A 32-year-old woman at 34 weeks gestation presents to the emergency department with sudden onset of severe abdominal pain and vaginal bleeding. Which assessment finding would be most indicative of abruptio placentae?
1Painless, bright red vaginal bleeding
2Intermittent uterine contractions with fetal heart rate accelerations
3Board-like uterine rigidity with concealed hemorrhage✓ 정답
4Cervical dilation with mucus plug discharge
해설
Board-like uterine rigidity with concealed hemorrhage is the classic sign of abruptio placentae, indicating severe placental separation and internal bleeding. Other options describe findings more typical of placenta previa (painless bleeding) or normal labor (intermittent contractions).
Clinical Judgment
This question assesses the ability to identify the most characteristic clinical finding of placental abruption (Abruptio Placentae). The key is to find the decisive clue that distinguishes placenta previa from placental abruption within the common symptoms of "sudden abdominal pain and vaginal bleeding." Option 3's "board-like uterine rigidity and concealed hemorrhage" is a classic sign that directly reflects the pathophysiology of placental abruption (uterine muscle irritation due to retroplacental hematoma formation). In contrast, Option 1's "painless bright red bleeding" is typical of placenta previa. Options 2 and 4 are findings of a normal labor process.
Memory Tip: Abruptio = Agonizing pain & Absent relaxation. Placenta Previa = Painless & Precise bright red bleeding.
KR vs US
In Korea, placental abruption is commonly called "태반 조기 박리," and the clinical findings are the same. However, the US NGN exam often requires the very specific term "board-like rigidity" as the correct answer. In Korean clinical settings, it might be described as a "firm and hard uterus," but remembering the precise terminology is important for the exam.
임상 시나리오
Clinical Practice Guide
When assessing a patient with suspected placental abruption:
1. Notify HCP! Immediately report to the physician and begin preparations for massive transfusion and emergency cesarean section.
2. Recognize concealed hemorrhage: External bleeding may be minimal compared to clinical findings (pain, fetal distress, maternal hypotension). Do not underestimate blood loss.
3. Continuously monitor vital signs, especially pulse and blood pressure, to detect early signs of hypovolemic shock.
4. Continuously monitor fetal heart rate to identify fetal distress (e.g., late decelerations, decreased variability).
Caution
In SATA (Select All That Apply) questions, it is very common to see traps that mix symptoms of placental abruption and placenta previa. Clearly distinguish between "sudden pain" and "painless bleeding" as opposite signs. Also, do not perform a vaginal examination on a patient with placental abruption (risk of worsening bleeding).
핵심 개념
Abruptio Placentae — Placental abruption. A condition where the placenta partially or completely separates from the uterine wall before delivery of the fetus. A life-threatening emergency for both the mother and the fetus.
Concealed Hemorrhage — Concealed hemorrhage. Bleeding where blood is trapped behind the placenta and not expelled externally. Clinical findings can be much more severe than the amount of external bleeding, making it dangerous.
Uterine Rigidity (Board-like) — Uterine rigidity (board-like). A state where the uterus is hard and does not relax. A characteristic sign occurring in placental abruption when a hematoma behind the placenta stimulates the uterine muscle.
Placenta Previa — Placenta previa. A condition where the placenta partially or completely covers the cervical canal. Characterized by painless, bright-colored vaginal bleeding.
Third Trimester Bleeding — Third trimester bleeding. Vaginal bleeding occurring in late pregnancy. Placental abruption and placenta previa are the main causes, requiring immediate evaluation and management.