MEDizzy - A 19-year-old woman at 32 weeks’ gestation was the driver in

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Basic obstetrics

A 19-year-old woman at 32 weeks’ gestation was the driver in a front-end motor vehicle crash. The air bags did not inflate, and the patient sustained blunt trauma to the abdomen. The patient is taken to a nearby emergency department in stable condition, where she notes a small amount of bright red blood on her underwear. Maternal vital signs are significant for a heart rate of 110/min and blood pressure of 110/55 mm Hg. What is most appropriate next step in management?

ExplanationC. Abruption placenta refers to premature separation of a normally implanted placenta after 20 weeks’ gestation, but prior to delivery of the infant. Since the detached portion of the placenta is unable to ex- change gases and nutrients, the fetus can become compromised if the area of separation is large. This patient is at risk for placental abruption secondary to compression-decompression and acceleration-deceleration stresses of a motor vehicle crash. Vaginal bleeding in this set ting is concerning, as bleeding is one of the first signs of abruption. It is unlikely that a complete abruption has occurred, as the pa- tient is not frankly hypotensive and her bleeding was minimal. All women >24 weeks of gestation subjected to abdominal trauma should have continuous fetal and uterine monitoring with an external fetal heart rate to assess for preterm labor and/or an abruption. Signs of fetal compromise are associated with moderate to severe abruption and would necessitate immediate delivery.