A 29-year-old G2P1 at 34 weeks presents with sudden severe abdominal pain, a woody-hard tender uterus, and dark vaginal bleeding. Fetal heart rate is absent. Her blood pressure is 160/100 mmHg and urine protein is 2+. What is the most likely underlying etiology?
- A Placenta previa
- B Uterine rupture
- C Abruptio placentae ✓
- D Vasa previa
Correct answer: C. Abruptio placentae
Explanation
The triad of painful vaginal bleeding, a woody-hard tender uterus, and fetal demise with underlying hypertension and proteinuria is classic for abruptio placentae. Placenta previa is painless. Uterine rupture occurs in labor with a prior scar. Vasa previa causes painless bleeding with fetal distress, not a hard uterus.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.