A 28-year-old woman at 36 weeks gestation with severe pre-eclampsia develops sudden onset of severe abdominal pain with uterine tenderness, rigidity, and fetal bradycardia (100 bpm). The most likely diagnosis is:
- A Placenta previa with hemorrhage
- B Uterine rupture
- C Abruptio placentae ✓
- D Ectopic pregnancy rupture
Correct answer: C. Abruptio placentae
Explanation
Pre-eclampsia is the strongest risk factor for abruptio placentae due to decidual vasculopathy and spiral artery thrombosis. The triad of abdominal pain, uterine tenderness/rigidity, and fetal distress is classic for placental abruption. Placenta previa presents with painless vaginal bleeding. Uterine rupture is rare without prior uterine scarring and presents with loss of station and hemodynamic collapse. Ectopic pregnancy rupture is not possible at 36 weeks with an intrauterine fetus.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.