Clinical Pearls

Painful antepartum bleeding should make one suspicious of placental abruption.

The major risk factors for abruptio placentae are hypertension, trauma, and cocaine use.

Concealed abruption may hide significant bleeding without external hemorrhage.

The most common cause of antepartum bleeding with coagulopathy is abruptio placentae.

Placental abruption may lead to fetai-to-maternal hemorrhage.


Hayashi RH, Gambone JC. Obstetrical hemorrhage and puerperal sepsis. In: Hacker NF. Moore JG. Gambone JC. eds. Essentials of obstetrics and gynecology, 4th ed. Philadelphia: Saunders. 2004:146-156. Cunningham FG. Leveno KJ. Bloom SL, Hauth JC. Gilstrap LC III. Wenstrom KD. Obstetrical hemorrhage. In: Williams obstetrics. 22nd ed. New York: McGraw-HilJ, 2005:810-823.

A 50-year-old G5 P5 woman complains of postcoital spotting over the past 6 months. Most recently, she complains of a malodorous vaginal discharge. She states that she had syphilis in the past. Her deliveries were all vaginal and uncomplicated. She has smoked one pack of cigarettes per day for 20 years. On examination, her blood pressure is 100/80, heart rate 80 bpm. and temperature 99°F. Heart and lung examinations are within normal limits. The abdomen reveals no masses, ascites, or tenderness. Back examination is unremarkable, and there is no costovertebral angle tenderness. Pelvic examination reveals normal external female genitalia. Speculum examination reveals a 3-cm exophytic lesion on the anterior lip of the cervix. No other masses are palpated.

^ What is your next step?

^ What is the most likely diagnosis?

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