When a woman's water breaks and she experiences vaginal bleeding, which complication should be considered?

When a woman's water breaks and she experiences vaginal bleeding, vasa previa is a significant complication to consider. Vasa previa occurs when the fetal blood vessels lie across or near the internal cervical os, at risk of rupture when the membranes break. This situation can lead to catastrophic bleeding and fetal distress because the fetal blood vessels are very fragile and can easily rupture during labor, especially when the amniotic sac ruptures.

In cases where water breaks early, such as before labor begins, monitoring the condition becomes crucial. If the membranes have ruptured and there is accompanying bleeding, vasa previa may be indicated, and it’s essential to identify it early to prevent fetal loss.

The other conditions listed typically do not manifest with this particular combination of symptoms. Ectopic pregnancy generally occurs outside the uterus and would not present in this scenario, while placenta accreta is associated with abnormal implantation in the uterus rather than directly causing bleeding upon membrane rupture. Uterine rupture is a serious emergency but is less common than vasa previa and usually presents with more severe abdominal pain or changes in the fetal heart rate rather than vaginal bleeding alone following the rupture of membranes.