Delivery

Termination of pregnancy and timing of delivery remain a matter of debate (yisse£.and..Walle.Db.urg 1995 ). Fear of maternal complications has driven the common rule of expeditious delivery (Sibai..efa/ 1993). Concurrent eclampsia, fetal distress, abruptio placentae, DIC, subcapsular liver hematoma, or progression to the class 1

syndrome (platelet count below 50 000/mm3) should remain absolute indications for delivery (Table...,?). Vaginal delivery, although preferred, is less common than Cesarean section because of fetal distress and an immature cervix. Cesarean section was performed in 42 to 79 per cent of cases reported by Sibai et al. (1993) and Visser and Wallenburg (1995). Incision should be made in the midline to enable better evacuation of intra-abdominal or liver subcapsular hematomas.

Platelet transfusions and fresh frozen plasma may be given just before incision to correct coagulation disorders and severe thrombocytopenia (< 30 000/mm 3). Blood products and platelet transfusions can be continued during delivery and in the postpartum period because of diffuse oozing or intra-abdominal hematoma. Adequate control of hypertension should complete the treatment.

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