Persistent pelvic bleeding during labor with a contracted uterus is most consistent with which diagnosis?

• A. Coagulopathy
• B. Placental abruption
• C. Fetal distress
• D. Uterine rupture

Answer: (A)

Persistent pelvic bleeding with a contracted uterus points to a problem of clotting, not uterine tone. When the uterus is firm and well-toned, it should constrict bleeding at the placental site. Ongoing bleeding in this setting suggests a systemic coagulopathy, such as DIC, where platelets and clotting factors are consumed and normal hemostasis cannot be maintained. The result is continued bleeding from multiple sites despite a normally contracting uterus.

Placental abruption often presents with a painful, tender uterus and signs of placental separation, while uterine rupture typically features sudden severe pain, fetal distress, and abnormal contractions. Fetal distress describes the fetus’ oxygenation status rather than a maternal bleeding mechanism. Thus, coagulopathy best explains persistent bleeding with a contracted uterus.