A G1P0 client at 38 weeks presents with sudden onset of severe abdominal pain and a large amount of bright red vaginal bleeding after cocaine use; abdomen is rigid and tender; external monitor shows a fetal heart rate of 60/min. What is the diagnosis?

A G1P0 client at 38 weeks presents with sudden onset of severe abdominal pain and a large amount of bright red vaginal bleeding after cocaine use; abdomen is rigid and tender; external monitor shows a fetal heart rate of 60/min. What is the diagnosis?

• A. Abruptio Placentae
• B. Placenta Previa
• C. Uterine Rupture
• D. Vasa Previa

Answer: (A)

Placental abruption is the separation of the placenta from the uterine wall before delivery, which causes painful vaginal bleeding and a tender, rigid uterus. Cocaine use is a strong risk factor because it triggers vasospasm and uteroplacental ischemia, increasing the chance that the placenta will detach. The fetal heart rate of 60/min indicates severe fetal distress from reduced oxygen delivery due to the abrupt detachment and blood loss. This presentation fits abruption better than the other options. Placenta previa typically causes painless vaginal bleeding with a soft uterus, not a rigid, tender abdomen. Uterine rupture can present with severe pain and signs of fetal distress, but it usually occurs in women with prior uterine surgery or a scar and often includes loss of fetal station. Vasa previa can cause fetal distress with bleeding, but the bleeding is fetal in origin and the uterus is not characteristically rigid and tender in the same way, and it is typically diagnosed prenatally.

Placental abruption is the separation of the placenta from the uterine wall before delivery, which causes painful vaginal bleeding and a tender, rigid uterus. Cocaine use is a strong risk factor because it triggers vasospasm and uteroplacental ischemia, increasing the chance that the placenta will detach. The fetal heart rate of 60/min indicates severe fetal distress from reduced oxygen delivery due to the abrupt detachment and blood loss.

This presentation fits abruption better than the other options. Placenta previa typically causes painless vaginal bleeding with a soft uterus, not a rigid, tender abdomen. Uterine rupture can present with severe pain and signs of fetal distress, but it usually occurs in women with prior uterine surgery or a scar and often includes loss of fetal station. Vasa previa can cause fetal distress with bleeding, but the bleeding is fetal in origin and the uterus is not characteristically rigid and tender in the same way, and it is typically diagnosed prenatally.