Placental abruption is most likely when vaginal bleeding is accompanied by which finding?

• A. Severe abdominal pain and a tender, rigid uterus
• B. Painless bleeding with mild cramps
• C. Absence of contractions
• D. Normal fetal heart rate

Answer: (A)

Placental abruption presents as a painful vaginal bleed with signs of uterine irritation. When the placenta separates prematurely, the uterus often becomes hypertonic and tender—leading to a rigid, tense uterus. That combination of severe abdominal pain and a palpable firm uterus is a classic clue that the bleeding is arising from placental separation rather than from a less dangerous cause.

Painless bleeding with mild cramps, by contrast, suggests placenta previa rather than abruption, where bleeding occurs without drastic uterine tenderness. Absence of contractions or a normal fetal heart rate can occur in various obstetric situations and does not fit the typical pattern of abruptio placentae, which often features increased uterine tone and pain along with fetal distress in more severe cases.