Review Question - QID 105178

This woman with a history of hypertension and painful antepartum hemorrhage after trauma with a normal ultrasound (not always diagnostic) is most likely experiencing abruptio placentae.

Abruptio placentae can be classified as a revealed or concealed abruption. The former includes the presence of active vaginal bleeding and accounts for the majority of cases while the latter presents with no vaginal bleeding. The condition can also be classified by the degree of separation with both total and partial abruptions. The treatment of placental abruption is aggressive fluid/blood product resuscitation and immediate delivery via cesarean section. For cases where there is not a definitive diagnosis and the mother and fetus are stable, observation may be considered.

Incorrect Answers:
Answer 2: Normal labor would present with a gush of clear fluid with intermittent painful contractions. Painful vaginal bleeding is not a part of normal labor, in particular, after trauma.

Answer 3: Placenta previa normally presents with painless vaginal bleeding. If the placenta is covering/near the cervical os at the time of delivery, then a C-section is indicated to deliver the fetus.

Answer 4: Uterine rupture presents with painful vaginal bleeding, a loss of contractions, and palpable fetal parts through the abdomen. This would occur after major trauma.

Answer 5: Vasa previa presents with painless vaginal bleeding and may present with fetal bradycardia. The fetus can exsanguinate and the treatment is C-section rather than vaginal delivery.

Bullet Summary:
Placental abruption presents with painful vaginal bleeding after abdominal trauma.