Question of the Week # 453

Your patient is a gravida 1 para 0,  19 year old female at 33 weeks gestation that presents with a complaint of heavy vaginal bleeding and severe abdominal pain for an hour. Her pregnancy has been uneventful, and she is in good health, although she continues to smoke cigarettes, admitting to one pack per day.

Blood pressure is 110/80 with a heart rate of 110. The patient is afebrile, with respirations of 20/minute. Examination reveals a contracted uterus with a closed cervical os. The patient expels a large amount of blood from her closed cervix during the examination. Fetal heart rate monitoring reveals severe late decelerations. What is the best treatment option for this patient?

A. Expectant management with bed resT

B. Terbutaline

C. Oxytocin

D. Magnesium sulfate

E. Caesarean section delivery

8 Responses

  1. e. due to severe late decelerations

  2. E

  3. A

  4. E. Caesarean section delivery

  5. e
    but a little early

  6. E

  7. Placental abruption and fetal distress- emergency c section, probably classic or vertical incision as she is only 33 weeks into the pregnancy!!

  8. this is a case of placental abruption complicated by fetal jeapordy, continuing the pregnancy will be hazardous for both the mother and the fetus so emergency caesarian section is indicated

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