Which of the following are signs and symptoms of placenta abruption? (Select all that apply.)

Choice A rationale Increased fetal movement is not a typical sign of placental abruption; in fact, fetal distress or decreased fetal movement is common due to compromised uteroplacental perfusion and resultant fetal hypoxemia caused by the placental separation and hemorrhage. Severe abruption can lead to fetal demise, resulting in a cessation of fetal movement. Choice B rationale Placental abruption involves significant internal and external hemorrhage, often leading to a reduction in circulating blood volume. The typical hemodynamic response to acute blood loss is maternal hypovolemia and hypotension (mean arterial pressure < 65 mmHg or systolic BP < 90 mmHg). Elevated blood pressure is commonly associated with preeclampsia, which is a risk factor for abruption, but not a direct sign of the abruption process itself. Choice C rationale The premature separation of the placenta from the highly innervated uterine wall, coupled with intramyometrial hemorrhage, causes significant irritation and uterine hypertonicity. This results in a distinctive, severe, often sudden-onset, non-remitting knife-like or tearing abdominal pain, which is a classic clinical indicator differentiating abruption from other causes of late pregnancy bleeding. Choice D rationale The retroplacental hemorrhage and uterine hypertonus characteristic of abruption cause the uterus to become rigidly firm, non-relaxing, and sensitive to palpation. This uterine tenderness, or board-like abdomen, is a key sign reflecting the underlying pathology of blood accumulation within the decidua and myometrium, significantly raising the uterine resting tone. Choice E rationale The separation process typically involves tearing of the maternal vessels within the decidua, leading to bleeding. Although the hemorrhage can be concealed (confined behind the placenta), it often tracks down and escapes through the cervix, manifesting as external vaginal bleeding that ranges from scant spotting to profuse hemorrhage, depending on the location and extent of the separation.