A 25-Year-Old Primigravida at 37 Weeks Gestation Is Brought to the Emergency

A 25-year-old primigravida at 37 weeks gestation is brought to the emergency department with constant, excruciating abdominal pain and sudden vaginal bleeding for the past 3 hours.  The patient is Rh negative and received Rh(D) immunoglobulin at 28 weeks gestation.  She has no chronic medical conditions and takes no medications.  Blood pressure is 160/100 mm Hg and pulse is 118/min.  Physical examination shows a firm and tender uterus.  Speculum examination reveals a moderate amount of bleeding coming from an open cervical os.  Fetal heart tracing shows a baseline of 105/min and no variability.  Which of the following is the most likely cause of this patient's bleeding?

A) Attachment of the placenta onto the myometrium
B) Full-thickness disruption of the uterine wall
C) Injury to the fetal placental vessels
D) Placental implantation over the cervix
E) Premature placental separation

Correct Answer:

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