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Difficulty: MediumObstetric Complications

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

  • Placental abruptionSudden-onset, continuous dark red vaginal bleeding with a rigid, highly tender uterus and frequent, low-amplitude contractions.
  • Placenta previaEpisodes of painless, bright red vaginal bleeding in the third trimester associated with a soft, non-tender uterus.
  • Vasa previaPainless vaginal bleeding occurring immediately after spontaneous or artificial rupture of membranes, rapidly followed by fetal bradycardia.
  • Uterine ruptureSudden cessation of uterine contractions, loss of fetal station, and severe, tearing abdominal pain during a trial of labor.

Answer

Placental abruption is characterized by painful bleeding and a rigid uterus. Placenta previa presents with painless bleeding and a soft uterus. Vasa previa features painless bleeding directly tied to membrane rupture with rapid fetal distress. Uterine rupture presents with sudden severe pain, loss of fetal station, and abrupt cessation of uterine contractions.
Each obstetric complication has a highly specific clinical hallmark: abruption features pain and hypertonus; previa features painless bleeding; vasa previa is tied to membrane rupture and fetal distress; and uterine rupture features loss of station and contraction cessation.

Step-by-Step Solution

1
Analyze the presentation for the presence or absence of maternal pain and uterine tenderness.
Painful bleeding suggests placental abruption or uterine rupture; painless bleeding suggests placenta previa or vasa previa.
Pain is a key initial differentiating factor in evaluating antepartum hemorrhage.
2
Evaluate the timing of bleeding relative to membrane rupture and fetal heart rate changes.
Bleeding immediately after rupture of membranes with rapid, severe fetal bradycardia points directly to vasa previa.
The bleeding in vasa previa is purely fetal, leading to rapid fetal exsanguination before maternal hemodynamic changes occur.
3
Assess labor progress and the uterine contraction pattern.
Loss of fetal station and sudden cessation of contractions are classic, life-threatening signs of uterine rupture.
When the myometrium completely tears, the uterus can no longer generate contractions, and the fetus may be extruded into the maternal abdomen.

Key Concept

Differentiating etiologies of antepartum hemorrhage and acute intrapartum emergencies based on classic clinical presentation features.
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Topics

Obstetric Complications

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