Placental Abruption @ 35 weeks, best care choices?


#1

For all the OB nurses out there, can you provide me with as much details/info/advice regarding best practice (safest tx.) for 35 week gestational age & chance of mom/baby survival?


#2
One very important item is to deliver at a hospital that has a top notch NICU. No small hospitals. When I first became a nurse (1995) mortality for mom and baby was almost always the outcome. I rec. an OB physician that does (or has done) VBAC`s or vaginal delivery after a c-section. Has this OBGYN handled an abruption before? A top notch anesthesia team with an OR on the OB floor is a must. The anesthesia team should include CRNA`s and physicians to have good coverage and help. A hospital with a very high delivery rate is generally not the best place to work (or deliver) for high risk deliveries.   The last hospital I worked at was a midsize hospital that had all these elements. I was there for about 9 years and we had over 10 abruptions during that time. Mainly with the same OBGYN who lost only one mother. Otherwise excellent outcomes. We had one abruption where the baby did not make it and it was over 35 weeks. However this was due to a physician who did no high risk pregnancies and was borderline incompetent. I am not an L and D nurse so I don`t now exact interventions. DIC (in the mother) is a common high risk for abruptions. The NICU should have a resuscitation team ready at the bedside. If it is unlikely that a small rural hospital will have a good outcome with any delivery this risky. ONE of the most important details is that everyone MUST BE ABLE TO WORK TOGETHER!  At this hospital any OBGYN, OB nurse, CRNA, Midwife, tech, NICU nurse and NICU doctor and would help. I hope this helps you.

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