Identify the most likely diagnosis for each of the following third-trimester obstetric presentations.
- A 33-year-old at 37 weeks gestation with severe preeclampsia presents with sudden, constant abdominal pain, dark red vaginal bleeding, and a rigid, hypertonic uterus.Placental abruption
- A 28-year-old at 35 weeks gestation presents with an episode of painless, bright red vaginal bleeding. Her vital signs are stable, and the fetal heart tracing is reassuring.Placenta previa
- A 35-year-old at 38 weeks gestation undergoing a trial of labor after a previous cesarean delivery suddenly experiences intense lower abdominal pain, loss of fetal station, and fetal bradycardia.Uterine rupture
- A 30-year-old at 39 weeks gestation with a known velamentous umbilical cord insertion experiences a gush of blood and abrupt fetal bradycardia immediately following artificial rupture of membranes.Vasa previa
Cevap
The vignettes describe placental abruption, placenta previa, uterine rupture, and vasa previa, respectively.
Each obstetric complication has a distinct clinical presentation. Placental abruption presents with painful bleeding and a rigid uterus. Placenta previa presents with painless bleeding. Uterine rupture presents with severe pain, loss of fetal station, and fetal distress in a patient with a prior uterine scar. Vasa previa presents with painless bleeding and immediate profound fetal distress upon rupture of membranes.
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Anahtar Kavram
Differentiation of third-trimester bleeding and intrapartum emergencies based on maternal pain, fetal heart rate changes, and specific risk factors.