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  #1  
Old 08-09-2012
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ObGyn abruptio or rupture ? and why ?

A 37-year-old patient, gravida VI, para V, in her 38th week of gestation is undergoing elective labor induction. Her pregnancy has been uncomplicated, and she has no history of past serious illness. Her third delivery was via cesarean section, all others were normal spontaneous vaginal deliveries. Fifteen minutes after administration of intravenous (IV) oxytocin, fetal heart monitoring shows prolonged decelerations. Vaginal bleeding is noted, and eight, then ten uterine contractions are documented during two consecutive 10-minute intervals.



A. Abruptio placentae
B. Bloody show
C. Cervical cancer
D. Cervical laceration
E. Hypotonic uterus
F. Placenta accreta
G. Placenta previa
H. Uterine rupture
I. Vasa previa
J. Vulvovaginal candidiasis
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Old 08-09-2012
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vasa previa i think .....triad is --
1.rupture of membranes
2.fetal bradycardia
3.painless vaginal bleeding

no definitely histroy is given to rule out rupture or abruptio placenta......
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Old 08-09-2012
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She has uterine hyperstimulation from oxytocin by the number of contractions in a 10min observation period....she has a previous CS, Grand multiparous woman...over 35 yrs and on her 6th pregnancy.....all these support a weak uterus and coupled with hyperstimulation...only likely answer is uterine rupture....

Last edited by stfidel; 08-09-2012 at 06:56 PM.
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Old 08-13-2012
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The most likely answer to this vignette although rare is Vasa previa. This is due to the painless vaginal bleeding coupled with fetal deceleration. Uterine rupture will be unlikely because the patient appears stable and there is no pain mentioned in this vignette...
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Old 08-13-2012
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Quote:
Originally Posted by tyagee View Post
A 37-year-old patient, gravida VI, para V, in her 38th week of gestation is undergoing elective labor induction. Her pregnancy has been uncomplicated, and she has no history of past serious illness. Her third delivery was via cesarean section, all others were normal spontaneous vaginal deliveries. Fifteen minutes after administration of intravenous (IV) oxytocin, fetal heart monitoring shows prolonged decelerations. Vaginal bleeding is noted, and eight, then ten uterine contractions are documented during two consecutive 10-minute intervals.



A. Abruptio placentae
B. Bloody show
C. Cervical cancer
D. Cervical laceration
E. Hypotonic uterus
F. Placenta accreta
G. Placenta previa
H. Uterine rupture
I. Vasa previa
J. Vulvovaginal candidiasis
qbank says its uterine rupture because events occuring after oxytocin administration with hyperstimulation of uterine contraction. she having more than 5 contractions in 10 minutes ....
so ?
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  #6  
Old 08-13-2012
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Quote:
Originally Posted by Zamalek View Post
The most likely answer to this vignette although rare is Vasa previa. This is due to the painless vaginal bleeding coupled with fetal deceleration. Uterine rupture will be unlikely because the patient appears stable and there is no pain mentioned in this vignette...
Where did u see it mentioned she had a rupture of membranes,...fetal decelerations is not only unique to vasa previa....and all the risk factors i mentioned is what makes it Uterine rupture...however let tyagee provide the answer.....cheers
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Old 09-23-2012
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I didn't get it,, why uterine rupture is the answer ??

in uterine rupture there's loss of FHR & cessation of uterine contractions
this patient continued to have contractions after the onset of vaginal bleeding !!!
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Old 09-26-2012
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placentio abruptiae? increased contractions seen there

hypotonic uterus-they dont have contractions..MCC postpartum hemorrhage

uterine rupture-no contractions and lots of pain.

C and D and J make no sense with her clinical pres
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