A 23-year-old female in the third trimester has low abdominal pain and dark-colored vaginal bleeding. The pain increases with contractions every ten minutes. Which condition should you suspect?

• A. Placenta previa
• B. Abruptio placentae
• C. Bloody show
• D. Uterine rupture

Answer: (B)

Painful vaginal bleeding in the third trimester with contractions points to placental abruption, because detachment of part of the placenta from the uterine wall causes both bleeding and a contracting, tender uterus. The dark color suggests blood that has been accumulating as the placenta separates, and the ongoing contractions indicate the uterus is reacting to that detachment. This contrasts with placenta previa, which typically causes painless bleeding since the placenta is sitting over the cervix and the uterus remains relatively soft and non-tender. A bloody show is a small amount of blood-tinged mucus that accompanies cervical dilation and usually isn’t associated with frequent contractions or heavy bleeding. Uterine rupture would present with sudden, severe pain and signs of maternal instability or fetal distress, often with a history of uterine surgery, not a gradually increasing pain with regular contractions as described here. Treat this as an obstetric emergency: monitor mother and fetus if possible, establish IV access, provide oxygen if needed, and arrange rapid transport to a facility with obstetric capability; avoid routine vaginal examination if previa is a concern, and be ready for potential delivery.