Thanks for listening to the second episode of this 4 part series on one patient's pregnancy. 
Listen to episode 3 first if you have not yet. 
Remember to say your answers out loud and summarize the information you've heard to make this an active learning process. 

Part 2
Imagine now that we have the same otherwise healthy mother who presents at 25 weeks with sudden onset of vaginal bleeding, abdominal pain, and high-frequency, low-intensity contractions every 3 minutes. Exam shows a tender and hard uterus. Her cervix is closed with a speculum exam. Fetal heart tracing is Category 1. CBC shows a slightly worse normocytic anemia, and antibody screen for Rh is still negative. What is the most likely diagnosis?

1. Uterine rupture: 
2. Placental abruption: Correct. Classic clinical presentation. In summary, presenting signs of placental abruption include
    
   • Sudden-onset vaginal bleeding, 
   • Abdominal or back pain,
   • High-frequency, low-intensity contractions, 
   • Rigid & tender uterus. 
3. Sub-chorionic hemorrhage 
4. Concealed uterine abruption

Bonus Question! If this patient had no signs of bleeding, would the diagnosis still likely be placental abruption? 

Part 3

What is the next best step in management?

Part 4
At 28 weeks gestation, she was seen in the office for her regularly scheduled 28-week appointment, and as a part of screening at this time, her blood-work showed anti-D antibody titers are 1:32. What happened? 

Soon we'll have the answers posted online so watch out for updates. 
Thanks for listening!

This week's episodes include 4 questions about the same patient and her pregnancy from the first trimester to post-partum. 
Remember to say your answers out loud and summarize as we go!

Question 1
A 21-year-old G1P0 who is a smoker presents to the hospital for vaginal bleeding and was found to be pregnant at 13 weeks gestation, and a subchorionic hematoma was found. She has not been had any prenatal care yet. Her vital signs are stable and within normal limits. CBC demonstrates baseline normocytic anemia unchanged from previous lab tests. The patient is known to be Rh(D) negative. Bleeding resolved towards the end of her hospital emergency department stay without admission or intervention. The father of the child’s Rh (D) status is unknown. Select the best choice for the next steps concerning Rh (D) alloimmunization in this patient?

Question 2
Imagine now that we have the same otherwise healthy mother who presents at 25 weeks with sudden onset of vaginal bleeding, abdominal pain, and high-frequency, low-intensity contractions every 3 minutes. Exam shows a tender and hard uterus. Her cervix is closed with speculum exam. Fetal heart tracing is Category 1. CBC shows a slightly worse normocytic anemia, and antibody screen for Rh is still negative. What is the most likely diagnosis?

Stay tuned for parts 3 & 4 coming soon!

A 34-year-old woman G1 P0 at 19 weeks gestation comes to your office for a regular prenatal visit. She reports that she's had some pelvic pressure and noted its clear vaginal discharge for several days. Yesterday she noticed a blood spot-on on tissue paper after wiping. She has no cramping or pelvic pain. Her vitals are stable. Fetal heart rate is 150 by Doppler ultrasound. Speculum exam shows amniotic membrane bulging at the vaginal Introits. Nitrazine paper does not turn blue on the application of the vaginal discharge. Speculum exam shows 2 cm dilated cervix, and amniotic membrane's bulging at the cervical introitus. 

What is the most likely diagnosis of this patient? What is the appropriate management? What if we did something different? Why are the other MCQ choices wrong?

Hope this helps you be prepared for your patients and the boards!

Medical information contained in this podcast episode and series is not intended for medical advice. Seek help from your doctor for treatment and information.