Obs - Abruptio

Question 1

Madam C, a 40-year-old primigravida housewife is carrying a singleton pregnancy. She was diagnosed to have primary hypertension 3 years ago after investigation, and was put on atenolol.
Her antenatal test are normal.

On 30 weeks of gestation, presented with PV bleeding, abdominal pain, drop in BP, tachycardia, fetal heart rate is 80 bpm. What is your diagnosis and management?

Answer 1

The ddx is abruptio with hypovolemic shock and fetal bradycardia.

Admit to labour ward, check vitals & CTG, resuscitation with IV fluid.

Abdominal exam for uterine tenderness and woody hard uterus, and USG for retroplacental clot and fetal viability.
CBP, RFT, Clotting profile and crossmatch
Call senior, paedi, prep crash CS.

Give steroid

Question 2

After the emergency caesarean section, she develops SOB, oliguria, oxygen desaturation. Blood pressure
is 80/50.

Answer 2

Resuscitation.

Ddx:

1. Acute pulmonary edema induced by impending eclampsia
   Check intraop fluid resuscitation
   cvs/resp examination for basal creps and volume overload
   CVP/BP/IO monitoring and ICU support
   No frusemide as BP not stable
2. PPH
   Check intraop blood loss
   CBC, L/RFT, clotting, X-match
   IV Fluid, Syntocinon
3. MgSO4 toxicity
   S/S: Absence of deep tendon reflex, respiratory depression, oliguria, slurring of speech, double vision, N/V
   Calcium gluconate, full rate IV fluid
4. Pulmonary embolism / amniotic fluid embolism
   PE: tachy, hypotension, SOB, pleural effusion, right heart strain, increased JVP
   Order CT pulmonary angiogram, D-dimer, ABG