A Sue Brown, at approximately 28 weeks gestation, presents with a moderate amount of bright red vaginal bleeding and no prenatal care; fundal height measures 27 cm; fetal heart rate is 160/min; blood pressure is 98/62 mmHg. Which diagnosis best fits this presentation?

A Sue Brown, at approximately 28 weeks gestation, presents with a moderate amount of bright red vaginal bleeding and no prenatal care; fundal height measures 27 cm; fetal heart rate is 160/min; blood pressure is 98/62 mmHg. Which diagnosis best fits this presentation?

• A. Placenta Previa
• B. Placental Abruption
• C. Uterine Rupture
• D. Ectopic Pregnancy

Answer: (A)

Painless vaginal bleeding in the second half of pregnancy strongly points to placenta previa, where the placenta implants near or over the cervix and bleeds without causing contractions or abdominal tenderness. In this scenario, the patient is around 28 weeks with a moderate amount of bright red bleeding but no abdominal pain or uterine tenderness, and the fetal heart rate is normal with stable maternal blood pressure. Those features fit placenta previa well: bleeding is present but not associated with painful contractions or a rigid uterus, and the fetus is currently doing fine. Placental abruption would typically present with painful bleeding, a tender or rigid uterus, and possible fetal distress. Uterine rupture is an emergency trauma pattern usually occurring during labor or with a scarred uterus, presenting with severe pain and signs of maternal or fetal compromise. An ectopic pregnancy is unlikely at this gestation and would usually involve abdominal pain and an unstable clinical picture earlier in pregnancy.

Painless vaginal bleeding in the second half of pregnancy strongly points to placenta previa, where the placenta implants near or over the cervix and bleeds without causing contractions or abdominal tenderness. In this scenario, the patient is around 28 weeks with a moderate amount of bright red bleeding but no abdominal pain or uterine tenderness, and the fetal heart rate is normal with stable maternal blood pressure. Those features fit placenta previa well: bleeding is present but not associated with painful contractions or a rigid uterus, and the fetus is currently doing fine.

Placental abruption would typically present with painful bleeding, a tender or rigid uterus, and possible fetal distress. Uterine rupture is an emergency trauma pattern usually occurring during labor or with a scarred uterus, presenting with severe pain and signs of maternal or fetal compromise. An ectopic pregnancy is unlikely at this gestation and would usually involve abdominal pain and an unstable clinical picture earlier in pregnancy.