Maternal-Fetal Medicine — MCQs

Q: A 32-year-old pregnant woman presents with mild bleeding and pain. On examination, the uterus is tender, and fetal heart sounds are absent. What is the most likely diagnosis?

Abruptio placenta. ***Abruptio placenta*** - This condition involves the **premature detachment of the placenta** from the uterine wall, leading to bleeding and severe abdominal pain due to uterine contractions and irritation. - The **tender uterus** is a characteristic finding, often described as a "woody hard" uterus in severe cases. - The absence of fetal heart sounds suggests **fetal demise**, which is a common and severe complication of placental abruption due to oxygen deprivation. *Uterine rupture* - **Uterine rupture** can present with abdominal pain, vaginal bleeding, and loss of fetal heart tones, making it an important differential. - However, it typically occurs during **active labor**, especially in women with previous cesarean sections or uterine surgery. - The presentation usually includes **sudden severe pain**, loss of uterine contractions, and the fetus may be palpable abdominally if completely extruded. *Ectopic pregnancy* - This occurs when the **fertilized egg implants outside the uterus**, most commonly in the fallopian tube. - Symptoms typically appear much earlier in pregnancy **(first trimester)** and the pain is usually localized, often presenting with a smaller, non-tender uterus. - Not consistent with the clinical picture of an obviously pregnant uterus. *Placenta previa* - **Placenta previa** is characterized by the placenta covering the cervical opening, leading to **painless vaginal bleeding**, often bright red. - The uterus is typically **soft and non-tender**, in contrast to the tender uterus described in the case. - This is the key differentiating feature from placental abruption.

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Fetal Assessment Techniques

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Hypertensive Disorders in Pregnancy

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Intrauterine Growth Restriction

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Intrauterine Fetal Therapy

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Prenatal Diagnosis and Genetic Counseling

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Placental Abnormalities

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Preterm Labor and Delivery

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Management of Medical Disorders in Pregnancy

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