You are called to the obstetric suite to help care for a patient in her third trimester of pregnancy who is presenting with painless vaginal bleeding. Which of the following diagnoses is MOST likely?
The classic presentation of placenta previa (Figure) is a patient in her second or third trimester of pregnancy with painless vaginal bleeding that is not associated with labor or any other inciting event. Diagnosis is best made by transvaginal ultrasound, measuring the distance from the uterine os to the edge of the placenta. If this distance is greater than 1 cm and bleeding is minimal, a trial of labor may be offered. Otherwise, cesarean delivery is usually recommended.
Uterine rupture has a variable presentation, but classically presents as sudden and severe maternal abdominal pain, hypotension, or shock with profound fetal bradycardia.