Which presentation is most consistent with placental abruption?

• A. Painless vaginal bleeding with a soft uterus
• B. Preterm labor without bleeding
• C. Vaginal bleeding with uterine tenderness and contractions
• D. Fetal distress with normal contractions

Answer: (C)

Placental abruption occurs when the placenta prematurely detaches from the uterus, causing uterine irritability and bleeding behind the placenta. The hallmark is vaginal bleeding accompanied by a tender, contracting uterus, reflecting the underlying detachment and ongoing uterine contractions. That combination—bleeding with uterine tenderness and contractions—is the presentation that fits best.

In contrast, painless vaginal bleeding with a soft, non-tender uterus points to placenta previa, not abruption. Preterm labor without bleeding lacks the key sign of vaginal bleeding. Fetal distress can occur with placental problems, but if contractions are normal and there isn’t bleeding with uterine tenderness, it’s less characteristic of abruption.