Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with acute onset of vaginal bleeding and/or continuous abdominal pain. Associated symptoms include uterine hypertonicity, frequent contractions, or back pain. Fetal heart rate tracing demonstrates non-reassuring patterns (e.g., late decelerations, bradycardia, or loss of variability). Denies recent trauma or prior episodes of similar bleeding.
Clinical Examination Findings
Abdominal exam reveals a firm, tender, and hypertonic uterus ("woody" consistency). Fundal height may be increased or rapidly changing. Speculum exam confirms vaginal bleeding; cervical status assessed for dilation. Maternal vitals may show tachycardia or hypotension if significant blood loss has occurred. Fetal status via EFM shows signs of fetal distress.
Treatment Protocol
Immediate stabilization: Large-bore IV access, fluid resuscitation, and type and cross-match for blood products. Continuous fetal and maternal monitoring. If fetal distress is present or maternal status is unstable, proceed to emergency cesarean section. If stable and preterm, consider corticosteroids for fetal lung maturity and close observation in a high-risk unit.