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Consider if motorcar collision and/or seat belt bruise on stomach Clinical Presentation Clinical Presentation Vaginal bleeding is usually painless, with brilliant red blood Vaginal bleeding in eighty% of circumstances, but could also be Blood loss is usually not large with preliminary bleed, but concealed (retroplacental bleeding); therefore, bleeding tends to recur and become heavier because the being pregnant maternal hemodynamic scenario will not be progresses, blood loss is in line with visualized bleed; explained by noticed blood loss uterine tone not increased and full rest of uterus Pain and increased uterine tone typical and between contractions incomplete relaxation of uterus between contractions Pain will increase with severity Physical Findings Physical Findings Heart rate may be normal or elevated Dependent on diploma of detachment, amount of Blood strain regular, low or hypotensive blood loss Postural blood pressure drop could also be present With mild abruption, indicators may be minimal Fetal coronary heart fee normally normal Heart fee mildly to severely elevated Mild distress to frank shock Blood stress normal, low or hypotensive Bright purple bleeding per vagina Fetal coronary heart rate elevated, reduced or absent Fundal top according to dates Client could seem like in acute misery Uterus delicate, regular tone, nontender Client may be pale or unconscious (if in shock) Uterine dimension consistent with dates Vaginal bleeding moderate, profuse or absent Transverse, oblique or breech lies widespread If membranes ruptured, amniotic fuid may be bloody Should be suspected in shopper with persistent breech Uterus could also be bigger than expected for dates presentation Uterus tender Fetal coronary heart fee is determined by quantity of bleeding Increased uterine tone (tense or hard) Advisability of speculum examination debatable Uterine contractions may be current and extended Digital cervical examination should be avoided till placenta Uterus may fail to relax fully between previa is dominated out by an ultrasound scan report at 18 20 contractions weeks or beyond that confrms the placenta is free from the os or until an ultrasound could be accomplished to rule out placenta previa. 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