Placental abruption – management and delivery

A woman at 37 weeks presents with placental abruption. Ultrasound confirms intrauterine fetal death. Following initial resuscitation she is haemodynamically stable, bleeding is controlled and there is no contraindication to vaginal birth. What is the preferred mode of delivery?

A woman at 35+6 weeks presents with placental abruption. She has received initial resuscitation and is currently haemodynamically stable. CTG demonstrates persistent severe fetal compromise. The cervix is 3 cm dilated and vaginal birth is not imminent. What is the most appropriate next step?

A woman at 30+2 weeks presents with vaginal bleeding and painful uterine contractions. Placental abruption is suspected clinically. Maternal observations are currently stable and CTG is reassuring. The cervix is 2 cm dilated. Which factor would most strongly argue against using tocolysis?

A woman at 38+2 weeks develops a clinically significant placental abruption in established labour. She is being resuscitated and is currently haemodynamically stable. CTG demonstrates persistent profound fetal bradycardia. The cervix is fully dilated, the fetal head is at +2 station in an occipito-anterior position and immediate assisted vaginal birth is considered achievable. What is the most appropriate obstetric strategy?

A woman at 35+2 weeks presents with suspected placental abruption. She has received initial resuscitation. Her blood pressure is 92/58 mmHg with persistent tachycardia. Vaginal bleeding continues. CTG shows recurrent prolonged decelerations. Ultrasound shows a normally situated placenta and no retroplacental collection. Which finding should have the least influence on the decision to expedite delivery?

A woman at 37+4 weeks presents with placental abruption and confirmed intrauterine fetal death. After resuscitation she is haemodynamically stable. Coagulation results are satisfactory, bleeding is not increasing, the fetus is cephalic and there is no independent indication for caesarean birth. Which management principle best minimises additional maternal risk?

A woman at 36+1 weeks presents with suspected placental abruption. She has approximately 500 mL visible bleeding, severe continuous abdominal pain and a tense uterus. Her pulse is 128 beats/min and blood pressure 86/48 mmHg. CTG demonstrates persistent fetal bradycardia. The cervix is 4 cm dilated. Ultrasound shows no retroplacental clot. Which management sequence is most appropriate?

A woman at 38 weeks presents with placental abruption and intrauterine fetal death. After initial resuscitation she is cardiovascularly stable. She has continuing but modest vaginal bleeding. Cervix is 3 cm dilated. Laboratory results show evolving coagulopathy. Which consideration most strongly favours vaginal rather than routine caesarean birth?

A woman at 39 weeks develops a major placental abruption during labour. Resuscitation is underway. CTG demonstrates persistent fetal bradycardia. The cervix is fully dilated and the fetal head is occipito-anterior at +1 station. A technically straightforward assisted vaginal birth is considered immediately achievable. Which principle should determine the route of birth?

A woman at 32+3 weeks is admitted following unexplained APH. Bleeding initially settles, maternal observations remain normal and CTG is reassuring. Six hours later she develops recurrent bleeding, constant abdominal pain, uterine tenderness and a new pathological CTG. Which principle should govern management?

A woman at 37+3 weeks presents with a moderate APH and suspected placental abruption. Maternal observations remain stable after initial assessment. CTG initially shows a normal baseline with preserved variability but subsequently develops persistent fetal bradycardia. The cervix is 5 cm dilated and the fetal head remains high. Which change most importantly alters management from close assessment to immediate delivery?

A woman at 38+6 weeks develops placental abruption during labour. Maternal resuscitation is underway and she is currently cardiovascularly stable. CTG shows persistent profound fetal bradycardia. The cervix is 9 cm dilated, but the fetal head is occipito-posterior at −1 station and immediate vaginal birth is not considered achievable. Which is the most appropriate next step?

Select the single most appropriate immediate management.

Select the single most appropriate immediate management decision.