Savita is 32 weeks pregnant presents in causality and diagnosed as a case of APH. Vitals are unstable with BP 80/60 which of the following is next step in M/n:
Ans. is b, i.e. Blood transfusionRef. Dutta Obs. 6/e, p 259; Fernando Arias 3/e, p 342, fig. 13.2Unstable vitals (BP =80/60) belong most probably to moderate category bleeding.In Mild cases - Vitals remain stable.Severe cases - Patient is in shock with very low or unrecordable B.P.The gestational age of patient is 32 weeks: As discussed, beyond 36 weeks with moderate bleeding - terminate the pregnancy.Between 32-36 weeks moderate bleeding - Management depends on whether pulmonary maturity is achieved or not.If maturity is not achieved, patient is managed conservatively on:-Close monitoring-Blood transfusions-Betamethasone (to accelerate lung maturity)This is done for 24-48 hours.If patients condition improves: expectant management is continued.If patients condition does not improve: pregnancy is terminated.As the patient in the question is 32 weeks pregnant with moderate bleeding, first we will try to improve the general condition of the patient by giving blood transfusion.
Careful observation
Blood transfusion
Medical induction of labor
Immediate cesarean section
Antepartum Haemorrhage