A patient presents at 28 weeks gestation with severe abdominal pain, bleeding and hypeension. The most likely diagnosis is :
## **Core Concept**
The patient's presentation at 28 weeks gestation with severe abdominal pain, bleeding, and hypertension suggests a pregnancy complication. The symptoms point towards a condition affecting the placenta and maternal vascular system. The key is to identify a condition that can cause severe abdominal pain, vaginal bleeding, and hypertension in a pregnant woman.
## **Why the Correct Answer is Right**
The correct answer, **C. Placental abruption**, is the most likely diagnosis. Placental abruption is a condition where the placenta separates from the uterus, leading to maternal bleeding and fetal distress. The bleeding can be external or concealed, and it often presents with severe abdominal pain, vaginal bleeding, and uterine hypertension or tenderness. The condition can lead to maternal coagulopathy and fetal growth restriction if not promptly managed.
## **Why Each Wrong Option is Incorrect**
- **Option A: Uterine rupture** - While uterine rupture can cause severe abdominal pain and bleeding, it is more commonly associated with a history of uterine surgery (like cesarean section) and typically presents with more hemodynamic instability and possibly loss of fetal station.
- **Option B: Eclampsia** - Eclampsia is characterized by new-onset seizures in a pregnant woman with preeclampsia. While hypertension is a component of preeclampsia, eclampsia itself does not primarily present with abdominal pain and bleeding.
- **Option D: Placenta previa** - Placenta previa involves the placenta covering the cervical os and typically presents with painless vaginal bleeding. The absence of pain and the specific mention of severe abdominal pain in the question make this less likely.
## **Clinical Pearl / High-Yield Fact**
A key clinical pearl is that placental abruption often presents with a "woody" or rigid abdomen due to uterine hypertonus, and the pain is typically out of proportion to the physical findings. The presence of hypertension and severe pain alongside bleeding should raise suspicion for placental abruption.
## **Correct Answer: C. Placental abruption**