Case 16 · Obstetrics
Placental abruption with DIC
A woman at 35 weeks with pre-eclampsia has sudden constant pain, a hard uterus and only a little visible bleeding. Recognise a concealed abruption with fetal death, find and correct the clotting failure, empty the uterus safely, and prevent bleeding after delivery.
About this case
What you will practise
Learning objectives
- Recognise a major concealed abruption when visible bleeding is small.
- Call for help early and start a massive transfusion response.
- Detect consumptive coagulopathy with a bedside clotting test and fibrinogen.
- Replace red cells, FFP, cryoprecipitate and platelets, and limit clear fluid.
- Choose the safest way to empty the uterus when the baby has died.
- Manage the third stage and break the news with care.
Key decisions this case tests
- How much blood has she really lost?
- Which clotting test, and what do you give for low fibrinogen?
- ARM and vaginal birth, or caesarean?
- Which uterotonic, and which one to avoid?
- Is heparin ever right in this DIC?
Reference basis
- RCOG Green-top Guideline No. 63: Antepartum haemorrhage (2011).
- RCOG Green-top Guideline No. 52: Prevention and management of postpartum haemorrhage (2016).
- WHO. Managing complications in pregnancy and childbirth, 2nd ed. (2017).
- WOMAN Trial Collaborators. Tranexamic acid in postpartum haemorrhage. Lancet 2017.
Content version 1.0 · November 2026 · clinical review pending. See the Clinical content policy.
Before you start
The physiology is a simplified teaching model: concealed bleeding, fibrinogen consumption, labour length after ARM and the effect of each blood product are timed for learning, not prediction. Doses follow the cited guidelines but have not yet been signed off by a clinician.
Visle is for education only and is not medical advice. Bleeding or severe pain in pregnancy is an emergency: seek care immediately.
Ready for another emergency?
Case 15 puts you beside a pregnant woman who has just collapsed with no pulse.