Review Question - QID 109543

This patient presents with regular uterine contractions, cervical change with a small amount of blood, and a reassuring fetal heart rate tracing. This is consistent with normal labor.

Labor is defined by uterine contractions and cervical change. Many women will have a small amount of blood or blood-tinged mucous (“bloody show”) just before labor begins, during early labor, or at the time of rupture of membranes. This is accompanied by a reassuring fetal heart rate tracing and is considered normal.

Figure A shows a fetal heart rate tracing that is reassuring – there are three contractions, a baseline heart rate of 145/min, moderate variability, multiple accelerations, and no decelerations.

Incorrect Answers:
Answer 2: Vasa previa is the crossing of fetal vessels across the cervical os. When the membranes rupture, these vessels may also rupture and cause hemorrhage of fetal blood, which is an obstetrical emergency. Fetal heart rate tracing would show fetal distress (likely bradycardia followed by a sinusoidal pattern).

Answer 3: Placenta previa occurs when the placenta partially covers the cervical os. In this condition, labor and rupture of membranes often trigger extensive bleeding and fetal distress without significantly increased abdominal pain. Fetuses at term should be delivered promptly via C-section.

Answer 4: Placental abruption can result from hypertension, cocaine use, or abdominal trauma and most commonly presents with painful vaginal bleeding. Uterine contractions are often mild but frequent, and the fetal heart rate tracing will show fetal distress.

Answer 5: DIC is a common cause of abnormal hemorrhage in labor and results from over consumption of clotting factors. This patient presents with very minor bleeding which does not trigger suspicion for DIC.

Bullet Summary:
Normal labor presents with regular uterine contractions and cervical change, and there may be a small amount of blood or blood-tinged mucous (“bloody show”).