Got something to say to this podcast? Send a voicemail, and you might hear yourself on the next episode! A 25-year-old woman at 37 weeks is found by an EMT crew with a shock index of 1.98, SpO2 of 86% on room air, and a fetal heart rate of 195. Hosts Dr. Daniel Olinga and Dr. Emmanuel David sit down with guest expert Dr. Sarah Oworinawe to unpack a real student-led case of placenta abruptio with haemorrhagic shock, tracing the patient from the community, through ED resuscitation and emergency Caesarean section, to the postpartum haemorrhage that followed. Key Discussion Points: Pre-hospital priorities in obstetric haemorrhage: two large-bore IVs, left lateral positioning, oxygen, early pre-notification, and a “scoop and run” mindsetWhy the shock index (HR ÷ systolic BP) beats blood pressure alone, and why pregnancy’s 40–50% blood volume expansion hides how sick the mother really isReading the clues: sudden pain at rest, dark clotted blood, and the hallmark hard, woody, tender uterusBuilding the differential: placenta abruptio vs. placenta praevia, vasa praevia, and uterine ruptureWhy a haemoglobin of 12.4 g/dL doesn’t rule out Class III shock, and why Hb and coagulation results lag behind the clinical pictureControlled vs. uncontrolled haemorrhagic shock: crystalloid first, hypotensive resuscitation (MAP >65), and early blood productsBalancing two patients at once: why a well-perfused mother is the baby’s best life support, and why delivery is the definitive treatmentThe TXA question: what the WOMAN trial showed in PPH, and where the evidence is less clear before deliveryAnalgesia choices in shock: why paracetamol, morphine, or ketamine beat IM diclofenacThe gap that’s easy to miss: why you should always check the random blood sugarCouvelaire uterus and the PPH that followed: the uterotonic ladder from oxytocin to surgical options, and DIC warning signsWhy ultrasound can’t rule out abruption, and why waiting for it can be fatalTakeaways: Trust the shock index: as it approaches 2.0, the patient is dying, even if the haemoglobin looks reassuringA hard, woody, tender uterus plus antepartum bleeding is abruptio until proven otherwise. Diagnose clinically and move to theatreDelay kills: call the obstetrician, anaesthetist, theatre, and blood bank at the same timePPH is anticipated in abruptio, so have your uterotonic protocol and TXA ready before surgery endsObstetric hemorrhage is a two-patient emergency. Keep mother and baby in your frame at all timesListen to learn. Share to save lives. Mastering Emergency Care Disclaimer: For Educational Purposes only, refer to guidelines for definitive management Show Notes & Resources: · Watch the Full Case Video:
