Reference no: EM133616002

Read the case and give the DIAGNOSIS:

The patient is a 40-year-old woman with five prior normal vaginal deliveries. She had no abnormal medical or family history. She smoked 10 cigarettes per day. She also denied the occurrence of any trauma.
She presented with sudden severe lower abdominal pain at 17 weeks gestation, accompanied by severe vaginal bleeding. She was immediately transferred from primary hospital to tertiary hospital.
Clinical findings: She was pale, blood pressure was 80/50 mmHg, and pulse rate was 122 per minute saturating at 93-94% on room air. Heavy vaginal bleeding with blood clots was confirmed. The uterus was contracting continuously, leading to severe lower abdominal pain.
Abdominal ultrasound was handed to the OB Resident by the husband done 2 hours ago.
REPORT: showed a single live fetus with a normal heart rate. Additionally, the placenta was attached to the anterior uterine wall, but a well-defined 5×3 cm high-intensity region and a 1×2-cm low intensity region was noted within the placenta suggestive of intra-placental hemorrhage.

STAT laboratory findings: hemoglobin, 7.9 g/dL; platelet count, 82,000/L; prothrombin time, 32 seconds (control, 11.4 seconds); partial prothrombin time, >40 seconds (control, 11.4 seconds); serum fibrinogen, 17 mg/dL (reference range: 270-471 mg/dL). The results confirmed the presence of anemia and consumptive coagulopathy.
A diagnosis of placental abruption at 17 weeks of gestation Grade 1 was made by clinical symptoms and ultrasonographic finding.
They immediately given the patient oxygen therapy via nasal cannula at 3-4LPM, started IV therapy of PNSS 1L FD 500mL then regulate to 62-63gtts/min. then ordered immediate Blood typing and cross matching for blood transfusion ASAP.
A total of 16 units frozen plasma and 10 units packed red cells were transfused to treat the DIC and hemorrhagic shock. However, hematological parameters 2 h post-transfusion worsened: hemoglobin, 5.0 g/dL; platelet count, 42,000/L; blood pressure, 70/40 mmHg; pulse rate, 120 per minute. Vaginal bleeding continued, with a total blood loss of 2200 ml. Fetal heartbeat was confirmed by ultrasound.
The condition became worse due to DIC and hemorrhagic shock, so the doctor decided to schedule the pt. for hysterotomy and terminate the pregnancy for life-threatening maternal hemorrhage.
She had been in a serious condition due to the DIC and hemorrhagic shock. MD determined that the delivery of the fetus is necessary to save her. However, since the dilation of the uterine cervix was only 2 cm, rapid delivery could not be expected. Therefore, MD decided to perform a hysterotomy and terminate the pregnancy for life-threatening maternal hemorrhage.