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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 32-year-old woman at 34 weeks' gestation has sudden painful vaginal bleeding after cocaine use. The uterus is tender and firm, blood pressure is 160/98 mm Hg, and the fetal tracing shows recurrent late decelerations. Which of the following is the most likely diagnosis?

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Correct answer: E — Placental abruption

Painful third-trimester bleeding with uterine tenderness, hypertension, cocaine exposure, and fetal distress suggests placental abruption.

Reference: ACOG obstetric hemorrhage guidance