Match the following clinical presentations of acute obstetric emergencies with their most appropriate definitive diagnoses.
- A 32-year-old patient at 37 weeks gestation complains of sudden-onset, severe abdominal pain and dark vaginal bleeding. Palpation demonstrates a firm, hypertonic, and tender uterus.Placental abruption
- A 29-year-old patient at 36 weeks gestation reports a sudden gush of bright red vaginal blood without any pain. Palpation demonstrates a soft, non-tender uterus.Placenta previa
- A 35-year-old multipara at 39 weeks gestation experiences a sudden, sharp, tearing lower abdominal pain while laboring. This is followed immediately by the cessation of uterine contractions and the loss of fetal station.Uterine rupture
- A 26-year-old patient at 38 weeks gestation has an amniotomy performed. Immediately after the procedure, there is a moderate amount of painless vaginal bleeding and the fetal heart tracing shows persistent bradycardia.Ruptured fetal vessels
Answer
Painful bleeding with a rigid uterus corresponds to placental abruption. Painless bleeding with a soft uterus corresponds to placenta previa. Tearing pain with loss of fetal station corresponds to uterine rupture. Bleeding following amniotomy with fetal bradycardia corresponds to ruptured fetal vessels.
Each clinical scenario contains pathognomonic features that distinguish the different etiologies of obstetric hemorrhage. Pain and uterine rigidity point to abruption; painless bleeding with a soft uterus points to previa; loss of station points to rupture; and bleeding with severe bradycardia upon amniotomy points to ruptured fetal vessels.
Step-by-Step Solution
Key Concept
Differentiating etiologies of third-trimester bleeding and intrapartum emergencies based on the presence of pain, uterine tone, and fetal status.