In late pregnancy, a patient with painless bright red vaginal bleeding and a soft uterus is most consistent with which condition?

• A. Placenta previa
• B. Placental abruption
• C. Uterine rupture
• D. Vasa previa

Answer: (A)

Painless vaginal bleeding in the third trimester with a soft, non-tender uterus points to placenta previa. This occurs when the placenta implants low in the uterus, near or over the cervical os, so bleeding can occur as the cervix or uterus changes without causing uterine contractions or tenderness. In contrast, placental abruption usually presents with painful bleeding and a uterus that feels firm or tender due to placental separation and ongoing contractions; uterine rupture tends to bring severe abdominal pain, signs of maternal distress, and often fetal distress or loss of fetal monitoring findings; vasa previa can cause bleeding but is typically associated with fetal bleeding and distress from ruptured fetal vessels. The painless, bright red bleeding with a relaxed uterus is the classic clue for placenta previa. Management considerations include avoiding vaginal exams and preparing for possible cesarean delivery while monitoring mother and fetus.