Which physical exam finding is most consistent with placental abruption?

• A. Painless vaginal bleeding with a soft uterine contour
• B. Normal vital signs and stable condition
• C. Uterine relaxation and no contractions
• D. Hypovolemia with tachycardia, hypotension, uterine tenderness and contractions

Answer: (D)

Placental abruption typically presents with painful vaginal bleeding and signs of maternal hemorrhage due to premature placental separation. The uterus often becomes tender and firm, and there are uterine contractions or a hypertonic uterus as the bleeding irritates the uterine muscle. As blood loss progresses, the mother may develop hypovolemia with tachycardia and hypotension. This combination—hypovolemia with tachycardia and low blood pressure, plus a tender uterus and contractions—fits placental abruption best.

In contrast, painless vaginal bleeding with a soft, non-tender uterus suggests placenta previa, not abruption. Normal vital signs argue against ongoing hemorrhage, and uterine relaxation with no contractions is not typical of abruption, which usually involves increased uterine tone and contractions.