A 22-year-old female with vaginal bleeding but no pain is most consistent with which condition?

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

Answer: (B)

Painless vaginal bleeding during mid to late pregnancy is most consistent with placenta previa. In placenta previa the placenta implants low in the uterus and covers part or all of the cervix. Because the bleeding occurs with cervical changes or membrane rupture rather than from placental separation, it tends to be painless, and the uterus may feel soft and non-tender.

Other conditions fit different patterns: placental abruption usually causes sudden, painful bleeding with a tender or rigid uterus; an ectopic pregnancy often presents with abdominal pain and usually occurs earlier in pregnancy; uterine rupture involves sudden, severe pain and signs of maternal distress.

Thus, painless bleeding in this setting points to placenta previa, which is diagnosed by ultrasound showing placental tissue over the cervical os and managed based on bleeding, gestational age, and stability, often requiring delivery by cesarean if placenta previa persists.