A woman at 35 weeks presents with sudden severe abdominal pain, a woody-hard uterus, and vaginal bleeding. What is your differential diagnosis and how would you manage this?

Tips to guide your answer

- Placental abruption: premature separation of a normally sited placenta from the uterine wall; causes approximately 5% of maternal deaths

- Clinical features: sudden severe abdominal pain (constant, not colicky), vaginal bleeding (may be concealed), woody-hard tender uterus, maternal tachycardia/shock, fetal distress or absent fetal heart

- Contrast with placenta praevia: painless bleeding, soft non-tender uterus, abnormal lie

- Concealed abruption: no visible bleeding but massive retroplacental haemorrhage - the most dangerous form

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How to approach this Obstetrics & Gynaecology interview question

This quality improvement question is common in Obstetrics & Gynaecology NHS interviews because it reveals how you think under interview pressure, not just what facts you can recall. Use "A woman at 35 weeks presents with sudden severe abdominal pain, a woody-hard uterus, and..." as the anchor for a concise answer with a clear opening, a clinical or professional structure, and a reflective close.

What the panel is testing

A strong quality-improvement answer uses method as well as enthusiasm. Be clear about the problem, baseline measurement, intervention, re-measurement, and how the change was made sustainable. For obstetrics and gynaecology, show that you can balance urgency, consent, escalation, and multidisciplinary working. Labour ward, theatre, safeguarding, and communication with women and families may all be relevant.

Separate audit, QI, research, and clinical governance clearly so the panel can follow your reasoning.
Use a real cycle: baseline, intervention, re-measurement, learning, and sustainability.
Link the project back to patient safety, service reliability, or measurable outcomes.

How to structure your answer

For a quality improvement prompt, aim for a short opening sentence, then two or three evidence-led points, then a final reflection. If you use STAR, keep the result and reflection as strong as the situation. If it is a clinical scenario, say what you would do now, what you would do next, and how you would keep the patient safe while help is coming.

Open by naming the main issue in the question.
Give a structured response rather than a memorised script.
End with escalation, documentation, learning, or follow-up.

Common mistakes to avoid

The weakest answers usually stay too vague, ignore the specific role, or miss the safety issue hidden in the question. Do not use this page to memorise a perfect paragraph. Use it to rehearse the shape of a safe answer, then adapt it to your own experience and the post you are applying for.

Placental abruption: premature separation of a normally sited placenta from the uterine wall; causes approximately 5% of maternal deaths
Clinical features: sudden severe abdominal pain (constant, not colicky), vaginal bleeding (may be concealed), woody-hard tender uterus, maternal tachycardia/shock, fetal distress or absent fetal heart
Contrast with placenta praevia: painless bleeding, soft non-tender uterus, abnormal lie