Abruptio Placenta

[rehman_naveed]

Hi Everybody, Greetings from Canada

I have a quick question, in case of mom presented with severe abruption placenta, can the baby present with severe anemia? will you arrange O-ve blood ahead before delivery or standby?

Thnaks

[Stefan Johansson]

Hello in Canada!

If time allows and circumstances looks complicated / bad; we def would 1) prepare for a UVC, 2) prepare syringes with sodium chloride bolus  and 3) order O- blood to the resusc room.

Better safe than sorry!

I would argue that the volume may be more important than the erytrocytes, but I think the "jury is out" and that other people argue differently. Let's see what others respond!

 

[tarek]

If you from the history that there is antepartum hemorrhage and you have the time to arrange O -ve PRBCs

It will be more superior than NS

If the baby deliverd and resuscitation was required and O- ve blood not there you will give 10 ml/ kg NS over 5-10 minutes 

In side nicu after stabilization of the baby you can arrange for cross matched PRBCs if the baby us really anaemic

[rehman_naveed]

Thanks Stefan and tarek

let me frame this question in a different way. 

In abruptio placenta the blood lost is fetal blood or maternal blood?

 Thanks 

Naveed

[tarek]

The placental circulation brings into close relationship 2 curculation systems: the maternal and the fetal

in severe abruptio

the mother will present with shock and fetus may die

detection of fetal blood in a maternal bleeding is worrisome

 The clinical manifestations and prognosis depends on the amount of fetal blood and the rapidity with which it occurs

see the attached study

25-30.pdf

[rehman_naveed]

Thanks terek for reference. What is not mentioned in study how they excluded feto maternal hemorrhage. May be that is contributing to KB positive test. It is highly unlikely that abruptio fetal blood is lost. Fetus either die or present with severe shock/acidosis secondary impaired exchange of nutrition and acids across placenta but anemia is not likely unless it is feto maternal hemorrhage.

Naveed

[bimalc]

On 11/24/2018 at 9:36 AM, rehman_naveed said:

Thanks terek for reference. What is not mentioned in study how they excluded feto maternal hemorrhage. May be that is contributing to KB positive test. It is highly unlikely that abruptio fetal blood is lost. Fetus either die or present with severe shock/acidosis secondary impaired exchange of nutrition and acids across placenta but anemia is not likely unless it is feto maternal hemorrhage.

Naveed

The issue is that in most resuscitation (at least in my experience) you cannot be confident which is the case at the moment that you are handed a grey and lifeless baby.  You are forced to proceed with full resuscitation and if you need volume and O- blood is available, given the alternatives, it seems reasonable to push some blood (of course, if you need volume and appropriate blood isn't available push saline as Stefan suggested - in the acute phase if you're in that much trouble you probably just need some preload while you try to get the heart going again)