Patricia Douglass Case Summary

Patricia Douglass is a 28-year-old, gravida I, para 0 at 34 weeks gestation. She is carrying a set of twins. At her most recent office visit with Dr. Sanders, Patricia had an elevated blood pressure of 158/86. She was brought to the hospital by ambulance. Upon arrival Patricia is immediately assessed and states that she has failed to comply with her prescribed blood pressure medication, Labetalol 200mg BID. The paramedic reports a moderate amount of dark red vaginal bleeding, blood pressure 84/46, heart rate of 130, and respiratory rate of 26. The patient complains of severe abdominal pain rating it a 9/10. When the abdomen is palpated by the nurse there is localized uterine tenderness in the upper right quadrant and it is boardlike. Upon observation a large blood clot is seen on the patient’s pad. She is experiencing contractions every 2 minutes. Patricia is placed on the external fetal monitor. The fetal heart rate of baby A is noted in low 80’s, while baby B has a baseline of 120. The nurse suspects abruptio placentae and immediately telephones the physician. The physician orders the nurse to draw a stat CBC, CMP, PT, PTT, INR, blood type and cross match, and an Apt test. Dr. Sanders also places orders for the nurse to start two large bore venous access lines, start a fluid bolus of lactated ringers, and insert a Foley

Sanders arrives she evaluates lab results; clotting factors are decreased, along with hemoglobin and hematocrit, and the Apt test is positive. The doctor orders fresh frozen platelets to be transfused followed by a blood transfusion of 2 units packed red blood cells. Dr. Sanders speaks with Patricia, explains the procedure, and obtains informed consent. She then performs crash cesarean section for the twins. Baby B is delivered with no complications and Baby A requires life-saving measures from NICU team, but does not survive. Once the placenta is delivered the doctor officially diagnoses a complete abruption of Baby A’s