Approach to third trimester bleeding Quiz: Ace Your Exams
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A 30-year-old woman, gravida 4, para 3, presents at 34 weeks estimated gestational age (EGA) with painless vaginal bleeding. She reports light but consistent spotting since waking up 4 hours ago. She has no contractions, loss of fluid, or decreased fetal movement. Her medical history is notable for well-controlled asthma. An ultrasound performed at 32 weeks EGA showed an anterior placenta with the placental edge extending 2 mm over the internal cervical os. Temperature is 36.5°C (97.7°F), pulse is 80/min, respirations are 18/min, and blood pressure is 120/74 mmHg. On exam, the uterus is soft and non-tender without palpable contractions. The fetal heart rate is in the 150s with moderate variability. Which of the following would be the most significant risk factor for the likely underlying cause of bleeding in this patient?
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