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Old 11-15-2012
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ObGyn Management of stable Placenta Previa

A 34-year-old G1P0 woman at 29 weeks’ gestation with placenta previa diagnosed by ultrasound presents to the ED complaining of 2 hours of vaginal bleeding which has now stopped. She denies any abdominal pain, cramping, or contractions associated with the bleeding. Her temperature is 36.8°C (98.2°F), blood pressure is 118/72 mm Hg, pulse is 75/min, and respiratory rate is 13/min. She reports that she is Rh-positive, her hemoglobin is 11.1 g/dL, and coagulation tests, fibrinogen, and D-dimer levels are all normal. On examination her gravid abdomen is nontender. Fetal heart monitoring is reassuring, with a heart rate of 155/min, variable accelerations, and no decelerations. Two large-bore peripheral intravenous lines are inserted and two units of blood are typed and crossed. What is the most appropriate next step in management of this patient?

(A) Admit to the antenatal unit for bed rest and betamethasone
(B) Admit to the antenatal unit for bed rest and blood transfusion
(C) Admit to the antenatal unit for bed rest and treatment with Rho(D) immune globulin
(D) Emergent cesarean section
(E) Outpatient expectant management
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B.................
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(A) Admit to the antenatal unit for bed rest and betamethasone

If she is gonna blow then we are ready with blood tx but have to be prepared for fetal lungs too.
Doesn't need blood right now since she and the baby are OK.
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Quote:
Originally Posted by anomali View Post
B.................
Picked the same ans in the test

Quote:
Originally Posted by Novobiocin View Post
(A) Admit to the antenatal unit for bed rest and betamethasone

If she is gonna blow then we are ready with blood tx but have to be prepared for fetal lungs too.
Doesn't need blood right now since she and the baby are OK.
You get it coz the pt and her baby are ok as you said and also Hb=11.1 g/dL so betamethasone is indicated to to promote fetal lung maturity coz there is high risk of experience a recurrence of bleeding which is may complicated by Preterm labor.
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Old 11-17-2012
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well they r both fine now. but if the bleeding starts again they need to be prepared for delivery. so lung maturity to be achieved. so bed rest and betamethasone.
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(A) Admit to the antenatal unit for bed rest and betamethasone
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