Use of beta-adrenergic agents can cause tachycardia and mask the signs of bleeding. Once 36 to 37 weeks of gestation is reached with fetal maturity demonstrated by amniocentesis, the patient is readied for elective double-setup examination. Add 3 drops of maternal blood to one tube and 3 drops of vaginal blood to the other. The maternal blood will turn green yellowish brown after 2 minutes. If fetal red blood cells are present, the solution will turn pink.
Immediate delivery is indicated.
Remember that placenta accreta may complicate placenta previa in women with history of previous C-section. Hemorrhage can necessitate hysterectomy. If placental abruption is mild and the fetus is immature, expectant management may be indicated, with fetal heart rate monitoring and serial laboratory and ultrasound examination. Occasionally a small separation occurs without further problem. These patients have no uterine symptoms.