Madam Hawa, 32 year old, housewife, G4P2 +1 at 33 weeks of gestation

Currently presenting with

Bleeding an hour ago while sleeping
About the bleeding,
Bright red, a lot of fluid, a few clot
Large amount of blood (4-5 pads)

First episode
No fall, no trauma, no massage, no pain

Symptoms of anaemia: dizziness, gidding lying down even since bleeding

No fainting

No fever, no recent infection

No decrease in fetal movement, no water coming out

Antepartum history
Booking at 9 weeks
BMI 23, BP 110/80, Ix normal, O+ blood
Haemoglobin 9.6
Done U/S at 11 week, normal
Repeat U/S at 24 weeks & 28 weeks
Placenta low like, breech position

Obstetric history
2014 (6 years ago) - SVD
2016 (4 years ago) - miscarriage
● 8 wks pregnant
● Incomplete miscarriage
● On contraceptive barrier for 1 year
2017 (3 years ago) - C section at 32 weeks for breech
No other problem, all healthy

Gynaecology history
Regular menstruation
4-5 days duration / 28-30 days cycle
Menarche at 12 years of age
No dysmenorrhoea

Spontaneous conception, not planned

Condom contraception
No pap smear
Immunisation - completed childhood immunisation, 2 shots of tetanus during pregnancy

Medical history
No diabetes, No HPT
No medical illness
No surgery

Family history
Healthy & fine

Social history
No drug, no smoking, no alcohol
Husband businessman, smoke
No financial stress, earn a lot of money

Physical examination
General
● Medium built
● Vital sign
○ 100 bpm, 100/75, RR 18/min, no fever
● Mildly pale

No thyroid swelling
Heart lung clear

Abdominal examination
General
● Pregnancy
● Distended with gravid uterus
● 32cm
● C section scar at bottom
● No pain

Palpation
● Uterus soft, no tenderness
● Single
● Transverse lie
● Head on right side
● Movement felt

Auscultation
● Fetal heart at level of umbilicus

Speculum
● Clot, no fluid
VE not done

Ix
● Hb 9.6, clotting profile normal, O+
● U/S: single fetus, transverse
○ Placenta previa type 3