Match each clinical presentation of third-trimester or intrapartum vaginal bleeding with its most likely diagnosis.
- A 32-year-old G2P1 at 36 weeks gestation presents with sudden-onset, severe abdominal pain, dark red vaginal bleeding, and a rigid, tender uterus.Placental abruption
- A 29-year-old G3P2 at 34 weeks gestation experiences a sudden episode of painless, bright red vaginal bleeding. Her abdomen is soft and non-tender.Placenta previa
- A 26-year-old G1P0 at 38 weeks gestation in active labor undergoes artificial rupture of membranes, immediately followed by moderate vaginal bleeding and sudden fetal bradycardia.Vasa previa
- A 24-year-old G1P0 at 39 weeks gestation reports a small amount of blood-tinged mucous discharge associated with irregular contractions and cervical dilation.Bloody show (normal labor)
Answer
Painful bleeding with rigid uterus matches Placental abruption. Painless bleeding with soft abdomen matches Placenta previa. Bleeding with bradycardia post-rupture of membranes matches Vasa previa. Blood-tinged mucus with contractions matches Bloody show.
The correct matches rely on hallmark clinical signs. Placental abruption involves premature placental separation, causing painful bleeding and a hypertonic uterus. Placenta previa involves abnormal placentation over the cervical os, causing painless bleeding. Vasa previa involves fetal vessels overlying the cervix, which tear upon membrane rupture, causing immediate fetal hemorrhage and bradycardia. Bloody show is a normal sign of cervical dilation involving blood-tinged mucus.
Step-by-Step Solution
Key Concept
Differentiating the etiologies of third-trimester and intrapartum vaginal bleeding based on pain, uterine tone, and fetal status.