What condition should you suspect if a patient at 33 weeks gravida has vaginal bleeding with 500 cc of dark, clotted blood?

In a case where a 33-week pregnant patient presents with vaginal bleeding of 500 cc of dark, clotted blood, abruptio placenta should be suspected. Abruptio placenta, or placental abruption, occurs when the placenta detaches from the uterus prematurely, which can lead to significant bleeding and poses serious risks to both the mother and the fetus.

The characteristics of the bleeding—dark, clotted blood—are indicative of older blood, which is often associated with placental abruption rather than new, bright red bleeding that might be seen in other conditions. This detachment can cause abdominal pain and contractions, and it can compromise the oxygen and nutrient supply to the fetus, making prompt recognition and management critical.

Normal labor typically does not present with significant vaginal bleeding, especially in the absence of uterine contractions. While placenta previa can lead to vaginal bleeding, the volume and the description of the blood would lean more towards abruptio placenta. Ectopic pregnancy is generally not a consideration at 33 weeks and is characterized by different symptoms and timing earlier in the pregnancy.

Understanding these distinguishing features helps in the clinical assessment and highlights the seriousness of abruptio placenta, thereby prompting timely intervention.