Underlying

A 30 year old woman presents with spontaneous painless vaginal bleeding at 32 weeks of her third pregnancy.

She experienced vaginal spotting about a month ago, after she had engaged in sexual intercourse.

Her medical history is unremarkable, while her two previous pregnancies were uncomplicated, ending with vaginal deliveries at term.

Select Relevant Investigations
Transvaginal Ultrasound

Performed

The ultrasound scan shows an anterior placenta in the lower uterine segment, with its inferior edge partially overlapping the internal cervical os.
Cardiotocography

Performed

Cardiotocography shows a baseline fetal heart rate of 150 bpm with normal variability and periodic accelerations. There are no decelerations; nor is there evidence of uterine contractions.
Grouping & Crossmatching

Performed

Her blood group is O negative.
Two pints of blood are crossmatched and reserved.
MRI Abdomen

Performed

You realize that the resultant delay might not be a good idea in a patient with recent bleeding.

Select Relevant Management
Transfuse Blood
Urgent Cesarean Section
Anti-D Immunoglobulin
IM Corticosteroids