A 30-year-old G3P2 at 35 weeks presents with sudden severe abdominal pain, a board-like uterus, and absent fetal heart sounds. Bleeding is estimated at 1200 mL. Coagulation profile shows platelets 70 x 10^9/L, fibrinogen 0.9 g/L, and prolonged PT and aPTT. After stabilization with blood products, the most appropriate delivery plan is:

• A Immediate cesarean section regardless of cervical findings
• B Cesarean hysterectomy to remove the source of thromboplastin release
• C Expectant management until coagulation parameters fully normalize
• D Vaginal delivery, augmenting labor if needed, provided maternal condition permits ✓

Explanation

With intrauterine demise from abruption, vaginal delivery is preferred whenever the mother is stable, because cesarean adds surgical blood loss and trauma to an already coagulopathic patient. Labor often proceeds rapidly once abruption occurs, aided by augmentation. Expectant management is unsafe with active consumptive coagulopathy, and hysterectomy is not indicated merely to remove the placenta. Delivery removes the source of thromboplastin and allows coagulation to recover with support.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.