A 19-year-old female at 23 weeks with lower abdominal pain lies on her left side in approximately 1200 ml of blood. Vital signs show BP 58/0, P 134, R 22. What should you do?

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Multiple Choice

A 19-year-old female at 23 weeks with lower abdominal pain lies on her left side in approximately 1200 ml of blood. Vital signs show BP 58/0, P 134, R 22. What should you do?

The most important concept here is prioritizing oxygenation during a pregnant patient with massive hemorrhage and shock. Giving high-flow oxygen quickly ensures the mother’s tissues—and therefore the fetus’s tissues as well—receive as much oxygen as possible while you mobilize definitive care. Administering 15 L/min of oxygen via a non-rebreather delivers near-ambient FiO2 rapidly, which helps counteract the effects of shock on oxygen delivery. This is the fastest action you can take that directly improves tissue oxygenation in the moment. While establishing IV access and starting fluids or preparing for transfusion and delivery are all essential steps, they take a moment to set up and act on. Oxygen therapy is immediate and supports patient and fetal oxygenation while you proceed with resuscitation and obtain definitive care. Preparing for emergency delivery isn’t the immediate move here because the mother’s instability needs to be stabilized first, and at 23 weeks the fetus is not viable in most settings, so the priority remains maternal stabilization and rapid transport.

The most important concept here is prioritizing oxygenation during a pregnant patient with massive hemorrhage and shock. Giving high-flow oxygen quickly ensures the mother’s tissues—and therefore the fetus’s tissues as well—receive as much oxygen as possible while you mobilize definitive care.

Administering 15 L/min of oxygen via a non-rebreather delivers near-ambient FiO2 rapidly, which helps counteract the effects of shock on oxygen delivery. This is the fastest action you can take that directly improves tissue oxygenation in the moment.

While establishing IV access and starting fluids or preparing for transfusion and delivery are all essential steps, they take a moment to set up and act on. Oxygen therapy is immediate and supports patient and fetal oxygenation while you proceed with resuscitation and obtain definitive care. Preparing for emergency delivery isn’t the immediate move here because the mother’s instability needs to be stabilized first, and at 23 weeks the fetus is not viable in most settings, so the priority remains maternal stabilization and rapid transport.

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