In third-trimester obstetric bleeding due to 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 accompanied by severe cramps
• D. Painless vaginal bleeding

Answer: (D)

Painless vaginal bleeding in the third trimester is characteristic of placenta previa because the placenta is implanted low in the uterus, near or over the cervical os. When bleeding occurs, it does so without triggering strong uterine contractions, so the uterus feels soft and non-tender and the patient often reports little or no pain. This painless bleeding pattern contrasts with placental abruption, which typically presents as painful bleeding with uterine tenderness and a firm, rigid uterus due to placental separation and ongoing contractions. Bleeding described as dark and clotted is not the usual presentation for previa, which is more often bright red; severe cramps would align more with labor or abruption. Therefore, painless vaginal bleeding best fits placenta previa.