Placental abruption Quiz: Ace Your Exams

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A 31-year-old primigravid non-binary pregnant person presents to the emergency department at 31 weeks estimated gestational age (EGA) after a motor vehicle accident 45 minutes ago. The patient was a restrained passenger, and the airbag deployed. Since the accident, the patient has developed moderate abdominal cramping and light vaginal bleedingFetal movement is normal, and no other symptoms are present. Their past medical history is unremarkable, and the only medication is a daily prenatal vitaminTheir temperature is 36.9°C (98.4°F), pulse is 78/min, respirations are 18/min, and blood pressure is 118/80 mmHg. On examination, the uterus is firm and mildly tender to palpation. A speculum exam shows brown-tinged cervical mucus but no active bleeding. The cervix is 1 cm dilated, thick, and high in the pelvis. Labs are shown in the table below. An ultrasound shows an anterior placenta with a small fluid collection behind its inferior margin. Four hours of cardiotocographic monitoring demonstrates initial high-frequency, low amplitude contractions, but these resolve over time. A repeat cervical exam and ultrasound are unchanged. Which of the following is the most appropriate next step in management? 

 Test      Result     
 Hemoglobin      11.3 g/dL     
 Hematocrit      34%     
 Platelets      189,000/mm3     
 Prothrombin time (PT)      12 sec     
 International normalized ratio (INR)      1.1     
 Activated partial thromboplastin time (aPTT)      30 sec     
 Fibrinogen      345 mg/dL     
 Kleihauer-Betke (KB) test      Negative     
 Blood type      A     
 Rh D      Positive     
 Antibody screen      Negative     

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