A 27-year-old primigravida at 33 weeks presents with constant abdominal pain and minimal dark vaginal bleeding. Pulse 118/min, BP 88/54 mmHg. The uterus feels tense and tender, fundal height larger than dates, and fetal heart sounds are absent. The degree of shock is disproportionate to the visible blood loss. The most likely explanation for this disproportion is:

• A Rupture of a succenturiate lobe vessel
• B Vasovagal response to pain
• C Amniotic fluid embolism
• D Concealed hemorrhage retained between the detached placenta and uterine wall ✓

Explanation

In about 20 percent of abruptio placentae the hemorrhage is concealed: blood collects between the separated placenta and the myometrium, so external bleeding underestimates true loss and shock appears disproportionate. Amniotic fluid embolism typically occurs during labor or immediately after delivery with sudden collapse, not with a tense tender uterus. Succenturiate vessel rupture gives brisk bright red bleeding without uterine tetany.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.