28 year old woman with vaginal bleeding

Grace Huang on May 26, 2013

28 year old G1P0 at 37 weeks presents to the emergency department with painful vaginal bleeding after a motor vehicle accident. Patient has a history of preeclampsia but the pregnancy has been otherwise uneventful. 

  • Temp  37 C
  • HR  100
  • BP  150/100
  • RR  16
  • O2  99% on Room Air

On physical exam, you note blood in the vaginal vault and fundal tenderness. Fetal heart tones are 160. 

Which of the following must be seen to confirm a diagnosis of placenta abruptia?

Expand all answers
Ultrasound confirmation of placental abruption
Ultrasound is not sensitive because fresh blood clot has the same texture as the placenta on ultrasound.


External vaginal bleeding
Blood may be trapped behind the placenta and not be seen externally.


Abnormal fetal heart tones
Mild abruption will not show any fetal heart tone abnormalities. Fetal heart tone abnormalities associated with moderate and severe abruption include tachycardia, decreased variability, and late decelerations.


Couvelaire uterus
Couvelaire uterus is seen when blood seeps into the uterine muscle, causing the uterus to look discolored/bruised.


Kleihauer-Betke test
This test distinguishes between maternal and fetal hemoglobin. Fetal to maternal hemorrhage can occur as a result of placenta abruptia.


None of the above
Diagnosis is based on overall clinical picture.


Which of the following is not a known risk factor for placental abruption?

Select all that apply
Expand all answers
Hypertension
Cocaine use
Trauma
Lupus
Cigarette smoking
Herpes

Which of the following is true regarding the treatment of placenta abruptia?

Expand all answers
Emergent cervical cerclage is effective in the first 4 hours
If the fetus is dead, it should be delivered via c-section
If gestational age >34 weeks, then delivery is the best management option
Because the fetus is viable outside the mother at this age, the risks to the fetus outweigh the benefits and delivery is the goal


Placenta abruptia only needs to be treated if there is external bleeding

Patient's bleeding is controlled and she is currently hemodynamically stable. Therefore, you decide to proceed with vaginal delivery. You perform an amniotomy and induce her with misoprostol. 

DIC is a potential complication of placenta abruptia, especially in severe cases leading to fetal loss. Which lab values are most suggestive of DIC?

Expand all answers
Decreased fibrinogen, Increased PT, increased PTT, increased BT
Increased fibrinogen, increased PT, increased PTT, decreased D-dimers
decreased PT, decreased PTT, decreased fibrinogen, increased BT
increased D-dimer, increased fibrinogen, increased PT, increased PTT

28 year old G1P0 at 37 weeks presents to the emergency department with painful vaginal bleeding after a motor vehicle accident. Patient has a history of preeclampsia but the pregnancy has been otherwise uneventful. 

  • Temp  37 C
  • HR  100
  • BP  150/100
  • RR  16
  • O2  99% on Room Air

On physical exam, you note blood in the vaginal vault and fundal tenderness. Fetal heart tones are 160. 

Which of the following must be seen to confirm a diagnosis of placenta abruptia?

Expand all answers
Ultrasound confirmation of placental abruption
Ultrasound is not sensitive because fresh blood clot has the same texture as the placenta on ultrasound.


External vaginal bleeding
Blood may be trapped behind the placenta and not be seen externally.


Abnormal fetal heart tones
Mild abruption will not show any fetal heart tone abnormalities. Fetal heart tone abnormalities associated with moderate and severe abruption include tachycardia, decreased variability, and late decelerations.


Couvelaire uterus
Couvelaire uterus is seen when blood seeps into the uterine muscle, causing the uterus to look discolored/bruised.


Kleihauer-Betke test
This test distinguishes between maternal and fetal hemoglobin. Fetal to maternal hemorrhage can occur as a result of placenta abruptia.


None of the above
Diagnosis is based on overall clinical picture.


Which of the following is not a known risk factor for placental abruption?

Select all that apply
Expand all answers
Hypertension
Cocaine use
Trauma
Lupus
Cigarette smoking
Herpes

Which of the following is true regarding the treatment of placenta abruptia?

Expand all answers
Emergent cervical cerclage is effective in the first 4 hours
If the fetus is dead, it should be delivered via c-section
If gestational age >34 weeks, then delivery is the best management option
Because the fetus is viable outside the mother at this age, the risks to the fetus outweigh the benefits and delivery is the goal


Placenta abruptia only needs to be treated if there is external bleeding

Patient's bleeding is controlled and she is currently hemodynamically stable. Therefore, you decide to proceed with vaginal delivery. You perform an amniotomy and induce her with misoprostol. 

DIC is a potential complication of placenta abruptia, especially in severe cases leading to fetal loss. Which lab values are most suggestive of DIC?

Expand all answers
Decreased fibrinogen, Increased PT, increased PTT, increased BT
Increased fibrinogen, increased PT, increased PTT, decreased D-dimers
decreased PT, decreased PTT, decreased fibrinogen, increased BT
increased D-dimer, increased fibrinogen, increased PT, increased PTT

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