A 27-year-old woman (gravida 3, para 2) comes to the delivery floor at 37 weeks gestation. She has had no prenatal care. She complains that, on bending down to pick up her 2-year-old child, she experienced sudden, severe back pain that now has persisted for 2 h. Approximately 30 min ago she noted bright red blood coming from her vagina. By the time she arrives at the delivery floor, she is contracting strongly every 3 min; the uterus is quite firm even between contractions. By abdominal palpation, the fetus is vertex with the head deeply engaged. Fetal heart rate is 130/min. The fundus is 38 cm above the symphysis. Blood for clotting is drawn, and a clot forms in 4 min. Clotting studies are sent to the laboratory. Which of the following actions can wait until the patient is stabilized?
The patient described in the question presents with a classic history for abruption-that is, the sudden onset of abdominal pain accompanied by bleeding. Physical examination reveals a firm, tender uterus with frequent contractions, which confirms the diagnosis. The fact that a clot forms within 4 min suggests that coagulopathy is not present. Because abruption is often accompanied by hemorrhaging, it is important that appropriate fluids (i.e., lactated Ringer solution and whole blood) be administered immediately to stabilize the mother's circulation. Cesarean section may be necessary in the case of a severe abruption, but only when fetal distress is evident or delivery is unlikely to be accomplished vaginally Internal monitoring equipment should provide an early warning that the fetus is compromised. The internal uterine catheter provides pressure recordings, which are important if oxytocin stimulation is necessary. Generally, however, patients with abruptio placentae are contracting vigorously and do not need oxytocin.
Stabilizing maternal circulation
Attaching a fetal electronic monitor
Inserting an intrauterine pressure catheter
Administering oxytocin
Normal Labour