A 27-year-old G2 P1 woman comes to the maternity unit for evaluation for
regular uterine contractions at 34 weeks’ gestation. Her previous delivery
was an emergency cesarean section at 32 weeks because of hemorrhage
from placenta previa. A classical uterine incision was used because of lower
uterine segment varicosities. Pelvic exam shows the cervix to be closed and
long. As she is being evaluated, she experiences sudden abdominal pain,
profuse vaginal bleeding, and fetal bradycardia. Uterine contractions cannot
be detected. The fetal head, which was at –1 station, now is floating.
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