A 25-year-old woman in her third trimester in a car crash presents with severe tearing abdominal pain and bright red vaginal bleeding. Suspect?

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Painful vaginal bleeding in the third trimester after blunt abdominal trauma points to placental abruption. The trauma can cause the placenta to detach from the uterine wall, leading to bleeding into the uterus and severe abdominal pain. The uterus is often tender or rigid, and fetal distress is common because placental blood flow is compromised.

Placenta previa typically presents with painless vaginal bleeding, so the tearing abdominal pain makes it less likely. An ectopic pregnancy isn’t consistent with a third-trimester presentation. Uterine rupture can occur, especially with a uterine scar or during labor, and presents with sudden severe pain and signs of fetal distress, but the combination of late gestation and traumatic, painful bleeding most strongly points to abruptio placentae.