The diagnosis and management of accidental haemorrhage with associated coagulopathy

An approach to the diagnosis and management of accidental haemorrhage with associated coagulation failure is discussed and outlined. It is stressed that special investigations play a minor role in planning management. The main aim should be to achieve rapid delivery, preferably via the vaginal route. About 50% of these cases are associated with uterine atony and inertia. This is probably due to raised local and circulating levels of fibrin/fibrinogen degradation products (FDP). In such cases uterine activity can be restored by the administration of large intravenous doses of Trasylol (Bayer). Life-endangering complications such as acute respiratory and renal failure should be prevented by prophylactic management and by treatment aimed at rapid delivery. The indications for Caesarean section are outlined. The need for careful assessment prior to discharge of these patients and for re-assessment throughout the puerperium is stressed.