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STABLE SHOCK/Anemia
Active * Expectative *
Management Management
2
Failed Success
NOTE :
If one of those conditions are not fulfilled then CS delivery should
be done promptly.
Caesarian Section
Indicated in :
- Primigravide
- Placenta previa totalis
- The bleeding is still progressive after the
amniotomy is done.
- Cervical dilatation is less than 5 cm when
IE under Double Setup is done.
- There is contraindication to vaginal delivery
Expectant management
Indication :
- preterm pregnancy or non-viable baby(< 36 weeks or <
2500 grams)
- not in labor
- normal or moderate bleeding with the tendency to
minimal
- mother condition is well/stable
- Fetal is alive without fetal distress
Including :
- Bed rest with close observation to bleeding, fetal monitor,
and maternal condition.
- improve maternal condition and provide blood
transfusion
- Tocolytics and corticosteroid
- USG to determine the localization of placenta
- mobilization after 72 hours and there is not bleeding
Abruptio Placenta
Open* Closed* 2
Active * Caesarean
Management Sectio
Expectant *
Management(72 h)
1
Success Failed
Vaginal Delivery
Wait until Full term
With closed observation
to recurrent bleeding,
Fetal distress, or poor
Maternal condition.
Open and Closed bleeding
Clinical manifestation of open hemorrhage :
- Uterine pain is not too severe.
- Maternal general condition is relevant to the level of
bleeding.
- Fetal condition is not too bad
Clinical manifestation of closed hemorrhage :
- There is mild or minimal bleeding.
- Usually, maternal general condition is very bad
and it is not relevant to the level of bleeding.
- Fetal condition is poor or death.
- Uterine pain is severe and abdominal muscle is very
distended.
Expectative Management
Especially in a preterm labor( <36 weeks of gestation or < 2500
grams in weight) and no signs of fetal distress. This, should be
continued with close observation on fetal and maternal condition.
Including :
- Bed rest
- IVFD RL
- Provide 2 bags of fresh blood
- Urine catheterization
- Corticosteroid
- observation of maternal condition
- fetal heart monitor
If in the observation :
- Bleeding is still permanently or progressively
- clinical manifestation more clearly, or
- fetal distress happens
GO TO THE ACTIVE MANAGEMENT
Active Management
Especially in moderate to severe abruptio
placenta, in a full term pregnancy or if the
expectative management fails.
Including :
- amniotomy
- oxitocyn to induced labor
* The delivery in active management is immediate
per vaginam but if the delivery is not done within 6
hours since clinical manifestation happens than
SC should be considered.
1 (Foot Note)
Indication for vaginal delivery :
- Maternal general condition is stable
with minimal bleeding.
- There is no sign of fetal distress
- After amniotomy is done, the bleeding
tends to minimal or stop.
- The delivery should be done in 6 hours
since the clinical symptoms appeared.
2 (Foot Note)
Indication to Caesarean Section :
- There is sign of fetal distress
- Maternal condition is unstable
- The bleeding tends to progress or
permanently even after the amniotomy.
- After 6 hours since the clinical findings
and the delivery is not done yet.
ABRUPTIO PLACENTA
No Sign of
Fetal distress Fetal Distress/Death
1 2
Wait until Full term
With observation to
Recurrent bleeding or Vaginal Caesaren
Fetal distress, or Delivery Sectio *
Maternal shock
THANK
YOU