Placental abruption — MCCQE Part 1 MCQ

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HardBleeding in PregnancyPlacental abruptionMCCQE Part 1

A 37-year-old woman at 35 weeks' gestation presents with painful vaginal bleeding after cocaine use. She has a tender hypertonic uterus, fetal tachycardia, and BP 158/96 mmHg. What is the most likely diagnosis?

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Correct answer: A — Placental abruption

Painful bleeding, uterine tenderness, hypertonus, fetal distress, hypertension, and cocaine exposure strongly suggest placental abruption. Placenta previa classically causes painless bleeding with a soft uterus. Vasa previa causes fetal bleeding after membrane rupture rather than a tender hypertonic uterus. Bloody show is mild and associated with labour changes, not maternal-fetal compromise.

Reference: SOGC antepartum haemorrhage guidance