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Question

Difficulty: MediumObstetric Complications

Match each distinct clinical presentation of acute third-trimester or intrapartum bleeding with its most likely underlying obstetric complication.

  • Painless, bright red vaginal bleeding with a soft, non-tender uterusPlacenta previa
  • Sudden-onset severe abdominal pain, a rigid uterus, and dark vaginal bleedingAbruptio placentae
  • Painless vaginal bleeding immediately following artificial rupture of membranes, accompanied by a sinusoidal fetal heart rateVasa previa
  • Sudden tearing lower abdominal pain, rapid cessation of uterine contractions, and loss of fetal station during a trial of laborUterine rupture

Answer

Painless bleeding with a soft uterus matches Placenta previa. Painful rigid uterus matches Abruptio placentae. Post-amniotomy bleeding with a sinusoidal fetal tracing matches Vasa previa. Loss of station with pain matches Uterine rupture.
Each etiology of obstetric hemorrhage has hallmark clinical signs: placenta previa is painless with normal uterine tone, abruptio placentae features a tender and hypertonic uterus, vasa previa is directly linked to membrane rupture and triggers rapid fetal exsanguination, and uterine rupture uniquely presents with loss of fetal station and sudden cessation of contractions.

Step-by-Step Solution

1
Evaluate the presence or absence of abdominal pain and uterine tone.
Pain and a rigid uterus point to abruptio placentae or uterine rupture, whereas painless bleeding suggests placenta previa or vasa previa.
Myometrial irritation differentiates structural tears or concealed bleeding from superficial implantation bleeding.
2
Analyze the timing of bleeding relative to amniotic membrane rupture.
Bleeding precisely coinciding with artificial rupture of membranes strongly indicates torn fetal vessels.
In vasa previa, the aberrant fetal vessels cross the internal os and are physically sheared when the amniotic sac ruptures.
3
Assess labor progression anomalies and fetal station changes.
A sudden loss of fetal station combined with cessation of contractions confirms uterine rupture.
When the uterus completely tears, it loses the ability to contract, and the fetus recedes out of the birth canal into the peritoneal cavity.

Key Concept

Clinical differentiation of late-pregnancy hemorrhage
Estimated Time:1m 30s
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Topics

Obstetric Complications

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