Placenta accreta spectrum Quiz: Ace Your Exams
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A 28-year-old woman, gravida 3, para 1, presents in labor at 39 weeks’ gestation with an uncomplicated pregnancy. The patient's medical history includes one prior uncomplicated vaginal birth and one septic abortion at 10 weeks’ gestation managed with antibiotics and dilation and curettage (D&C). Labor progresses normally, and the patient delivers a 3,600 g (8 lb) healthy neonate. Immediately after delivery, vital signs are stable, the uterine fundus is firm at the umbilicus, and a second-degree laceration is noted that is slowly oozing blood. Five minutes later, there is a sudden increase in vaginal bleeding. Temperature is 36.5°C (97.7°F), pulse is 122/min, respirations are 22/min, and blood pressure is 84/60 mmHg. The patient's skin is cold and clammy. A bimanual examination reveals a firmly adherent placenta. Intravenous (IV) fluids are initiated, labs are drawn, and O-negative blood is requested. Which of the following is the most appropriate next step in management?
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