Match each clinical presentation of third-trimester obstetric complications with its most likely diagnosis.
- A grand multiparous patient at term undergoing a trial of labor after cesarean suddenly reports sharp, tearing pelvic pain. Contractions abruptly cease, and the fetal presenting part has retracted on pelvic exam.Uterine rupture
- Shortly after artificial rupture of membranes, a patient at 38 weeks gestation experiences moderate vaginal bleeding without uterine discomfort. The fetal monitor immediately displays a sinusoidal pattern and severe bradycardia.Vasa previa
- A pregnant individual at 33 weeks gestation with a history of severe preeclampsia complains of unremitting, knife-like abdominal pain. Exam shows a hypertonic, board-like uterus and moderate dark-colored vaginal bleeding.Placental abruption
- A patient at 32 weeks gestation reports experiencing a sudden gush of bright red vaginal blood that soaked her clothes, completely without any associated cramping or abdominal pain. Her uterus is soft to palpation.Placenta previa
Cevap
The sudden tearing pain with loss of fetal station matches Uterine rupture; the painless bleeding upon membrane rupture with fetal bradycardia matches Vasa previa; the painful bleeding with a hypertonic uterus matches Placental abruption; and the painless bleeding with a soft uterus matches Placenta previa.
Antepartum hemorrhage etiologies are distinguished clinically: Placenta previa presents with painless bright red bleeding; Vasa previa presents with painless bleeding and immediate fetal distress at amniotomy; Placental abruption presents with painful dark bleeding and uterine tetany; and Uterine rupture presents with sudden severe pain, loss of contractions, and loss of fetal station.
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Anahtar Kavram
Clinical differentiation of third-trimester bleeding etiologies based on pain, uterine tone, and fetal heart rate changes.