Treatment of Placental Abruption with Intrauterine Fetal Death

Clinical Scenario

This protocol addresses placental abruption in the setting of intrauterine fetal death (IUFD). Even when heavy vaginal bleeding is not the presenting feature, abruption associated with fetal death is classified as severe and carries an elevated risk of maternal morbidity.

Abruption associated with intrauterine fetal death should be categorised as a severe abruption — maternal risk remains significant regardless of the degree of visible haemorrhage.

Delivery Approach

The preferred delivery strategy follows a non-operative route to reduce the risk of operative bleeding, which may be worsened by coagulopathy in this setting. The complete protocol specifies the method of delivery and addresses considerations for patients with prior uterine surgery — access the full regimen below.

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References

DOI: 10.1016/j.ajog.2022.06.059

IUFD. Although some of these cases may not manifest with heavy vaginal bleeding, abruption associated with fetal death should be categorized as severe abruptions that may also be associated with an increased risk of maternal morbidity.

Vaginal delivery is the preferred mode of delivery as it avoids the risks of operative bleeding that may be exacerbated by coagulopathy and the potential sequelae associated with multiple repeat cesarean deliveries.

Induction of labor in patients with 1 previous cesarean delivery via low transverse hysterotomy may be considered.

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