Acute intrapartum obstetric emergency
BMJ 2008; 337 doi: https://doi.org/10.1136/bmj.a1940 (Published 22 October 2008) Cite this as: BMJ 2008;337:a1940
- Sharon R Sheehan, research fellow1,
- Helen M McMillan, consultant in obstetrics and gynaecology2,
- Deirdre J Murphy, professor of obstetrics and gynaecology1
- 1Coombe Women and Infants University Hospital, Dublin 8, and Trinity College Dublin, Ireland
- 2Coombe Women and Infants University Hospital
- Correspondence to: S R Sheehan sharon.sheehan{at}tcd.ie
A 30 year old primigravida was admitted in spontaneous labour at term. Vaginal bleeding was seen after spontaneous rupture of the membranes, and shortly afterwards a profound fetal bradycardia was recorded on cardiotocography. A “crash” emergency caesarean section was performed with delivery of a live male infant in good condition, weighing 3620 g. Apgar scores were 9 at one minute and 10 at five minutes with normal paired cord blood samples. Figure 1⇓ shows the placenta after delivery.
Fig 1 Image of the placenta after delivery
Questions
1. What is the diagnosis?
2. What is the ideal emergency management?
3. What risk factors are associated with this condition?
Answers
Short answers
1. Rupture of a vasa praevia is the most likely diagnosis.
2. The patient should …
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