Rani (G2P1) presents to labor room in labor at 34 weeks of pregnancy with dilatation of cervix 3 cm and minimal uterine contractions. On ARM, fresh bleeding is seen with late decelerations. LSCS was done but fetus could not be saved. No abruptio or placenta previa was noted. Most likely diagnosis is:

**Core Concept**
In cases of antepartum hemorrhage (APH) at or beyond 28 weeks of gestation, the differential diagnosis includes placenta previa, placental abruption, and vasa previa. However, the presence of late decelerations and fresh bleeding in the absence of abruptio or placenta previa suggests a condition characterized by fetal vascular compromise.

**Why the Correct Answer is Right**
The clinical presentation of fresh bleeding on ARM and late decelerations in the absence of abruptio or placenta previa is suggestive of vasa previa. Vasa previa occurs when fetal blood vessels are present in the membranes covering the internal cervical os. These vessels can rupture, leading to fetal exsanguination and death. The presence of late decelerations indicates fetal distress due to compromised placental blood flow.

**Why Each Wrong Option is Incorrect**
**Option A (Placenta previa):** While placenta previa is a cause of antepartum hemorrhage, it is typically associated with painless vaginal bleeding, not fresh bleeding with contractions. The presence of late decelerations also suggests fetal distress, which is not typical of placenta previa.

**Option B (Placental abruption):** Placental abruption is characterized by pain and vaginal bleeding, often accompanied by uterine tenderness. The absence of pain and the presence of late decelerations make this diagnosis less likely.

**Option C (Uterine rupture):** Uterine rupture is a catastrophic event that typically presents with severe abdominal pain and vaginal bleeding. The clinical scenario does not suggest a rupture, as there is minimal uterine contractions and no mention of severe pain.

**Clinical Pearl / High-Yield Fact**
Vasa previa can be a devastating diagnosis, often with a poor outcome for the fetus. Prompt recognition and delivery are essential in cases of vasa previa to prevent fetal exsanguination.

**Correct Answer:** C.

✓ Correct Answer: C. Vasa previa