A 34-year-old multigravida at 35 weeks presents with severe abdominal pain, vaginal bleeding, and a rigid uterus. There is no fetal heart activity on ultrasound. Her fibrinogen level is 120 mg/dL and platelet count is 60,000/mm3. According to the Page classification, this abruption corresponds to:
- A Grade I
- B Grade II
- C Grade IIIb ✓
- D Grade IIIa
Correct answer: C. Grade IIIb
Explanation
Page grade III denotes severe abruption with fetal demise. Grade IIIa means fetal death without clinically significant coagulopathy, while grade IIIb adds demonstrable hypofibrinogenemia or DIC, exactly matching this patient's fibrinogen below 150 mg/dL and thrombocytopenia. Grade II is moderate abruption with a live fetus showing distress, and grade I is mild with minimal symptoms. Recognizing grade IIIb matters because it mandates correction of coagulopathy along with delivery.
Reference: Williams Obstetrics, 25th ed.
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