Master the board step 3

Obstetrics
• Perform further steps in management:
– Give blood transfusion for large volume loss.
– Place Foley catheter and measure urine output.
– Perform vaginal exam to rule out lacerations.
– Schedule delivery if fetus is in jeopardy or gestational age is
≥ 36 weeks.
Never perform a digital or speculum examination in a patient with late vaginal
bleeding until a vaginal ultrasound first rules out placenta previa.
Abruptio Placenta
When there is sudden onset vaginal bleeding and severe, constant pelvic
pain in a patient with a history of hypertension or trauma (e.g., motor vehicle
accident), bleeding results from avulsion of anchoring placental villi from the
lower uterine segment.
Less commonly, the hematoma does not dissect through the margin of the placenta,
and bleeding remains concealed (concealed hemorrhage). The clue to the
diagnosis is severe, constant pain with only a scant amount of bleeding.
Disseminated intravascular coagulation (DIC) is a feared complication following
the release of tissue thromboplastin into the circulation.
Placenta
separated from
the uterus
Internal
bleeding
External
bleeding
Abruptio Placenta (Placental Abruption)
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