STUDENT PROBLEM-BASED LEARNING SESSION
Third Trimester Bleeding
A 25-year-old G 2 P 1 female at 32 weeks gestation is brought to labor and delivery by her husband. About an hour before, she was watching television when she noted a sudden gush of bright red blood vaginally. The bleeding was heavy and soaked through her clothes, and she has continued to bleed since then. She denies any cramps or abdominal pain. She says that her last sexual intercourse was a week ago. A review of her prenatal chart finds nothing remarkable other than a borderline high blood pressure from her first prenatal visit that has not required medication. There is no mention of bleeding prior to this episode. She had an ultrasound to confirm pregnancy at 14 weeks, but none since.
Physical examination reveals an extremely pale woman whose blood pressure is 98/60, pulse 130, respirations 30, temperature 99 ° F. Her abdomen is soft without guarding or rebound to palpation, and the uterus is nontender and firm, but not rigid. Fundal height is 33cm. Fetal heart tones are in the 140s with good variability. The external monitor reveals uterine irritability, but no discrete contractions are seen. There is a steady stream of bright red blood coming from her vagina.
Bleeding in the third trimester requires immediate patient evaluation. Thoughtful, prompt evaluation and management is necessary to reduce the threat to the lives of the mother and fetus.
The APGO Educational Objectives related to this topic are the following:
*Designated as Priority One in the APGO Medical Student Educational Objectives, 8 th Edition