A 29-year-old G2P1 at 34 weeks presents with sudden onset severe constant abdominal pain and vaginal bleeding. The uterus is hard and tender. Fetal heart rate tracing shows a prolonged deceleration. Her blood pressure is 100/60 mmHg and she is tachycardic. Which is the MOST likely diagnosis?

• A Placenta previa
• B Vasa previa
• C Uterine rupture
• D Placental abruption ✓

Explanation

Placental abruption presents with painful dark vaginal bleeding, a firm/woody uterus, and signs of fetal distress—distinguishing it from the painless bleeding of placenta previa. Concealed abruption may show no external bleeding but still causes hemodynamic instability. Emergency delivery is indicated when fetal compromise is present; if the fetus is live and mature, emergency cesarean is preferred.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.