Placenta Previa: Most Likely Associated Feature
The most likely associated feature of placenta previa is painless vaginal bleeding, not painful bleeding, coagulopathy, or profuse first-episode hemorrhage. 1
Clinical Presentation of Placenta Previa
Placenta previa characteristically presents with painless vaginal bleeding, which is the key distinguishing feature from other causes of antepartum hemorrhage 1, 2. The American College of Radiology explicitly states that "the most common etiologies for painless vaginal bleeding would be placenta previa" 1.
Typical Bleeding Pattern
- The bleeding in placenta previa is typically not profuse on the first episode 3, 4
- Bleeding episodes are usually recurrent and progressive rather than catastrophic initially 3
- The bleeding is often associated with uterine contractions, though the uterus remains soft and non-tender 2, 3
- Painless vaginal bleeding was the presenting feature in 73.8% of placenta previa cases in clinical series 4
Why Other Options Are Incorrect
Painful Vaginal Bleeding (Option B)
Painful vaginal bleeding is characteristic of placental abruption, not placenta previa 1, 2. The American College of Radiology guidelines clearly distinguish that "painful vaginal bleeding in the second and third trimesters includes an additional range of etiologies than that seen with painless vaginal bleeding, such as placental abruption, which is more commonly associated with abdominal pain" 1.
Coagulopathy (Option A)
Coagulopathy is not a typical associated feature of placenta previa itself 3, 5. While massive hemorrhage from placenta previa can eventually lead to consumptive coagulopathy, this is a complication of severe bleeding rather than an inherent feature of the condition 3.
Profuse First Episode (Option D)
The first bleeding episode in placenta previa is typically not profuse 3. Management guidelines emphasize expectant management with transfusion support to maintain hematocrit ≥30%, indicating that bleeding is usually manageable rather than immediately life-threatening 3.
Postcoital Spotting (Option C)
While postcoital spotting can occur with placenta previa, this is a minor and inconsistent finding rather than the most characteristic feature 3. The classic presentation remains painless vaginal bleeding unrelated to specific triggers 1.
Clinical Implications
- Painless bleeding at 27 weeks with confirmed placenta previa warrants expectant management with avoidance of digital vaginal examination, serial ultrasound monitoring, and preparation for cesarean delivery 3, 5
- The patient should be counseled about the likelihood of recurrent bleeding episodes that may increase in severity as pregnancy progresses 3
- Delivery planning should occur at a facility with adequate blood banking capabilities given the risk of hemorrhage at cesarean delivery 5