In a third-trimester patient with heavy vaginal bleeding and signs of poor perfusion, what is the priority during transport after ensuring oxygenation?

• A. Place in knee-chest position.
• B. Keep her warm and administer oxygen.
• C. Pack her vagina with sterile dressings.
• D. Place her supine with feet elevated.

Answer: (B)

The key idea here is that in a third-trimester patient with heavy bleeding and signs of poor perfusion, the immediate priorities during transport are to maximize oxygen delivery and minimize heat loss. Providing supplemental oxygen raises the amount of oxygen available to tissues despite blood loss, which is essential when perfusion is compromised. Keeping the patient warm helps prevent hypothermia, which can worsen coagulopathy and further impair clotting and circulation.

Positions that aim to “improve” venous return in late pregnancy are less reliable in this scenario, and some can even hinder comfort or airway management. While addressing vaginal bleeding is important, it does not improve the immediate need to ensure adequate oxygen delivery and maintain body temperature during transport. If feasible, a left-lateral position can help venous return, but the most important actions after ensuring oxygenation are keeping her warm and continuing oxygen therapy.