OVERVIEW
This page is dedicated to organizing various examples of standardized exam questions whose answer is abruptio placentae. While this may seem a odd practice, it is useful to see multiple examples of how abruptio placentae will be characterized on standardized exams (namely the boards and the shelf exams). This page is not meant to be used as a tradition question bank (as all of the answers will be the same), however seeing the classic “test” characterization for a disease is quite valuable.
QUESTION EXAMPLES
Question # 1
A 24 year old primigravida woman comes uno the emergency room with constant and severe abdominal pain that is accompanied by sudden vaginal bleeding. This has been occurring for the past 3 hours and the patient is very concerned. She is 37 weeks pregnant and is RH negative. She received RH (d) immune globulin at 29 weeks gestation. Group B streptococcal cultures were collected at her prenatal care visit last week. During this visit it was knotted that her cervix was closed. The patient’s past medical history is notable for nephrolithiasis that was diagnosed during her pregnancy, which has been mangled expectantly. Her blood pressure is currently 158/102 mm Hg, and her pulse is 120/min. Her physical exam shows a firm, distended, and tender uterus. A speculum exam shows ~ 80 mLs of red blood int eh vaginal canal. A moderate amount of blood is also observed coming from the cervical os. Fetal heart monitoring shows a baseline fetal heart rate of 105/min and no variability. What is the mostly likely cause of the patient’s bleeding?
Question # 2
A 37 year old woman, G1P0 (who is at 37 weeks gestation) is brought to the emergency room after the sudden onset of vaginal bleeding and severe lower abdominal pain. The patient’s prenatal course course is notable for diet-controlled gestational diabetes. At 20 weeks, a ultrasound showed normal fetal anatomy/a normal fundal placenta. The patient has a known 10 pack year smoking history, and has been trying to quit this habit. her temperature is 98.4 °F, her blood pressure is 160/90 mm Hg, and her heart rate is 115/min. A physical examination shows uterine tenderness, and the physician notes the presence of moderate vaginal bleeding. A digital cervical exam shows a 4-cm dilated cervix, the fetus in the breech presentation, and the fetus at 0 station. A fetal heart tracing shows a fetal heart rate of 130/min, present accelerations, and moderate variability. There are contractions every 2 minutes, and they last 20 seconds. A urinalysis shows 3+ protein. What obstetric complication might this patient have?
Question # 3
A 28 year old woman, G3P1, is at 31 weeks gestation. She is brought to the emergency department with vaginal bleeding after just being a part of a motor vehicle accident. She was restrained by a lap and shoulder seat belt, but comments that the steering wheel hit her abdomen. Her underwear and pants are soaked with blood, and she is curious if her “water broke”. Her prenatal course has been uncomplicated so far (as was the case during her prior pregnancy). Her blood pressure is 100/65 mm Hg, pulse is 115/min, respiration’s are 22/min, and her oxygen saturation is 98% on room air. On physical examination she has abdominal tenderness and her extremities are cool to the touch. When examining her with the speculum, the physician evacuates about 200 mL of blood from the vagina, then notes minimal active bleeding from the cervix. Laboratory results are as follows:
- Hemoglobin: 7.8 g/dL
- Blood type: 0 positive
Fetal heart monitoring shows contractions every 6 minutes in the absence of any accelerations or decelerations. What is the most likely diagnosis in this patient?
Question # 4
A 35 year old woman, G2P1, is at 36 weeks gestation. She comes to the labor and delivery untie for vaginal bleeding, and also complaints of back pain. She has a history of hypertension that has been controlled effectively with labetolol. Her prenatal lab tests and ultrasound are unremarkable. Her temperature is 98.0°F, blood pressure is 110/65 mm Hg, and pulse is 120/min. Physical examination reveals a smooth, firm, and distended uterus with a fun dual height of 37 cm. When the speculum exam is performed, a small amount of bleeding is seen, as well as a closed cervix. The first 10 minutes of fetal heart monitoring show a baseline heart rate of 160/min, minimal variability, and 3 late decelerations. Uterine contractions are seen every 1-2 minutes. What is the most likely diagnosis in this patient?
Question #5
A 29 year old primigravida woman is at 31 weeks gestation and is admitted to the hospital due to intense uterine contractions every 1-2 minutes for the past 3 hours. Her uterus is firm and tender. The fetal heart rate is 165/min, and there is dark blood flowing from the vagina. The cervix is completely effaced and 8 cm dilated. The vertex is at 0 station, and the fundal eight is 30 cm. What is the likely diagnosis?
Question #6
A 23 year old G1P0 woman at 37 weeks gestation presents with sudden onset of abdominal pain and bleeding. She admits to smoking a pack of cigarettes a day but denies alcohol or drug usage. Her pregnancy has been uncomplicated so far. She takes no medications other than prenatal vitamins. Her blood pressure is 155/90 mm Hg, pulse is 90/min and she is afebrile. Her uterus is tense and very tender during the abdominal exam. Pelvic ultrasound shows the placenta to be posterior and fundal, with a cephalic presentation of the fetus. A gynecological examination reveals no lesions but blood is observed leaking through the cervical os. Fetal heart tones have a baseline of 150, with a Category III fetal heart rate tracing and a tocometer reveals contractions every 30-45 seconds. What is the likely diagnosis in this patient?
Question #7
A 38 year old primigravida woman is at 37 weeks gestation and is being induced because of polyhydramnios. She has received cervical ripening with prostaglandin E2, and is now taking oxytocin. Her cervix is 10cm dilated, 80% effaced, and she is at -4 station. Her water has just broke, and she is now contracting every minute. She is also now having a large amount of bleeding. Her blood pressure is 100/80 mm Hg, pulse 100/min, and temperature is 99.99°F. She has a Category II tracing. What is a possible explanation for her bleeding and labor progression?
Page Updated: 10.08.2016