What condition should be suspected in a 29-year-old woman who is 38 weeks pregnant and presents with heavy vaginal bleeding and a blood pressure of 70/50 mm Hg?

In this scenario, the presentation of heavy vaginal bleeding combined with hypotension (blood pressure of 70/50 mm Hg) in a 29-year-old woman who is 38 weeks pregnant is highly indicative of a severe obstetric complication. The correct condition to suspect is abruptio placenta.

Abruptio placenta, or placental abruption, occurs when the placenta detaches from the uterus before delivery. This can lead to significant maternal and fetal complications and is often characterized by painful bleeding, which may not always be apparent at first, but when it occurs as heavy vaginal bleeding, it should prompt immediate medical evaluation. The low blood pressure suggests that the patient may be experiencing hemorrhagic shock as a result of the blood loss due to the detachment of the placenta. This is a critical condition requiring urgent care.

In contrast, while placenta previa (the incorrect answer) can also cause heavy bleeding in late pregnancy due to the placenta being located near or over the cervical opening, it is typically painless bleeding. The hypotensive state seen in this case would be less common in placenta previa without additional complications.

Overall, given the combination of heavy bleeding and hypotension in a pregnant woman at term, abruptio placenta is the most fitting diagnosis, necessitating