RML MAINS 2025
Obstetrics & Gynaecology
Easy
In concealed hemorrhage (in Abruptio Placentae), how does the uterus feel on palpation?
Appeared in: RML MAINS 2025
Explanation
- In concealed abruptio placentae, blood is trapped behind the separating placenta.
- This retroplacental blood infiltrates the uterine muscle fibers (myometrium), a condition known as a Couvelaire uterus.
- The infiltration of blood acts as an irritant, causing the uterine muscle to become tetanically contracted and rigid.
- On palpation, this tetanic contraction manifests as a hard, tender, and board-like uterus, which is a classic sign of severe abruption.
Why Other Options Were Wrong
- Option A: A soft and relaxed uterus is not characteristic of abruptio placentae, where muscle irritation causes rigidity.
- Option B: While the uterus is firm, the term 'non-tender' is incorrect. Abruptio placentae is associated with significant pain and tenderness due to myometrial irritation.
- Option D: Abruptio placentae is a painful and pathological condition. A normal and painless uterus is inconsistent with the pathophysiology of placental separation and concealed hemorrhage.
Related Visual
Clinical Relevance
- Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Uterine palpation findings in concealed abruptio placentae as background academic context rather than a clinical decision trigger.
- A nurse's ability to accurately palpate the uterus and differentiate between a hard, tender uterus and a soft, relaxed one is critical for the rapid diagnosis of antepartum hemorrhage.
- This assessment finding is a key differentiator between abruptio placentae and placenta previa, two obstetric emergencies requiring different management pathways.
- Recognizing a board-like uterus prompts immediate escalation for fetal monitoring, preparation for emergency delivery, and management of potential maternal shock and coagulopathy (DIC).
How to Approach the Question
- First, identify the key terms in the question: 'concealed hemorrhage' and 'Abruptio Placentae'.
- Recall the pathophysiology of this condition. 'Concealed' means the blood is trapped behind the placenta.
- Consider how trapped blood would affect the uterine muscle (myometrium). The blood acts as an irritant, causing the muscle to contract forcefully and persistently (tetany).
- Translate this physiological response into a physical finding. A tetanically contracted muscle will feel hard, rigid, and tender on palpation.
- Evaluate the options based on this understanding. 'Hard, tender, and board like' directly corresponds to the expected finding.
- Eliminate other options by contrasting them with the pathophysiology. 'Soft and relaxed' is the opposite and points to placenta previa. 'Firm and non-tender' and 'Normal and painless' are inconsistent with the pain and severity of an abruption.
Concept Tested & Keywords
- Concept Tested: Uterine palpation findings in concealed abruptio placentae
- Stem keywords: concealed hemorrhage, Abruptio Placentae, uterus, palpation
- Lead-in keywords: how does
- Clinical cues: Concealed hemorrhage implies retroplacental bleeding and myometrial irritation.
Question ID
QokxfyunPizv1WrSv4FRXo
Reference Book
E6 Obstetrics Williams p. 67-91
Practise the full RML MAINS 2025
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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