In placenta previa, the bleeding is typically described as which of the following?

• A. Painful bleeding with uterine tenderness
• B. Bleeding that is dark and clotted
• C. Bleeding following contractions
• D. Painless vaginal bleeding

Answer: (D)

Painless vaginal bleeding is the hallmark feature of placenta previa. When the placenta sits low and covers the cervical os, vessels in that area can bleed with minimal uterine activity or cervical dilation, so the bleeding occurs without pain and the uterus remains soft and non-tender. The blood is usually bright red and fresh, not dark or clotted, and bleeding can occur spontaneously or with minimal activity.

In contrast, painful bleeding with uterine tenderness suggests scenarios like placental abruption or uterine rupture, where the uterus is tender and often rigid. Bleeding that is dark and clotted points to older blood or another source than active placental bleeding at the os. Bleeding occurring after contractions aligns with labor-related placental separation (abruptio placentae) rather than previa, where bleeding frequently happens without contractions.