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Acute intrapartum obstetric emergency

BMJ 2008; 337 doi: (Published 22 October 2008) Cite this as: BMJ 2008;337:a1940
  1. Sharon R Sheehan, research fellow1,
  2. Helen M McMillan, consultant in obstetrics and gynaecology2,
  3. Deirdre J Murphy, professor of obstetrics and gynaecology1
  1. 1Coombe Women and Infants University Hospital, Dublin 8, and Trinity College Dublin, Ireland
  2. 2Coombe Women and Infants University Hospital
  1. Correspondence to: S R Sheehan sharon.sheehan{at}

    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


    • 1. What is the diagnosis?

    • 2. What is the ideal emergency management?

    • 3. What risk factors are associated with this condition?


    Short answers

    • 1. Rupture of a vasa praevia is the most likely diagnosis.

    • 2. The patient should …

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