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Difficulty: EasyObstetric Complications

Match each classic clinical presentation of an obstetric complication with its most likely diagnosis.

  • Sudden-onset, painful vaginal bleeding with a rigid, tender uterus in the third trimester.Placental abruption
  • Painless, bright red vaginal bleeding in the third trimester with reassuring fetal status.Placenta previa
  • Sudden cessation of uterine contractions, severe tearing pain, and loss of fetal station during labor.Uterine rupture
  • Painless vaginal bleeding immediately following artificial rupture of membranes with concurrent rapid fetal bradycardia.Vasa previa

Answer

The presentations match as follows: Painful bleeding with rigid uterus is placental abruption. Painless bleeding with reassuring fetus is placenta previa. Sudden cessation of contractions and loss of fetal station is uterine rupture. Painless bleeding with immediate fetal bradycardia upon membrane rupture is vasa previa.
Each obstetric emergency has distinct defining clinical features: pain and hypertonus characterize placental abruption, while placenta previa is classically painless. Uterine rupture is uniquely marked by loss of fetal station and cessation of contractions. Vasa previa is distinguished by the clinical triad of membrane rupture, painless bleeding, and immediate fetal distress (bradycardia).

Step-by-Step Solution

1
Analyze the presence or absence of pain associated with the third-trimester vaginal bleeding.
Painful bleeding points toward placental abruption; painless bleeding points toward placenta previa or vasa previa.
Pain is a primary differentiating factor in late-pregnancy bleeding etiologies.
2
Evaluate intrapartum mechanical signs such as uterine tone and fetal station.
Loss of fetal station and sudden cessation of contractions identify uterine rupture.
These specific findings indicate a catastrophic loss of uterine structural integrity.
3
Assess the timing of bleeding relative to amniotic membrane rupture and the corresponding fetal heart rate response.
Bleeding that precisely coincides with membrane rupture and is followed by rapid fetal bradycardia diagnoses vasa previa.
This presentation is the hallmark for torn fetal vessels, which leads to rapid fetal exsanguination.

Key Concept

Clinical differentiation of third-trimester bleeding and acute intrapartum emergencies.
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Topics

Obstetric Complications

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