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Placental Abruption — FRCA Final MCQ

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ModerateObstetric AnaesthesiaPlacental AbruptionFRCA Final

A 28-year-old primigravida at 32 weeks’ gestation with a twin pregnancy develops sudden, continuous severe abdominal pain and a small amount of dark vaginal bleeding. She is pale, with a blood pressure of 90/55 mmHg and a heart rate of 125 beats/min. Her abdomen is diffusely tender, and the uterus remains firm and hypertonic between contractions. Ultrasound confirms absent fetal cardiac activity in both fetuses. What is the most likely diagnosis?

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Correct answer: B — Placental abruption

The diagnosis is **placental abruption**. Continuous severe abdominal pain, uterine tenderness and persistent hypertonus are characteristic; maternal shock out of proportion to the visible bleeding suggests substantial concealed retroplacental haemorrhage. Severe abruption can cause fetal hypoxia or death and consumptive coagulopathy. Placenta praevia classically causes painless bleeding with a soft, non-tender uterus. Vasa praevia usually presents with bleeding after membrane rupture and acute fetal compromise while the mother initially remains haemodynamically stable. Uterine rupture can cause pain, shock and fetal death, but is much less likely in a primigravida and does not characteristically produce a persistently woody, hypertonic uterus. Amniotic fluid embolism typically causes abrupt hypoxaemia, hypotension and coagulopathy during labour or shortly after birth.

Reference: Royal College of Obstetricians and Gynaecologists. Antepartum Haemorrhage, Green-top Guideline No. 63, sections 7–8. First edition 2011, current posted edition. https://www.rcog.org.uk/media/pwdi1tef/gtg_63.pdf