The correct answer is C. Abruptio placenta (placental abruption).

This patient presents with classic signs of placental abruption, especially in the context of trauma:

Severe abdominal pain

History of trauma (MVC)

Uterine contractions

Minimal or concealed vaginal bleeding

Why C is correct (Abruptio placenta):

Placental abruption occurs when the placenta prematurely separates from the uterine wall. It is strongly associated with trauma during pregnancy.

Key features include:

Painful abdomen

Uterine irritability or contractions

Bleeding that may be minimal or concealed

NREMT-aligned guidance states:

“Placental abruption is commonly associated with trauma and presents with abdominal pain and uterine contractions.”

“Bleeding may be minimal because it can be concealed behind the placenta.”

Why the other options are incorrect:

A. Placenta previa: Presents with painless vaginal bleeding, not abdominal pain or contractions.

B. Ruptured uterus: Rare, usually associated with severe trauma or prior uterine surgery; presents with catastrophic signs.

D. Spontaneous abortion: Occurs earlier in pregnancy (typically < 20 weeks), not at 26 weeks.

Exact Extracts:

“Placental abruption presents with abdominal pain and vaginal bleeding following trauma.”

“Bleeding may be concealed and not externally visible.”

“Uterine contractions and tenderness are common findings.”