Question

An 18-year-old G1 woman at 32 weeks gestation presents with severe abdominal pain and a small amount of bleeding. She has received routine prenatal care, smokes one pack of cigarettes per day and admits to using crack cocaine. On exam, her blood pressure is 140/80, pulse 100 and she is afebrile. Her uterus is tense and very tender. Pelvic ultrasound reveals a fundal placenta, cephalic presentation of the fetus and no other abnormalities. Cervical examination reveals blood coming through the os and is one centimeter dilated. Fetal heart tones have a baseline of 160s, with a category III tracing. Which of the following is the most likely diagnosis?

A. Placenta previa
B. Premature rupture of the membranes
C. Preterm labor
D. Placental abruption
E. Chorioamnionitis

Answer 1

The most likely diagnosis for the 18-year-old G1 woman presenting with severe abdominal pain and bleeding during pregnancy is placental abruption.

Step-by-step explanation:

The most likely diagnosis for the 18-year-old G1 woman presenting with severe abdominal pain and a small amount of bleeding at 32 weeks gestation is D. Placental abruption.

Placental abruption is a serious condition where the placenta separates from the uterine wall before delivery. It can be caused by factors such as trauma, maternal hypertension, smoking, and drug use. The symptoms include severe abdominal pain, vaginal bleeding, uterine tenderness, and a cervix that may be dilated.

Given the woman's symptoms and risk factors, a placental abruption is the most likely diagnosis.