Abdominal trauma in pregnancy Quiz: Ace Your Exams
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A healthy 29-year-old woman, gravida 2, para 1, at 37 weeks estimated gestational age (EGA), presents for evaluation after she fell chasing her toddler 3 hours ago. She tripped over a curb and, although she partially caught herself, landed on her left side. She now has crampy abdominal pain, rated a 4 on a 10-point scale, and she noticed spotting when she used the restroom before she came. The pregnancy has been uncomplicated to this point, and her history is notable only for one prior spontaneous vaginal birth at term 2 years ago. Temperature is 36.5°C (97.8°F), pulse is 88/min, respirations are 14/min, and blood pressure is 100/66 mmHg. On exam, the patient is alert and oriented. Ecchymosis and mild tenderness to palpation are noted along the left abdomen and flank. A pelvic exam shows blood-tinged mucus, but no active bleeding, and the cervix is closed. The membranes appear intact. Twenty minutes of maternal-fetal monitoring shows a baseline fetal heart rate of 125/min, moderate variability, 2 accelerations, 1 variable deceleration, and 4 low-amplitude contractions. Her blood type is O-positive. Which of the following is the most appropriate next step in management?
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