Which clinical presentation is most consistent with placental abruption?

• A. Painless bright red bleeding in the second trimester with a soft uterus.
• B. 3rd trimester bleeding (dark red) with severe abdominal pain and a tender/rigid uterus; fetal distress.
• C. Uterine subinvolution postpartum.
• D. Blood-streaked vaginal discharge during the first trimester.

Answer: (B)

Placental abruption happens when the placenta begins to detach from the uterine wall before delivery, cutting off blood flow to the fetus. This typically presents in the third trimester as painful vaginal bleeding with a tender or rigid uterus, and fetal distress from reduced placental perfusion. The combination of severe abdominal pain, dark red bleeding, and a hard/tender uterus in the late pregnancy window makes this scenario the most characteristic.

Painless bleeding in the second trimester with a soft uterus points to placenta previa, not abruption. Postpartum uterine subinvolution involves delayed return of the uterus to normal size with abnormal lochia, not acute fetal distress. First-trimester bleeding with discharge is more consistent with threatened abortion or other early pregnancy issues.