A woman at 8 months of pregnancy complains of abdominal pain and slight vaginal bleed. On examination the uterine size is above the expected date with absent fetal heart sounds. The diagnosis:

Ans. is b, i.e. Concealed hemorrhageRef Dutta Obs. 7/e, p 255, 212, 429Let's analyse all options separately to see which suits the best.OptionsPoints in favourPoints against* Option "a" Hydramnios* Size of uterus > gestational age.* Absent fetal heart sounds (in polyhydramnios fetal heard sound is not distinctly heard) 05* Abdominal pain and vaginal bleeding (Main complain of patient with hydramnios is difficulty in breathing and swelling over legs Option "a" ruled out* Option "c" Active labor* Complain of abdominal pain and slight vaginal bleed (Which can be show of active labor)* Height of uterus > than the period of gestation (Height of uterus = period gestation in normal labor)* Absent fetal heart sound (FHS is present in normal laborOption "d"Rupture uterus Since period of gestation is 8 month i.e. rupture is occurring during pregnancy and since no H/o scared uterus is given we are taking it as spontaneous rupture during pregnancy* Height of uterus more than period of gestation* Absent fetal heart sounds* In rupture patient complains of acute pain in abdomen accompanied by fainting attack/collapse* Acute tenderness on abdominal examination* Palpation of superficial fetal parts Spontaneous rupture during pregnancy of un-scarred uterus occurs in high parous women and is not commonOption "b" Concealed hemorrhage* Abdominal pain and vaginal bleeding* Height of uterus more than period of gestation* Absent fetal heart sound So, concealed hemorrhage is the diagnosis.