A primigravid client at 38 weeks following a motor vehicle crash presents with heavy bright red vaginal bleeding and a firm, board-like abdomen. External fetal monitoring shows a baseline FHR of 80/min with absent variability. What is the most likely diagnosis?

A primigravid client at 38 weeks following a motor vehicle crash presents with heavy bright red vaginal bleeding and a firm, board-like abdomen. External fetal monitoring shows a baseline FHR of 80/min with absent variability. What is the most likely diagnosis?

• A. Placenta previa
• B. Abruptio Placentae
• C. Uterine rupture
• D. Vasa previa

Answer: (A)

Key concept: blunt trauma in late pregnancy with a tense, board-like abdomen and fetal distress points to uterine rupture. The combination of heavy bright red bleeding and a rigid, firm uterus after trauma suggests intra-abdominal bleeding from a rupture of the uterus rather than placenta previa. Placenta previa typically presents with painless vaginal bleeding and a soft, non-tender uterus, so the rigid uterus here argues against previa. Placental abruption can cause vaginal bleeding and a tender or firm uterus, but the history of blunt trauma with a markedly rigid abdomen and the markedly distressed fetal tracing (baseline fetal heart rate 80 with absent variability) makes uterine rupture much more likely. In uterine rupture, the uterus can become rigid due to hemorrhage into the peritoneal cavity, and fetal distress often accompanies the event. Thus, this scenario most strongly indicates uterine rupture requiring emergent surgical management.

Key concept: blunt trauma in late pregnancy with a tense, board-like abdomen and fetal distress points to uterine rupture.

The combination of heavy bright red bleeding and a rigid, firm uterus after trauma suggests intra-abdominal bleeding from a rupture of the uterus rather than placenta previa. Placenta previa typically presents with painless vaginal bleeding and a soft, non-tender uterus, so the rigid uterus here argues against previa. Placental abruption can cause vaginal bleeding and a tender or firm uterus, but the history of blunt trauma with a markedly rigid abdomen and the markedly distressed fetal tracing (baseline fetal heart rate 80 with absent variability) makes uterine rupture much more likely. In uterine rupture, the uterus can become rigid due to hemorrhage into the peritoneal cavity, and fetal distress often accompanies the event.

Thus, this scenario most strongly indicates uterine rupture requiring emergent surgical management.