Match each clinical presentation of an obstetric complication with its most likely diagnosis.
- Sudden-onset, tearing abdominal pain, abrupt cessation of uterine contractions, and loss of fetal station in a patient with a prior cesarean delivery.Uterine rupture
- Painless, bright red vaginal bleeding typically noted after sexual intercourse, with a reassuring fetal heart rate tracing.Placenta previa
- Painful, dark vaginal bleeding accompanied by a rigid, hypertonic uterus and high-frequency contractions.Placental abruption
- Painless vaginal bleeding immediately following spontaneous rupture of membranes, with rapid onset of fetal bradycardia or a sinusoidal heart rate pattern.Vasa previa
Answer
The correct matches differentiate the major causes of third-trimester hemorrhage and catastrophic intrapartum events based on the presence of pain, timing of bleeding, and specific fetal or maternal signs.
Each clinical presentation contains pathognomonic features for specific obstetric complications. Placenta previa involves painless maternal bleeding from a placenta overlying the internal os. Placental abruption involves painful bleeding and a rigid uterus due to premature placental detachment. Uterine rupture is characterized by sudden tearing pain, loss of fetal station, and cessation of contractions, usually in a scarred uterus. Vasa previa is marked by painless bleeding exactly at membrane rupture with immediate fetal distress due to fetal exsanguination.
Step-by-Step Solution
Key Concept
Clinical differentiation of major obstetric hemorrhages (placental abruption, placenta previa, vasa previa, uterine rupture).