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Placental abruption — USMLE Step 3 MCQ

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ModerateOB/GYN (prenatal care, contraception, screening)Placental abruptionUSMLE Step 3

A 34-year-old woman at 33 weeks' gestation has sudden painful vaginal bleeding after cocaine use. Uterus is tender and firm. Fetal heart tracing shows recurrent late decelerations. Blood pressure is 156/96 mm Hg. Which of the following is the most likely diagnosis?

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Correct answer: A — Placental abruption

Painful bleeding with uterine tenderness, hypertonus, fetal distress, hypertension, or cocaine exposure suggests placental abruption.

Reference: ACOG antepartum bleeding guidance: https://www.acog.org/