Your next patient is a 32 year old G6P5005 in the emergency room for vaginal bleeding at 34 weeks gestation,with a blood pressure of 100/50, pulse 98 and respiratory rate of 24, who is very anxious. Apparently, the bleeding was without warning or pain and soaked her clothing. You should:
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The amount of bleeding prior to arrival at the emergency room can be only estimated, but when it reaches the shoes a general rule of thumb is that they have lost at least 500cc. This patient is probably in shock, and requires fluid resuscitation. Spontaneous heavy third trimester bleeding is often of placental origin. The fetus is in jeopardy as well, because of poor perfusion of the placenta. Your differential diagnosis includes placenta previa, placental abruption, normal labor, vasa previa, or marginal sinus rupture.