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Placental Abruption


Step 1: View clinicals

A 32 year old primiparous lady with a period of amenorrhea of 34 weeks presents with vaginal bleeding and intermittent abdominal pain for 3 hours. There is no history of abdominal trauma. Her pregnancy was uncomplicated prior to this, while her medical history is unremarkable. Her blood group is AB -ve, while 1500 IU of anti-D immunoglobulin was administered at 28 weeks of amenorrhea.

Step 2: Order all relevant investigations


Cardiotocography shows a baseline fetal heart rate of 150 bpm with reduced variability.

Pelvic ultrasound

Pelvic ultrasonography shows the placenta to be embedded posteriorly in the upper segment of the uterus. No other abnormalities can be discerned.

Full blood count

WBC/DC: 7,400/mm3 N: 70% L: 25% Hb: 7.9 g/dl Hct (PCV): 28% Platelets: 300,000/mm3

Coagulation screen

INR: 1.0 (normal) APTT: 32 s (normal) TT: 12 s (normal) S. Fibrinogen Level : normal

Step 3: Select appropriate management

Blood transfusion
Anti-D immunoglobulin
Urgent cesarian section
Antenatal corticosteroids

Score: ★★☆