A patient at 36 weeks of gestation, who is pregnant with her first child, presents to the obstetrical triage unit complaining of sudden, intense abdominal pain accompanied by a moderate amount of dark vaginal bleeding. She recently relocated and has had limited prenatal care. Triage vital signs demonstrate a blood pressure of 168/108 mmHg, a heart rate of 112/min, and a respiratory rate of 18/min. On physical examination, the uterus is hypertonic, firm to palpation, and diffusely tender. The electronic fetal heart monitor reveals a baseline of 105/min with absent variability and recurrent late decelerations. Which of the following is the most appropriate next step in the management of this patient?
- Emergency cesarean deliveryCevap
- BAdministration of betamethasone and expectant management
- CReassurance for physiologic changes of early labor
- DIntravenous magnesium sulfate and observation
- EArtificial rupture of membranes and oxytocin augmentation
Cevap
Emergency cesarean delivery
The correct answer is emergency cesarean delivery. The patient's presentation of sudden, painful, dark vaginal bleeding combined with a hypertonic, tender uterus is the classic clinical picture of placental abruption. Furthermore, her severe hypertension is a major risk factor for this condition. Most importantly, the fetal heart tracing reveals a baseline bradycardia, absent variability, and recurrent late decelerations, all of which point to severe fetal hypoxia (a Category III tracing). In the setting of placental abruption with severe fetal distress, rapid surgical delivery is the definitive, life-saving intervention.
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Anahtar Kavram
Management of placental abruption with fetal distress requires immediate cesarean delivery.