A 28-year-old woman, gravida 3 para 2, at 30 weeks gestation is brought to the emergency department with vaginal bleeding

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A 28-year-old woman, gravida 3 para 2, at 30 weeks gestation is brought to the emergency department with vaginal bleeding after a

motor vehicle accident The patient was restrained by a lap and shoulder belt, but the steering wheel struck her abdomen. Her

underwear and pants are soaked with blood, but she is “not sure if my water broke.” The patient’s prenatal course had been

uncomplicated, as were her prior pregnancies. Blood pressure is 95/65 mm Hg, pulse is 116/min, respirations are 22/min, and pulse

oximetry is 98% on room air. Physical examination shows an alert but anxious-appearing woman with abdominal tenderness and cool

extremities. On speculum examination, 150 ml of blood is evacuated from the vagina and then minimal active bleeding from the

cervix is observed. Laboratory results are as follows:

Hemoglobin 7.6 g/dl

Blood type 0 positive

Fetal heart monitoring shows contractions every 5 minutes; there are no accelerations or decelerations. Which of the following is the

most appropriate next step in management of this patient?

  • QA Administer intravenous fluids
  • 0 B. Administer intravenous vasopressors
  • 0 C. Order Kleihauer-Betke test
  • 0 D. Perform biophysical profile
  • 0 E. Perform cesarean delivery
  • 0 F Transfuse packed red blood cells

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