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What is A pregnant patient presents with abdominal pain with twin gestation of 34 weeks and bleeding PV. The most probable diagnosis is? and explain in detail?
ANSWER: (A) Abruptio placentaREF: Dutta 6th ed p. 256, Current Diagnosis & Treatment Obstetrics & Gynecology, 10th edition Chapter 20The clue in the question in favour of abruptio placenta is pain abdomen which differentiates it from placenta previa. Abruptio placentaPlacenta previaHistoryFrequent association of preeclampsia or hypertension from any causeA single attack of vaginal bleeding, which usually continues until delivery Abdominal painNo association with preeclampsiaRepeated warning hemorrhages often occurring over a period of weeksUsually no abdominal painAbdominalExaminationLocal uterine tenderness, hypertonic "woody" uterus in a concealed abruption patient usually in laborPresenting part often engagedPresenting part maybe difficult to palpateFetal heart sounds often absentNormal uterine tone and usually no tenderness Patient rarely in laborPresenting part above brim, malpresentation usually foundFetal parts usually palpableFetal heart sounds usually presentxAncillary aidsplacenta demonstrated in upper uterine segment by ultrasoundPlacenta demonstrated in lower uterine segment by ultrasoundVaginalexaminationDouble set-up reveals no placenta within 5 cm of internal osDouble set-up reveals placenta implanted in the lower uterine segment