Snapshot A 33-year-old G4P3 presents to the obstetrician at 29 weeks gestation with painless vaginal bleeding. The bleeding began 2 hours ago and she has delivered a substantial amount of blood with clots. She is having no uterine contractions and the fetal pulse is 150/min. Her last pregnancy was delivered by emergency cesarean at 37 weeks due to double-footing breech presentation during labor. Findings on transvaginal ultrasound show the placenta extending over the internal cervical os. Epidemiology Incidence login to view 3 more bullets Risk factors login to view 3 more bullets Etiology Overview login to view 1 more bullet Associated conditions login to view 2 more bullets Presentation Symptoms login to view 5 more bullets Physical exam login to view 7 more bullets Imaging Ultrasound login to view 6 more bullets Studies Serum labs login to view 5 more bullets Differential Abruptio placentae login to view 3 more bullets Placenta accreta login to view 3 more bullets Vasa previa login to view 3 more bullets Treatment Medical login to view 9 more bullets Surgical login to view 6 more bullets Complications Congenital malformations login to view 1 more bullet Fetal malpresentation Vasa previa login to view 2 more bullets Postpartum hemorrhage