Scattered

A 37 year old woman at 30 weeks of her first pregnancy presents with severe abdominal pain and profuse vaginal bleeding for 45 minutes.

Her pregnancy has progressed normally until now. There is no personal or family history of bleeding tendencies, and her medical history is unremarkable.

A cardiotocograph (CTG) shows a baseline heart rate of 170 bpm, and 6 uterine contractions within 10 minutes. No decelerations are seen.

An ultrasound scan demonstrates a partially separated anterior placenta, with intra-placental hemorrhage.

Select Relevant Investigations
Full Blood Count

Performed

WBC: 11,600/mm3 (4000-11,000)
N: 76% (50-70)
L: 21% (20-40)
Hb: 7.4 g/dL (11.5-17.5)
Hematocrit: 22.2% (36-44)
Platelets: 42,000/mm3 (150,000-400,000)
Group & Crossmatch Blood

Performed

Group: O positive
4 units of blood crossmatched.
Coagulation Profile

Performed

aPTT: 93 seconds (30-40)
PT: 40 seconds (10-12)
Fibrinogen: 146 mg/dL (373- 619 in 3rd trimester)
Quantitative D-Dimer Assay

Performed

D-Dimers: 8805 ng/mL (≤250)

Select Relevant Management
Urgent Delivery
Blood Transfusion
Corticosteroids Stat
Recombinant Protein C stat