Placental abruption Quiz: Ace Your Exams

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A previously healthy 22-year-old primigravid woman is brought to the hospital at 30 weeks of estimated gestational age (EGA) after being thrown down the stairs during an argument with her partner 45 minutes ago, which resulted in direct abdominal trauma. Shortly after, she developed severe cramping abdominal pain and vaginal bleeding. Currently, she feels dizzy and lightheaded, and she is worried about the pregnancy. Temperature is 36.5°C (97.7°F), pulse is 108/min, respirations are 20/min, and blood pressure is 94/56 mmHg. On examination, the patient is alert, oriented, and conversant, though tearful. Bruising is noted on the left cheek, both wrists, and the abdomen. The uterus is firm and tender to palpation. After removing a grapefruit-sized clot from the vagina, a speculum exam shows active bleeding from a visually closed cervix. While applying the maternal-fetal monitors, the fetal heart rate is noted to be in the 90s/min, which does not change despite several changes in maternal position and supplemental oxygen. IV fluids are initiated, laboratory studies are sent, and blood products are ordered. Findings from the patient’s antenatal record are shown in the table below. Which of the following is the most appropriate next step in management? 

 Study      Result     
 Blood type      A negative     
 Antibody screen      Negative     
 Placental location      Fundal     
 Anatomy ultrasound at 20 weeks EGA      Normal     

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