Management is dependent upon whether the fetus is still alive at presentation and upon the wellbeing of the mother. If there is no evidence of placental insufficiency, then the mother may be allowed to labour, with careful fetal and maternal monitoring. Basic fluid resuscitation is essential, and platelet count, coagulation tests and fibrin degradation products should be measured on admission and at regular intervals. Regional analgesic techniques are not contraindicated, but normovolemia and unimpaired coagulation are of paramount importance if they are to be used. Blood should be cross-matched and available. Early artificial rupture of the membranes may reduce the risk of coagulopathy and amniotic fluid embolism.
When the fetus has already died, then vaginal delivery is the technique of choice. Particular attention should be paid to the risk of coagulopathy.
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