Abdominal trauma in pregnancy Quiz: Ace Your Exams
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A 24-year-old woman at 16 weeks gestational age presents to the emergency department with a single stab wound to the left lower abdominal quadrant. The pregnancy has been uncomplicated to this point. Past medical history is significant for anxiety and depression, managed with sertraline. Temperature is 36°C (96.8°F), pulse is 128/min, respirations are 26/min, blood pressure is 86/50 mmHg, and oxygen saturation is 96% on room air. On exam, the patient is conversant, but mildly confused, cold, and pale, with clammy skin. A 3 cm laceration is noted in the left lower abdominal quadrant, that continues to slowly bleed. There is rigidity and significant tenderness to palpation in the lower abdominal quadrants. A pelvic exam reveals blood-tinged discharge, but no active bleeding from the cervix, which is visually closed. A trauma-focused ultrasound shows significant free fluid in the pelvis, and a viable fetus, with the heart rate fluctuating between 100 and 140/min. A CBC, coagulation panel, fibrinogen, and type and screen are sent, and IV fluids are initiated. A review of records shows the patient is Rh-negative. Which of the following is the most appropriate next step in management?
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