Gynecologists recommends proceeding to immediate delivery regardless of gestational age in cases of maternal hemodynamic instability or uncontrolled hemorrhage, with transfusion of blood products in a fixed 1:1:1 ratio and consideration of tranexamic acid administration to reduce blood loss 1, 2
Cesarean delivery is indicated for non-reassuring fetal heart rate patterns that do not resolve with resuscitation, and in the previable period, counseling regarding pregnancy termination for maternal indications should be given due to significant maternal morbidity and mortality risks 1, 3

The American College of Obstetricians and Gynecologists recommends having cell salvage technology available if possible during cesarean delivery, and not attempting forced placental removal if placenta accreta spectrum is encountered, as this triggers profuse hemorrhage 1, 2, 4

Intensive care unit monitoring is recommended for severe cases, with maintenance of a low threshold for reoperation if ongoing bleeding is suspected, and monitoring for complications including renal failure, liver failure, infection, and pulmonary edema 1, 2, 5

The American College of Obstetricians and Gynecologists recommends stabilizing the patient with temporary measures, including abdominal packing if needed, tranexamic acid infusion, and transfusion with locally available products, and arranging immediate transfer to a tertiary care center with multidisciplinary expertise if the patient is hemodynamically stable 1, 3