A 30-year-old G2P1 at 38 weeks gestation presents with acute onset of severe continuous abdominal pain and dark vaginal bleeding. On examination, the uterus is hypertonic and tender to palpation, and fetal monitoring shows recurring late decelerations. What is the diagnosis and urgent management?
Answer and explanation
Correct answer: A. Placental abruption (Abruptio placentae); Urgent Cesarean delivery
- Step 1: Sudden painful vaginal bleeding with a tense, hypertonic, tender uterus ('woody uterus') and fetal distress indicates placental abruption.
- Step 2: Premature detachment of the placenta compromises maternal-fetal gas exchange, causing severe fetal hypoxia.
- Step 3: When associated with fetal compromise, emergent cesarean delivery is mandatory to prevent fetal demise and maternal coagulopathy (DIC).
Answer
Placental abruption (Abruptio placentae); Urgent Cesarean delivery.
Why not the others: Placenta previa is painless bleeding with a soft uterus; uterine inversion occurs after delivery; vasa previa causes painless fetal bleeding upon membrane rupture.
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