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Pregnancy, Childbirth, & the Puerperium


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 Relevant Investigations

1. Cardiotocography

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

2. Pelvic ultrasound

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

3. Full blood count

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WBC/DC: 7,400/mm3

N: 70% L: 25%


Hb: 7.9 g/dl

Hct (PCV): 28%


Platelets: 300,000/mm3

4. Coagulation screen

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INR: 1.0 (normal)

APTT: 32 s (normal)

TT: 12 s (normal)

S. Fibrinogen Level : normal

Step 3: Select Appropriate Management

1. Blood transfusion

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2. Anti-D immunoglobulin

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3. Urgent cesarian section

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4. Antenatal corticosteroids

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