A 28-year-old female, 34 weeks pregnant, presents with sudden onset of severe, constant abdominal pain and dark red vaginal bleeding. She denies any trauma. On examination, her abdomen is rigid and tender. Her vital signs are: BP 90/60 mmHg, HR 120 bpm, RR 24 bpm, SpO2 96%. Which of the following conditions is most likely occurring?
- APlacenta previa
- BAbruptio placentae
- CEctopic pregnancy
- DSpontaneous abortion
Show answer & explanationAnswer & explanation
Correct answer: B. Abruptio placentae
Abruptio placentae is characterized by sudden, severe, constant abdominal pain, dark red vaginal bleeding, and a rigid, tender uterus due to premature separation of the placenta from the uterine wall. The patient's vital signs indicate hypovolemic shock, which is a common complication. Placenta previa typically presents with painless bright red bleeding, ectopic pregnancy occurs much earlier in gestation, and spontaneous abortion would be less likely at 34 weeks with this presentation.
Why the other options are wrong
- A. Placenta previa typically presents with painless, bright red vaginal bleeding, not severe abdominal pain or a rigid abdomen.
- C. Ectopic pregnancy occurs in early gestation (usually before 12 weeks) and presents with unilateral abdominal pain, often with vaginal spotting.
- D. Spontaneous abortion (miscarriage) typically occurs before 20 weeks of gestation and would not usually present with a rigid abdomen and signs of shock at 34 weeks.
Abruptio Placentae
A serious obstetric complication where the placenta prematurely separates from the uterine wall before delivery, leading to vaginal bleeding, abdominal pain, and potential fetal distress or maternal shock.
- Occurs in the second half of pregnancy, often after 20 weeks.
- Presents with sudden, severe, constant abdominal pain and dark red vaginal bleeding.
- Uterus is typically rigid and tender.
- Can lead to maternal hypovolemic shock and fetal hypoxia.
Memory trick: PAINful Dark Blood = Abruptio; PAINless Bright Blood = Previa