Painless vaginal bleeding in the late third trimester is most classically associated with which condition?

• A. Placenta previa.
• B. Abruptio placentae.
• C. Ectopic pregnancy.
• D. Uterine rupture.

Answer: (A)

Painless vaginal bleeding in late pregnancy points to placenta previa, which happens when the placenta implants low in the uterus near or over the cervical os. Because the placenta covers the os rather than tearing away from a contracted uterus, bleeding can occur without uterine pain or contractions, and the uterus is typically soft and non-tender. Ultrasound is used to locate the placenta and guide management; if the placenta lies over the os and bleeding is present, delivery is usually planned by cesarean section. In contrast, abruptio placentae causes painful bleeding with a tense, rigid uterus due to placental separation and contractions; ectopic pregnancy and uterine rupture have different classic presentations—ectopic typically earlier with abdominal pain and possible shock, and uterine rupture with sudden severe pain, fetal distress, and a history of uterine scarring during labor.