Rosh Emergency Medicine Practice Test

In a case of heavy vaginal bleeding in a pregnant woman, after fluid resuscitation, what is the next best step in management?

1. Order hemoglobin and hematocrit

2. Order immediate obstetric ultrasound

3. Perform a digital cervical examination

4. Prepare for emergent cesarean section

The correct answer is: Prepare for emergent cesarean section

In a scenario of heavy vaginal bleeding in a pregnant woman, particularly when she is hemodynamically unstable or showing signs of significant blood loss, the priority is to ensure both the mother’s and the fetus's safety. After initiating fluid resuscitation to combat hypovolemia, preparing for an emergent cesarean section is critical if the bleeding is severe and there is a potential risk to the life of either the mother or the fetus. Heavy vaginal bleeding can indicate various complications, including placental abruption, placenta previa, or other life-threatening conditions. In these cases, the urgency of intervention cannot be overstated, as prolonged hemorrhage may lead to significant maternal morbidity or fetal demise. An emergent cesarean section allows for rapid delivery of the fetus, which may be crucial, especially in cases where the fetus is in distress or the mother is at risk of hemorrhagic shock. Other management steps, while important, may not address the immediate risk that heavy bleeding presents. For instance, obtaining hemoglobin and hematocrit levels is useful for assessing the degree of anemia but doesn't provide immediate intervention. An obstetric ultrasound can help evaluate the cause of bleeding but may delay necessary surgical intervention if bleeding is profuse. A digital cervical