This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: None, Subject name: Gynaecology & Obstetrics
A primigravida presents to casually at 32 weeks gestation with acute pain abdomen for 2 hours, vaginal bleeding and decreased fetal movements. She should be managed by: 
Select and explain. 
A. Immediate cesarean section, B. Immediate induction of labor, C. Tocolytic therapy, D. Magnesium sulphate therapy
A: Immediate cesarean section
Answer: A: Immediate cesarean section 
Explanation: Antepaum haemorrhage (Vaginal bleeding), with acute pain abdomen and fetal distress suggests a diagnosis of abruption placenta. Definitive treatment involves expediting the delivery to prevent maternal complications and give a chance of survival to the fetus. Presence of fetal distress is an indication of caesarean section and hence immediate caesarean section is the single best management option here. Ref: Dutta's Textbook of Gynaecology, 6th Edition, Pages 257, 259; Manual of Pathology of The Human Placenta: Second Edition By Rebecca N. Baergen, Ku Benirschke, 2010, Page 359.