A 33-year-old G3P2 at 35 weeks presents with constant dull abdominal pain, dark red vaginal bleeding of moderate amount, and a tense tender uterus. The fetal heart rate is 140 beats per minute with good variability. Transabdominal ultrasound shows no retroplacental collection. What is the appropriate interpretation?
- A A normal ultrasound never excludes abruption, which remains a clinical diagnosis ✓
- B Ultrasound excludes abruption, and placenta previa workup should begin
- C Findings indicate uterine rupture and mandate immediate laparotomy
- D Findings are consistent with vasa previa requiring immediate delivery
Correct answer: A. A normal ultrasound never excludes abruption, which remains a clinical diagnosis
Explanation
Ultrasound detects only a minority of abruptions, roughly a quarter to half of cases, because acute retroplacental clots may be isoechoic with placenta and small bleeds evade detection. Diagnosis therefore rests on the clinical triad of painful bleeding with a tense tender uterus. B normal scan neither reassures nor changes management, which follows maternal and fetal status.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.