Review Question - QID 109558

This patient is presenting with painful vaginal bleeding and late decelerations seen on external fetal monitoring suggesting a diagnosis of placental abruption. Placental abruption occurs secondary to separation of the placenta from the decidua.

Placental abruption presents with painful vaginal bleeding and can be associated with late decelerations on external fetal heart monitoring. Risk factors include hypertension, cocaine use, and abdominal trauma. In the setting of an unstable patient or fetus, the best next step in management is typically stabilization of vitals and emergency cesarean section. A feared complication of placental abruption is disseminated intravascular coagulation for which patients must be monitored.

Figure A is external fetal monitoring that reveals late decelerations which are suggestive of uteroplacental insufficiency.

Incorrect Answers:
Answer 2: Partial covering of the external cervical os by the placenta describes placenta previa. Placenta previa typically presents with painless vaginal bleeding which can occur spontaneously or after minor trauma.

Answer 3: Placental invasion of the decidua basalis describes placenta accreta which can present with delayed separation of the placenta and intractable bleeding in the third stage of labor.

Answer 4: Partial tear of fetal vessels describes vasa previa which presents with painless vaginal bleeding and fetal bradycardia.

Answer 5: Normal progression of labor describes the typical "bloody show," which occurs during normal labor. Late decelerations and painful vaginal bleeding are not a normal progression of labor.

Bullet Summary:
Placental abruption is associated with hypertension, cocaine use, and trauma and presents with painful vaginal bleeding.