Painless vaginal bleeding after 20 weeks gestation is most likely associated with which condition?

Painless vaginal bleeding after 20 weeks gestation is most likely associated with which condition?

• A. Placenta previa
• B. Ectopic pregnancy
• C. Uterine rupture
• D. Cervical polyps

Answer: (A)

Painless vaginal bleeding in the second half of pregnancy points to placenta previa. When the placenta implants in the lower uterus near or over the cervical os, minor or intermittent bleeding can occur without painful contractions or uterine tenderness. The uterus remains relatively soft and the bleeding can appear bright red. Key context: placenta previa is diagnosed by ultrasound to locate the placental position. Do not perform a vaginal exam until placental location is known, because introducing a finger could worsen bleeding if the placenta lies over the os. Management focuses on maternal-fetal stability and delivery planning, often by cesarean if the placenta continues to cover the os at term. Other causes fit different patterns: ectopic pregnancy typically presents earlier with abdominal pain and bleeding; uterine rupture involves sudden, severe pain and fetal distress, usually in labor or with a uterine scar; cervical polyps can bleed but are usually related to the cervix rather than timing in late pregnancy.

Painless vaginal bleeding in the second half of pregnancy points to placenta previa. When the placenta implants in the lower uterus near or over the cervical os, minor or intermittent bleeding can occur without painful contractions or uterine tenderness. The uterus remains relatively soft and the bleeding can appear bright red.

Key context: placenta previa is diagnosed by ultrasound to locate the placental position. Do not perform a vaginal exam until placental location is known, because introducing a finger could worsen bleeding if the placenta lies over the os. Management focuses on maternal-fetal stability and delivery planning, often by cesarean if the placenta continues to cover the os at term.

Other causes fit different patterns: ectopic pregnancy typically presents earlier with abdominal pain and bleeding; uterine rupture involves sudden, severe pain and fetal distress, usually in labor or with a uterine scar; cervical polyps can bleed but are usually related to the cervix rather than timing in late pregnancy.