The clinical scenario of painful antepartum haemorrhage

The clinical scenario of painful antepartum haemorrhage associated with pre-eclampsia (hypertension + proteinuria) and fetal death is suggestive of Grade 2 abruptio placentae.

The management of abruption is based on whether the patient is in labor and the fetal status, with the goal being to expedite delivery and prevent complications such as shock and DIC. Immediate management begins with the administration of IV crystalloids and arrangement of blood for the patient, along with BP control.

In this case, after giving anti-hypertensives, since the patient’s vitals are relatively stable with no signs of DIC, there is fetal demise (based on no fetal heart sounds), and the patient is in labor, the best approach would be to deliver the fetus vaginally after performing ARM.

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