4.1 It is rare that placental abruption combines with DIC during cesarean section. However, such situation has a ferocious onset, rapid progression and dangerous illness with high mortality rate. Without in time or appropriate treatment, it can endanger the lives of both mothers and infants [1][2][3]. Anesthesia treatment has its particularity, which requires multidisciplinary cooperation and joint consultation to eliminate the causes of DIC, supplement coagulation factors, as well as improve circulation and respiratory function as soon as possible. Consequently, it may contribute to active correction of pathological conditions such as hypovolemia, hypotension, coagulation function, severe anemia, acid-base balance disorder of water and electrolyte, so as to save lives at full steam[3][4].
4.1.1 Departments of Gynecology and Obstetrics, Anesthesia, Operation Room, Blood Bank, Ultrasound, Pediatrics and other departments should work closely together to reflect the good environment of the hospital, the superb first-aid level of relevant departments and the team spirit of medical risk management in the Departments of Gynecology and Obstetrics.
4.1.2 The whole treatment should be standardized and orderly, and the personnel of all parties should be well trained. Obstetricians and gynecologists should timely identify the condition; the operating room should open a green channel, and nurses should provide timely assistance for the surgeons and anesthesiologists (take surgical articles, check blood samples, etc.) after delivery of patients to the operation room; anesthesiologists should be able to complete induced tracheal intubation under general anesthesia in the shortest time; gynecologists and obstetricians should be resolute in decision-making and complete hemostasis of operation rapidly; anesthesiologists should be calm in the process and devote themselves to monitoring, performing blood transfusion and infusion, correcting acid and supplementing calcium, and preventing DIC[5][6].
4.1.3 The key points of first-aid and resuscitation for obstetric massive hemorrhage should be fully in place. It is essential for rapid diagnosis, establishment of effective fast venous and respiratory pathways, rapid stabilization of vital signs, rapid access to blood sources, and uninterrupted continuous support of blood products of blood components in the blood bank. Obstetricians and gynecologists should carry out rapid hemostasis. During the operation, surgeons and nurses should take comprehensive measures to prevent the triangle of death caused by hypothermia, metabolic acidosis and coagulation dysfunction. The whole treatment measures should be in place quickly and accurately to win new life for patients [4][5][6].
4.2 Specifically, the following eight aspects should be accomplished:
4.2.1 Be “fast”, i.e., early detection and diagnosis, green channel establishment for rapid rescue treatment. Early diagnosis and correct treatment are the key to prevent DIC induced by placental abruption.
4.2.2 The general anesthesia with tracheal intubation should be selected without hesitation, which is a safe and fast method, so as to lay a good foundation for the follow-up rescue treatment.
4.2.3 Placental abruption is easy to induce DIC. Cesarean section should be performed as soon as possible to terminate pregnancy. Surgical interventions such as uterine packing, intrauterine balloon compression hemostasis, B-Lynch suture, selective arterial embolization, ligation and hysterectomy when necessary are important steps to improve and rescue DIC caused by placental abruption [7][8][9]. None of the subjects underwent hysterectomy due to timely rescue in the present study.
4.2.4 Focus on the correction of hypovolemia. Light general anesthesia maintains hemodynamic stability and effective tissue perfusion, and protects the main organs such as heart, lung, kidney and brain.
4.2.5 Early transfusion of fresh frozen plasma, cryoprecipitation, erythrocyte and hormone can contribute to improving coagulation function and preventing DIC in placental abruption. Fresh frozen plasma is needed when PT and APTT are prolonged by 1.5 times as much as normal; meanwhile, patients with fibrinogen <80–100 mg/ml, platelet <50×109 /L and Hb <80 g/L require the transfusion of cryoprecipitation, platelet and erythrocyte, respectively[8][9]. Our experience is: In the specific rescue, the most important thing is to take the above measures to intervene according to the intraoperative maternal bleeding, vital signs, etc., do not wait for the test results.
4.2.6 Correction of acid and supplementation of calcium, application of hormones, oxytocin and vasoactive drugs are available to stabilize the intrauterine environment, increase stress and promote uterine contraction.. [8][9]
4.2.7 Pay attention to respiratory management improvement. Mechanical ventilation with small tidal volume and the best PEEP protective pulmonary ventilation strategy can prevent lung injury, improve oxygenation function and correct hypoxemia.
4.2.8 During arteriovenous puncture catheterization, monitoring of vital signs and biochemical indicators are conducive to perioperative diagnosis, rescue and treatment. [10].