A third-trimester patient reports sudden, painless vaginal bleeding with a soft uterus. Which condition is most likely and what is the initial nursing action?

• A. Placental abruption; stabilize mother and fetus and prepare for possible emergent delivery.
• B. Placenta previa; monitor fetal status and prepare for cesarean delivery.
• C. Placenta previa; avoid vaginal examinations and monitor maternal and fetal status.
• D. Uterine rupture; emergency cesarean delivery.

Answer: (C)

Painless vaginal bleeding in the third trimester points to placenta previa, in which the placenta implants low in the uterus near or over the cervical os. The key management step is to avoid any vaginal examinations or manipulations because inserting fingers or instruments through the cervix can disrupt placental vessels and trigger heavy bleeding.

The initial nursing action is to protect the patient from further bleeding while monitoring both mother and baby. This means maintaining external fetal monitoring to assess fetal status, keeping the patient on the side (often left lateral) to optimize placental perfusion, and closely tracking the amount and character of any bleeding along with maternal vital signs. Be prepared for cesarean delivery if the previa is confirmed or if bleeding worsens, but avoid vaginal exams until imaging has ruled in placenta previa and clarified the placenta’s location.

Contrast this with conditions that cause painful bleeding or acute distress. Placental abruption causes painful vaginal bleeding with a firm, tender uterus, reflecting placental separation and active bleeding. Uterine rupture presents with sudden severe pain, loss of fetal station, and rapid clinical deterioration, requiring immediate emergency delivery. The lack of pain and the soft uterus help distinguish placenta previa from these other emergencies.