Info

Medication or Drug Class

Dosage

Description

Rationale

Magnesium sulfate

4-6 g IV loading dose, 1-4 g/hr IV maintenance

Anticonvulsant

Effective tocolytic; relaxes the uterus, slowing the abruption

Oxytocin (Pitocin)

10-20 U in 500-1000 mL of IV fluid

Oxytocic

Assists the uterus to contract after delivery to prevent hemorrhage

Independent

During prenatal visits, explain the risk factors and the relationship of alcohol and substance abuse to the condition. Teach the patient to report any signs of abruption, such as cramping and bleeding. If the patient develops abruptio placentae and a vaginal delivery is chosen as the treatment option, the mother may not receive analgesics because of the fetus's prematurity; regional anesthesia may be considered. The labor, therefore, may be more painful than most mothers experience; provide support during labor. Keep the patient and the significant others informed of the progress of labor, as well as the condition of the mother and fetus. Monitor the fetal heart rate for repetitive late decelerations, decreased variability, and bradycardia. If noted, turn the patient on her left side, apply oxygen, increase the rate of the IV and notify the physician immediately.

Offer as many choices as possible to increase the patient's sense of control. Reassure the significant others that both the fetus and the mother are being monitored for complications and that surgical intervention may be indicated. Provide the patient and family with an honest commentary about the risks. Discuss the possibility of an emergency cesarean section or the delivery of a premature infant. Answer the patient's questions honestly about the risk of a neonatal death. If the fetus does not survive, support the patient and listen to her feelings about the loss.

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