Review Question - QID 109555

This patient has the signs and symptoms to support a clinical diagnosis of placental abruption following a motor vehicle accident.

Placental abruption occurs in 1-2% of all pregnancies. Most cases present with painful vaginal bleeding with or without hemorrhagic shock, but 20% of placental abruptions may have no overt evidence of bleeding. Fetal heart monitoring may reveal late decelerations reflecting maternal hypotension and decreased placental exchange. Trauma is the most common inciting factor, but spontaneous abruptions have been reported in patients with bleeding disorders or multiple risk factors. Risk factors include chronic hypertension, cigarette smoking, chorioamnionitis, multiparity, and preterm premature rupture of membranes.

Incorrect Answers:
Answer 1: Preeclampsia classically presents with hypertension and some degree of organ injury, commonly proteinuria. This patient's low blood pressure on presentation suggests another diagnosis.

Answer 2: Preterm labor is marked by the onset of labor before 37 weeks. This patient is 39 weeks pregnant.

Answer 3: Vasa previa describes a condition where unprotected fetal blood vessels run through the amniotic membranes and traverse the cervix. Bleeding can be associated with bradycardia and late decelerations but not necessarily maternal abdominal pain.

Answer 5: Eclampsia classically describes a pregnant patient with hypertension and seizures, the latter supporting neurological compromise. This patient has no symptom to suggest eclampsia.

Bullet Summary:
Placental abruption presents with sudden onset of painful vaginal bleeding during which late decelerations may be seen on fetal heart rate monitoring.