OB/GYN
A 24-year-old primigravida who is a heavy smoker presented at 34 weeks of gestation to the Emergency…
A 24-year-old primigravida who is a heavy smoker presented at 34 weeks of gestation to the Emergency Department with sudden heavy painful vaginal bleeding associated with uterine tenderness. Which of the following is the most likely diagnosis?
Explanation
Core Concept: Placental abruption (Abruptio placentae).
Clinical Presentation:
- Sudden onset of painful, dark red vaginal bleeding, uterine tenderness, hypertonus (rigid abdomen), and frequent contractions in the late second or third trimester.
Diagnosis:
- First-line: Clinical diagnosis. Ultrasound to rule out placenta previa (though US is poor at detecting abruption).
- Gold standard: Clinical presentation and retroplacental clot on placental exam post-delivery.
Management:
- Acute: Maternal stabilization (IV fluids, blood products if needed), continuous fetal monitoring, and corticosteroids for fetal lung maturity if < 37 weeks. Delivery (vaginal or Cesarean) depends on maternal and fetal stability.
- Long-term: Risk factor modification (smoking cessation, blood pressure control).