Abruptio Placentae: The Daily PANCE Blueprint

The answer is D. Emergency cesarean delivery

Painful dark bleeding with a firm, tender, hypertonic uterus is placental abruption, premature separation of a normally implanted placenta. Hypertension is the most common risk factor; cocaine, smoking, trauma, and a prior abruption are others. The diagnosis is clinical, because ultrasound misses most abruptions. Recurrent late decelerations mean the fetus is not tolerating the loss of placental surface, so at 36 weeks the answer is emergency cesarean delivery, while stabilizing the patient at the same time: two large-bore IVs, type and crossmatch, and a CBC with fibrinogen, because abruption is a leading cause of DIC. Tocolysis is contraindicated, and steroids or observation never delay delivery when the fetal tracing is nonreassuring. Placenta previa, by contrast, causes painless bright red bleeding.