BCoagulopathy

(1) Blood is transfused to replace blood loss.

(2) Clotting factors may be replaced using cryoprecipitate or fresh-frozen plasma. One unit of fresh-frozen plasma increases fibrinogen by 10 mg/dL. Cryoprecipitate contains 250 mg fibrinogen/unit; 4 gm (15-20 U) is an effective dose.

(3) Platelet transfusion is indicated if the platelet count is less than 50,000/mcL. One unit of platelets raises the platelet count 5000-10,000/mcL; 4 to 6 U is the smallest useful dose.

c. Oxygen should be administered and urine output monitored with a Foley catheter.

d. Vaginal delivery is expedited in all but the mildest cases once the mother has been stabilized. Amniotomy and oxytocin (Pitocin) augmentation may be used. Cesarean section is indicated for fetal distress, severe abruption, or failed trial of labor.

III. Placenta previa occurs when any part of the placenta implants in the lower uterine segment. It is associated with a risk of serious maternal hemorrhage. Placenta previa occurs in 1 in 200 pregnancies. Ninety percent of placenta previas diagnosed in the second trimester resolve spontaneously.

A. Total placenta previa occurs when the internal cervical os is completely covered by placenta.

B. Partial placenta previa occurs when part of the cervical os is covered by placenta.

C. Marginal placenta previa occurs when the placental edge is located within 2 cm of the cervical os.

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