title: Conservative management of placental abruption complicated by severe clotting disorders.
abstract: Placental abruption resulting in fetal death may seriously affect maternal health, especially when clotting disorders arise. The prevailing view is that the clotting system will only normalize after the uterus has been evacuated and therefore prompt delivery, often by induction of labor, is advocated. Over a 3-year period, 16 cases (0.35%) of intra-uterine fetal death due to placental abruption occurred at Leiden University Hospital. Five cases were complicated by severe clotting disorders. All women delivered vaginally. No maternal deaths occurred. In contrast to most authors, we present data showing that in four out of five cases the clotting system started to normalize before the uterus was emptied. We suggest that an expectant approach until recovery of the coagulopathy is safer than aiming at a quick delivery. After stabilization of the clotting disorder, one may then consider evacuation of the uterus, if need be by induction of labor.
authors.affiliation: Department of Obstetrics, University Hospital, Leiden, The Netherlands.
authors.forename: F C
authors.initials: FC
authors.lastname: Twaalfhoven
authors.forename: J
authors.initials: J
authors.lastname: van Roosmalen
authors.forename: E
authors.initials: E
authors.lastname: Briët
authors.forename: J B
authors.initials: JB
authors.lastname: Gravenhorst
mesh_terms: D000037:Abruptio Placentae / Q000097:blood* / Q000150:complications / Q000628:therapy*; D000328:Adult; D001778:Blood Coagulation Disorders / Q000150:complications*; D016913:Blood Component Transfusion; D002585:Cesarean Section; D005260:Female; D005313:Fetal Death / Q000209:etiology; D006801:Humans; D010121:Oxytocin / Q000627:therapeutic use; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000209:etiology; D011250:Pregnancy Complications, Hematologic; D011263:Pregnancy Trimester, Third; D011453:Prostaglandins / Q000627:therapeutic use; D014592:Uterine Hemorrhage / Q000209:etiology
chemical_list: D011453:Prostaglandins; D010121:Oxytocin