A 29-year-old G3 P2 female at 32 weeks of gestation presents to the emergency dept. with a small amount of vaginal bleeding. She doesn't have any pain. On examination, Her PR: 66/min, B/P: 100/70 mm of hg, RR: 10/min FHS tracings show fetal distress and shows late decelerations. What is the best course of action:
Now this question can be explained in 2 ways but answer still remains the same:
Expl 1: Patient is presenting at 32 weeks of gestation to the emergency department with a small amount of vaginal bleeding. She doesn’t have any pain., this could be a case of placenta previa.. now since there is fetal distress , we will do active management and terminate the pregnancy immediately by doing a cesarean section.
Expl 2: In this question patient has experienced small amount of painless vaginal bleeding…but the fetal distress doesnot coincide with the amount of blood loss, so probably this small amount of blood loss is fetal in origin this is why it has led to fetal distress i.e it is a case of vasa previa.
Management of vasa previa-Emergency cesarean section.
Emergent cesarean section
Fetal umbilical blood transfusion
Expectant management
Induction of labour with prost aglandins