Abruptio placentae: clinical management in nonacute cases.

One hundred thirty cases of clinically diagnosed abruptio placentae encompassing the wide range of acuity were grouped by gestational age at delivery into previable, preterm, and term divisions for comparison of demographic data, presenting symptoms, delay to delivery, mode of delivery, and delivery indications. Attention was focused on the preterm group of patients to assess the implications of presenting symptoms, the usefulness of ultrasonography, and the safety and efficacy of tocolysis. Cigarette smoking and a previous poor obstetric history were found to be more frequent in the preterm compared to the term abruptio placentae. Ultrasonic visualization of a clot was successful in 25% of the preterm patients but otherwise appeared to have little or no impact on course or management. Tocolysis for the preterm patients appeared to be beneficial in prolonging gestation and did not increase the likelihood of cesarean delivery, hemorrhage, or fetal distress. The cumulative rates of delivery following admission were compared with and without tocolysis, with and without sonographic visualization of a clot, and overall as a function of gestational age at initial hospitalization. Perinatal mortality was 17%. Inpatient management with frequent fetal heart rate monitoring, tocolysis if indicated, and timely use of cesarean delivery are advocated to promote prolongation of the pregnancy and minimized perinatal mortality.