Approach to third trimester bleeding Quiz: Ace Your Exams

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A 28-year-old primigravid woman at 30 weeks estimated gestational age (EGA) presents with abdominal pain and moderate vaginal bleeding that began 20 minutes ago. She also has a severe headache. She has had no prenatal care, though past medical history is otherwise non-contributory. Temperature is 36.9°C (98.4°F), pulse is 94/min, respirations are 18/min, and blood pressure is 174/102 mmHg. On exam, the uterus is firm and tender to palpation. Cardiotocographic monitoring shows a baseline fetal heart rate of 120 bpm with minimal to moderate variability, mild contractions every 1 to 2 minutes, and occasional U-shaped decelerations with the nadir lagging several seconds behind the peak of a contraction. Which of the following findings would support the most likely diagnosis?

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Cervical dilation of 6 cm

Placental tissue covering the cervical os

Fluid collection between the placenta and myometrium

Fetal vessels crossing the cervical os

Fetal limb outside the uterus