Family Nurse Practitioner Exam

A pregnant woman at 32 weeks gestation reports bright red vaginal bleeding and a painful hard uterus. Which condition is most likely?

1. Placenta previa

2. Placenta abruptio

3. A molar pregnancy

4. An ectopic pregnancy

The correct answer is: Placenta abruptio

The clinical presentation of bright red vaginal bleeding, coupled with a painful and hard uterus, is highly suggestive of placental abruption, also known as abruptio placentae. In this condition, the placenta detaches from the uterine wall prematurely, typically after 20 weeks of gestation. It is often associated with pain, which may be localized to the lower abdomen or back, and the uterus may feel hard due to the accumulation of blood between the placenta and the uterine wall. The presence of bright red blood indicates fresh bleeding, which aligns with the acute nature of placental abruption, as opposed to conditions like placenta previa, where bleeding may be more intermittent and painless, resulting from the placenta being located over or near the cervical opening. The symptoms of placental abruption can present suddenly and may also be accompanied by other signs such as uterine tenderness, increased uterine tone, or signs of fetal distress. In terms of the other conditions listed, a molar pregnancy usually presents with more severe symptoms, like significant uterine enlargement and abnormal hormone levels, rather than typical bleeding and uterine hardness. An ectopic pregnancy, on the other hand, tends to present with unilateral abdominal pain, and while it can cause bleeding, it is