A 36-year-old multigravida at 38 weeks gestation presents with sudden severe, continuous abdominal pain, dark vaginal bleeding, and high uterine resting tone (board-like rigidity). Fetal monitoring shows persistent decelerations and fetal bradycardia. Maternal blood pressure is 150/100 mmHg. What obstetric emergency does this represent?
Answer and explanation
Correct answer: D. Placental abruption (abruptio placentae)
- Step 1: Placental abruption is the premature separation of a normally implanted placenta from the decidua basalis.
- Step 2: The classic presentation is painful third-trimester bleeding accompanied by uterine hypertonicity, localized tenderness, and fetal compromise.
Answer
Placental abruption (abruptio placentae).
Why not the others: 'Placenta previa' presents with painless, bright red vaginal bleeding and a soft, non-tender uterus; 'Vasa previa' presents with painless bleeding immediately following membrane rupture with rapid fetal exsanguination and fetal sinusoidal heart rate; 'Cervical incompetence' causes painless mid-trimester cervical dilation.
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