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Early labour, prior postpartum haemorrhage

Room 6GA 40+1G4P336 yIntact

3 cm, contractions every 5 minutes, reassuring strip. New admission.

40+1wksG4P3 · 36 y
  1. Triage
  2. Latent
  3. Active
  4. Second stage
  5. Delivery
  6. Postpartum

11:30: 3 cm, 70% effaced, station -2

Maternal

BP
126/80
HR
86
Temp
36.8
Labs
Haemoglobin 104 g/L, Ferritin 18 micrograms/L
Running
Oral iron

Fetal

Monitor
Reassuring
Presentation
Cephalic, occiput anterior, station minus 2
Membranes
Intact
Next
IV access, crossmatch

Summary

36-year-old G4P3 at 40+1, early labour, prior postpartum haemorrhage. 3 cm, contractions every 5 minutes, reassuring strip.

Membranes
Intact
Fetal presentation
Cephalic, occiput anterior, station minus 2
Board status
New admission

Notes

  • Third birth complicated by an atonic haemorrhage of 1200 mL treated with oxytocin, carboprost and a balloon; transfused two units.
  • Mild iron deficiency anaemia despite oral iron.
  • Reassuring admission strip; three previous fast labours.

Plan

  1. Intravenous access and group and crossmatch two units now
  2. Active management of the third stage; second uterotonic and tranexamic acid at hand
  3. Fast labour anticipated: room ready early; anaesthesia and the charge nurse aware

Medications

  • Oral iron: Since 30 weeks

Maternal vitals

TimeHRBPTemp
11:3086126/8036.8

Labs

  • Haemoglobin104 g/L(110 to 150)
  • Ferritin18 micrograms/L
  • Blood groupB negative; anti-D given at 28 weeks; antibody screen negative
  • GBSNegative

What to watch

  • Rapid progress: she may deliver within the hour or two
  • Anti-D after birth if the infant is Rh positive
  • Blood loss weighed, not estimated, at delivery

OBGynSpace Tutor

It knows the chart and the monitor's context; it will not answer the pending decision or read the strip for you.