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Pregnancy, Childbirth, & the Puerperium


{"ops":[{"insert":"Diagnosis and reasoning"},{"insert":"\n","attributes":{"header":1}},{"insert":"This lady has presented with an antepartum hemorrhage. Although the vaginal bleeding appears mild, she is pale, tachycardic and has a borderline hypotensive blood pressure - all of which suggest significant concealed bleeding.\n\nVery few diseases give rise to this degree of bleeding - mainly placental abruption or placenta previa. While vasa previa may cause severe bleeding, the blood loss is from the baby - the mother would not become hemodynamically unstable.\n\nPlacenta previa is unlikely, as the bleeding is usually painless, while the uterus is typically soft and non-tender. In addition, the degree of hemodynamic compensation is usually proportionate to the severity of the vaginal bleeding.\n\nPlacental abruption is highly likely, as these patients usually present with abdominal pain and a tender and contracted uterus (due to uterine irritation following exposure to blood). Often, the bleeding may be mostly concealed, with hemodynamic decompensation disproportionate to the degree of vag"}]}

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