4.8 of 6 Ratings
A 35-year-old G3P2 woman currently 39 weeks pregnant presents to the emergency department with painful vaginal bleeding shortly after a motor vehicle accident in which she was a passenger. She had her seat belt on and reports that the airbag deployed immediately upon her car's impact against a tree. She admits that she actively smokes cigarettes. Her prenatal workup is unremarkable. Her previous pregnancies were remarkable for one episode of chorioamnionitis that resolved with antibiotics. Her temperature is 98.6°F (37°C), blood pressure is 90/60 mmHg, pulse is 130/min, and respirations are 20/min. The fetal pulse is 110/min. Her uterus is tender and firm. The remainder of her physical exam is unremarkable. What is the most likely diagnosis?
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A 35-year-old woman at 36 weeks gestation presents to the emergency department with voluminous bloody discharge from her vagina. The patient states that she was at home when her symptoms suddenly started. She states that she is currently experiencing abdominal pain and feels dehydrated. The patient has a past medical history of substance abuse, obesity, and hypertension. Her social history is significant for being a victim of domestic abuse. Her current medications include folic acid, ibuprofen, and sodium docusate. Her temperature is 99.5°F (37.5°C), blood pressure is 100/55 mmHg, pulse is 100/min, respirations are 19/min, and oxygen saturation is 98% on room air. External fetal monitoring is seen in Figure A. The patient is started on IV fluids and 100% oxygen. She continues to complain of abdominal pain. Which of the following best describes this patient's presentation?
Separation of the placenta from the decidua
Partial covering of the external cervical os by the placenta
Placental invasion of the decidua basalis
Partial tear of fetal vessels
Normal progression of labor
A 32-year-old G2P1 female at 30 weeks gestation presents to the emergency department with complaints of vaginal bleeding and severe abdominal pain. She states that she began feeling poorly yesterday with a stomach-ache, nausea, and vomiting. She first noted a small amount of spotting this morning that progressed to much larger amounts of vaginal bleeding with worsened abdominal pain a few hours later, prompting her to come to the emergency department. Her previous pregnancy was without complications, and the fetus was delivered at 40 weeks by Cesarean section. Fetal heart monitoring shows fetal distress with late decelerations. Which of the following is a risk factor for this patient's presenting condition?
Prior Cesarean section
A 31-year-old G1P0 woman with a history of hypertension presents to the emergency department because she believes that she is in labor. She is in her 38th week of pregnancy and her course has thus far been uncomplicated. This morning, she began feeling painful contractions and noted vaginal bleeding after she fell off her bike while riding to work. She is experiencing lower abdominal and pelvic pain between contractions as well. Her temperature is 97.6°F (36.4°C), blood pressure is 177/99 mmHg, pulse is 100/min, respirations are 20/min, and oxygen saturation is 98% on room air. Physical exam is notable for a gravid and hypertonic uterus and moderate blood in the vaginal vault. Ultrasound reveals no abnormalities. Which of the following is the most likely diagnosis?